Journal of Neural Transmission

, Volume 123, Issue 7, pp 737–750 | Cite as

Experimental new automatic tools for robotic stereotactic neurosurgery: towards “no hands” procedure of leads implantation into a brain target

  • P. Mazzone
  • P. Arena
  • L. Cantelli
  • G. Spampinato
  • S. Sposato
  • S. Cozzolino
  • P. Demarinis
  • G. Muscato
Neurology and Preclinical Neurological Studies - Original Article

Abstract

The use of robotics in neurosurgery and, particularly, in stereotactic neurosurgery, is becoming more and more adopted because of the great advantages that it offers. Robotic manipulators easily allow to achieve great precision, reliability, and rapidity in the positioning of surgical instruments or devices in the brain. The aim of this work was to experimentally verify a fully automatic “no hands” surgical procedure. The integration of neuroimaging to data for planning the surgery, followed by application of new specific surgical tools, permitted the realization of a fully automated robotic implantation of leads in brain targets. An anthropomorphic commercial manipulator was utilized. In a preliminary phase, a software to plan surgery was developed, and the surgical tools were tested first during a simulation and then on a skull mock-up. In such a way, several tools were developed and tested, and the basis for an innovative surgical procedure arose. The final experimentation was carried out on anesthetized “large white” pigs. The determination of stereotactic parameters for the correct planning to reach the intended target was performed with the same technique currently employed in human stereotactic neurosurgery, and the robotic system revealed to be reliable and precise in reaching the target. The results of this work strengthen the possibility that a neurosurgeon may be substituted by a machine, and may represent the beginning of a new approach in the current clinical practice. Moreover, this possibility may have a great impact not only on stereotactic functional procedures but also on the entire domain of neurosurgery.

Keywords

Brain stimulation Neurosurgery Medical robotics Robot kinematics 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest.

