Neurosurgical Intracerebral Hemorrhage Evacuation (NICHE) Robot

神经外科脑出血清除（NICHE）机器人

• 批准号: 8684084
• 负责人: JAYDEV P. DESAI
• 金额: $ 17.19万
• 依托单位: UNIV OF MARYLAND, COLLEGE PARK
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-06-01 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8684084
• 关键词: Address; Algorithms; Alteplase; Attention; Basal Ganglia; Blood coagulation; Brain; Caliber; Cannulas; Cerebral hemisphere hemorrhage; Characteristics; Coagulation Process; Conventional Surgery; Craniotomy; Diagnostic radiologic examination; Diffuse; Electrocoagulation; Excision; Fibrinolytic Agents; Freedom; Goals; Hematoma; Hemorrhage; Hour; Image; Individual; Infusion procedures; Injection of therapeutic agent; Intracranial Pressure; Irrigation; Joints; Length; Link; Local anesthesia; Low Dose Radiation; Measures; Medical; Methods; Modeling; Monitor; Neurosurgeon; Operative Surgical Procedures; Patients; Positioning Attribute; Procedures; Public Health; Risk; Robot; Robotics; Running; Safety; Scanning; Shapes; Speculums; Suction; Supratentorial; Surface; Technology; Thalamic structure; Time; Tissues; Trauma; Traumatic Brain Injury; Tube; Urokinase; Vision; X-Ray Computed Tomography; brain tissue; clinically relevant; cone-beam computed tomography; coronal suture; design; flexibility; frontal lobe cortex; imaging modality; improved; minimally invasive; mortality; programs; public health relevance; randomized trial; thrombolysis

DESCRIPTION (provided by applicant): Spontaneous supratentorial intracerebral hemorrhage (ICH) occurs in H2 million people worldwide every year and represents a major global public-health problem. ICH is associated with a 30-day mortality rate of 32-50%, and 6 month functional independence is achieved in only 20-25% of individuals who survive such hemorrhages. It is widely accepted that removal of the blood clot should be an important goal of early management of patients with ICH, but despite theoretical benefits, classic craniotomy for ICH removal remains controversial, because clear evidence of efficacy is lacking. Minimally invasive surgery (MIS) causes minimal trauma to brain tissues and significantly improves the number of functionally independent patients at 90 days. However, this apparent benefit is largely negated by high rates of rebleeding. Current technologies to remove ICH have serious limitations. All currently available methods of MIS for ICH evacuation employ line-of-sight, rigid tubes. Because of this, they generally rely on enzymatic thrombolytic agents [e.g., urokinase or tissue plasminogen activator (rtPA)] introduced into the clot to liquefy it, prior to irrigating itout. There are two important limitations with enzymatic thrombolysis. First, it is very slow, requiring multiple injections of thrombolytic agents and more than 24 hours to reduce ICH volume. Therefore, the potential benefit of rapidly reducing intracranial pressure, which can be lifesaving is completely lost. In addition, enzymatic thrombolysis can be dangerous, since there is no control over where the thrombolytic agent diffuses and thus re-hemorrhage rates are unacceptably high. There is a clear and urgent need to develop an alternative technology for evacuation of ICH without increasing the risk of rebleeding. We envision a Neurosurgical Intracerebral Hemorrhage Evacuation (NICHE) robot for ICH removal that will be: a) compatible with the imaging modality, b) 6 mm in diameter and about 20 cm long to allow deployment into a deep ICH in the basal ganglia or thalamus via non-eloquent frontal lobe cortex rostral to the coronal suture, c) discretely actuated with multiple degrees-of-freedom (DOFs) and the tip link of the robot having the capability to bend into a "J-shape" to allow ICH removal outside of the line-of-sight trajectory and additional joints to allow positioning the tip link within the ICH, d) equipped with suction and irrigation lines running through its hollow core and have bipolar electrocautery probes to liquefy the ICH, and e) under the immediate and direct guidance of the neurosurgeon at all times. To realize the NICHE robot, we will address three specific aims: 1) Design and develop a multi-joint discretely actuated and steerable NICHE robot with bipolar electrocautery probes and a suction and irrigation channel for electrocauterizing the ICH, 2) Develop an intra-operative imaging algorithm for precise, real-time tracking of robotic cannula and to monitor the progress of ICH evacuation using low radiation dose cone-beam CT, and 3) Demonstrate the safety and efficacy of NICHE robot in clinically relevant models of ICH.

描述（由申请人提供）：每年在全球200万人中发生自发性脑内出血（ICH），代表了一个主要的全球公共卫生问题。 ICH与32-50％的30天死亡率相关，而在幸存此类出血的个体中，只有20-25％实现了6个月的功能独立性。 人们普遍认为，去除血块应该是对ICH患者进行早期治疗的重要目标，但是尽管理论上的益处，但经典的ICH去除颅骨切开术仍然存在争议，因为缺乏明确的疗效证据。 微创手术（MIS）会导致最小的脑组织创伤，并在90天内显着改善功能独立的患者的数量。 但是，这种显而易见的收益在很大程度上被高额再出现率所否定。 当前去除ICH的技术有严重的局限性。 当前所有可用的MIS方法用于ICH疏散的方法采用视线，刚性 管。 因此，它们通常依靠酶溶栓剂[例如尿激酶或组织纤溶酶原激活剂（RTPA）]在灌溉ITOUT之前引入了凝块以液化为液化。 酶促溶栓有两个重要的局限性。 首先，它很慢，需要 多次注射溶栓剂和超过24小时以减少ICH体积。 因此，可以迅速降低颅内压的潜在益处可以完全丢失。 此外，酶促溶栓分解可能是危险的，因为无法控制溶栓剂扩散的位置，因此重新出现速率高可可较高。 显然和迫切需要开发一种替代技术来撤离ICH，而不会增加再出现的风险。 We envision a Neurosurgical Intracerebral Hemorrhage Evacuation (NICHE) robot for ICH removal that will be: a) compatible with the imaging modality, b) 6 mm in diameter and about 20 cm long to allow deployment into a deep ICH in the basal ganglia or thalamus via non-eloquent frontal lobe cortex rostral to the coronal suture, c) discretely用多个自由度（DOF）和机器人的尖端链路驱动，具有弯曲成“ J形”的能力，以允许在视线轨迹之外的ICH去除和其他关节以允许将尖端链路放置在ICH中，d） 配备有吸力和灌溉线穿过其空心芯，并具有双极电极探针以液化为ICH，E）始终在神经外科医生的直接和直接引导下。 To realize the NICHE robot, we will address three specific aims: 1) Design and develop a multi-joint discretely actuated and steerable NICHE robot with bipolar electrocautery