References

  1. Bekelis K, Radwan TA, Desai A, Roberts DW (2012) Frameless robotically targeted stereotactic brain biopsy: feasibility, diagnostic yield, and safety. J Neurosurg 116(5):1002–1006CrossRefPubMedGoogle Scholar
  2. Benabid AL, Pollak P, Louveau A, Henry S, de Rougemont J (1987a) Combined (thalamotomy and stimulation) stereotactic surgery of the VIM thalamic nucleus for bilateral Parkinson disease. Appl. Neurophysiol 50:334–346Google Scholar
  3. Benabid AL, Cinquin P, Lavalle S, Le Bas JF, Demongeot J, de Rougemont J (1987b) Computer-driven robot for stereotactic surgery connected to CT scan and magnetic resonance imaging: technological design and preliminary results. Appl Neurophysiol 50:153–154PubMedGoogle Scholar
  4. Benabid AL, Hoffmann D, Ashraf A, Koadse A, Esteve F, La Bas JK (1998) Robotics in neurosurgery; current status and future aspects. Chirurgie 123:25–31CrossRefPubMedGoogle Scholar
  5. Benabid AL, Wallace B, Mitrofanis J, Xia R, Piallat B, Chabardes S, Berger F (2005) A putative generalized model of the effects and mechanism of action of high frequency electrical stimulation of the central nervous system. Acta Neurol Belg 105:149–157PubMedGoogle Scholar
  6. Benazzouz A, Breit S, Koudsie A, Pollak P, Krack P, Benabid AL (2002) Intraoperative microrecordings of the subthalamic nucleus in Parkinson’s disease. Mov Disord 17(Suppl 3):S145–S149CrossRefPubMedGoogle Scholar
  7. Bouguet JY (2006) Camera Calibration Toolbox for Matlab. Available: http://www.vision.caltech.edu/bouguetj/calib_doc/index.html
  8. Burckhardt CW, Fluty P, Glauser D (1995) Stereotactic Brain Surgery Integrated MINERVA system meets demanding robotic requirements. IEEE Eng Med Biol 14(3):314–317CrossRefGoogle Scholar
  9. De Lorenzo D, De Momi E, Dyagilev I, Manganelli R, Formaglio A, Prattichizzo D, Shoham M, Ferrigno G (2011) Force feedback in a piezoelectric linear actuator for neurosurgery. Int J Med Robot Comput Assist Surg 7:268–275Google Scholar
  10. Fedele E, Mazzone P, Stefani A, Bassi A, Ansaldo MA, Raiteri M, Altibrandi MG, Pierantozzi M, Giacomini P, Bernardi G, Stanzione P (2001) Microdialysis in Parkinsonian patient basal ganglia: acute apomorphine-induced clinical and electrophysiological effects not paralleled by changes in the release of neuroactive amino acids. Exp Neurol 167:356–365CrossRefPubMedGoogle Scholar
  11. Flury P, Lopez P, Glauser D, Villotte N, Burckhardt CW, (1992) MINERVA, a robot dedicated to neurosurgery operations. In: Proceedings of the 23rd ISIR, Barcelona, 6–9 Oct., pp 729–733Google Scholar
  12. Galloway RL, Maciunas RJ (1990) Stereotactic neurosurgery. Crit Rev Biomed Eng 18(3):181–205PubMedGoogle Scholar
  13. Gildemberg PL, Tasker RR (1996) Textbook of stereotactic and functional neurosurgery, Part 1, Stereotactic Principles/1, Section 1, 2, 3, pp 5–256Google Scholar
  14. Joshi A, Scheinost D, Vives KP, Spencer DD, Staib LH, Papademetris X (2008) Novel interaction Techniques for neurosurgical planning and stereotactic navigation. IEEE Trans Vis Comput Graph 14(6):1587–1594CrossRefPubMedPubMedCentralGoogle Scholar
  15. Joskowicz L, Shamir R, Freiman M, Shoham M, Zehavi E, Umansky F, Shoshan Y (2006) Image-guided system with miniature robot for precise positioning and targeting in keyhole neurosurgery. Comput Aided Surg 11(4):181–193CrossRefPubMedGoogle Scholar
  16. Karas CS, Baig MN (2008) Robotic Neurosurgery. In: Medical Robotics, edited by Vanja Bozovic, ISBN 978-3-902613-18-9, I-Tech Education and Publishing, Vienna, Austria, p 526Google Scholar
  17. Kwoh YS, Reed IS, Chen JY, Shao HM, Truong TK, Jonckheere E (1985) A new computerized tomographic-aided robotic stereotaxis system. Robot Age 7(6):17–22Google Scholar
  18. Kwoh YS, Hou J, Jonckheere EA, Hayati S (1988) A robot with improved absolute positioning accuracy for CT guided stereotactic brain surgery. IEEE Trans Biomed Eng 35:153–160CrossRefPubMedGoogle Scholar
  19. Lefranc M, Le Gars D (2012) Robotic implantation of deep brain stimulation leads, assisted by intra-operative, flat-panel CT. Acta Neurochir (Wien) 154(11):2069–2074CrossRefGoogle Scholar
  20. Leksel L (1950) Stereotactic apparatus for intracranial surgery. Acta Chir Scand 99:229–233Google Scholar
  21. Li QH, Zamorano L, Pandya A, Perez R, Gong J, Diaz F (2002) The application accuracy of the NeuroMate robot—a quantitative comparison with frameless infrared and frame based surgical localization systems. Comput Aided Surg 7(2):90–98CrossRefPubMedGoogle Scholar
  22. Lollis SS, Roberts DW (2008) Robotic catheter ventriculostomy: feasibility, efficacy, and implications. J Neurosurg 108(2):269–274CrossRefPubMedGoogle Scholar
  23. Louw DF, Fielding T, McBeth PB, Gregoris D, Newhook P, Sutherland GR (2004) Surgical robotics: a review and neurosurgical prototype development. Neurosurgery 54:525–534CrossRefPubMedGoogle Scholar
  24. Masamune K, Kobayashi E, Masutani Y (1995) Development of an MRI compatible needle insertion manipulator for stereotactic neurosurgery. J Image Guid Surg 1:242–248CrossRefPubMedGoogle Scholar
  25. Mazzone P (2001) Il sistema stereotassico 3P Maranello. Eur Medicophys 3:318–319Google Scholar
  26. Mazzone P, Scarnati E (2009) Deep brain stimulation of the medial thalamus for movement disorders: the role of centromedianparafascicular complex. In: Krames ES, Peckham PH, Rezai AR (eds) Neuromodulation. Academic Press, New York, pp 599–615CrossRefGoogle Scholar
  27. Mazzone P, Della Marca G, Sposato S, Di Lazzaro V, Scarnati E (2008) Tridimensional modelling of midbrain and pontine structures: a proposed approach to the stereotactic targeting of nucleus pedunculopontine tegmenti. Neurotarget 3:8–20Google Scholar
  28. Mazzone P, Sposato S, Insola A, Scarnati E (2011) The deep brain stimulation of the peduncolopontine tegmental nucleus: towards a new stereotactic neurosurgery. J Neural Transm. 118(10):1431–1451CrossRefPubMedGoogle Scholar
  29. Mazzone P, Sposato S, Insola A, Scarnati E (2013) The clinical effects of deep brain stimulation of the pedunculopontine tegmental nucleus in movement disorders may not be related to the anatomical target, leads location, and setup of electrical stimulation. Neurosurgery 73:894–906CrossRefPubMedGoogle Scholar
  30. Mazzone P, Vilelha Filho O, Viselli F, Insola A, Sposato S, Vitale F, Scarnati E (2016) Our first decade of experience in deep brain stimulation of the brainstem: elucidating the mechanism of action of stimulation of the ventrolateral pontine tegmentum. J Neural Transm. doi: 10.1007/s00702-016-1518-5 PubMedCentralGoogle Scholar
  31. McBeth PB, Louw DF, Rizun PR, Sutherland GR (2004) Robotics in neurosurgery. Am J Surg 188(Suppl to October 2004):68S–75SCrossRefPubMedGoogle Scholar
  32. Modrák V, Paško J, Pavlenko S (2002) Alternative solution for a robotic stereotactic system. J Intell Robot Syst 35:193–202CrossRefGoogle Scholar
  33. Radstzky A, Radolph M (2001) Simulating tumor removal in neurosurgery. Int J Med Inf 64:461–472CrossRefGoogle Scholar
  34. Sam Eljamel M (2008) Robotic applications in neurosurgery. In: Medical Robotics, edited by Vanja Bozovic, ISBN 978-3-902613-18-9, I-Tech Education and Publishing, Vienna, Austria, p 526Google Scholar
  35. Sekhar LN, Ramanathan D, Rosen J, Kim LJ, Friedman D, Glozman D, Moe K, Lendvay T, Hannaford B (2011) Robotics in Neurosurgery. In: Rosen J, Hannaford B, Satava RM (eds) Surgical robotics systems applications and visions. Springer, New York, USAGoogle Scholar
  36. Stefani A, Fedele E, Galati S, Pepicelli O, Frasca S, Pierantozzi M, Peppe A, Brusa L, Orlacchio A, Hainsworth AH, Gattoni G, Stanzione P, Bernardi G, Raiteri M, Mazzone P (2005) Subthalamic stimulation activates internal pallidus: evidence from cGMP microdialysis in PD patients. Ann Neurol 57:448–452CrossRefPubMedGoogle Scholar
  37. Yoshikawa T (1995) Manipulability of robotic mechanisms. Int J Robot Res 4(2):3–9CrossRefGoogle Scholar
  38. Zimmermann M, Krishnan R, Raabe A, Seifert V (2002) Robot-assisted navigated neuroendoscopy. Neurosurgery 51:1446–1451CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2016

Authors and Affiliations

  • P. Mazzone
    • 1
  • P. Arena
    • 2
  • L. Cantelli
    • 2
  • G. Spampinato
    • 3
  • S. Sposato
    • 4
  • S. Cozzolino
    • 5
  • P. Demarinis
    • 5
  • G. Muscato
    • 2
  1. 1.Operative Unit for Stereotactic and Functional NeurosurgeryRegional Center for Functional Neurosurgery and DBS, ASL RM2RomeItaly
  2. 2.DIEEI Università degli Studi di CataniaCataniaItaly
  3. 3.Malardalen UniversityVästeråsSweden
  4. 4.Neuroradiology, ASL RM2RomeItaly
  5. 5.AO CardarelliNaplesItaly

Personalised recommendations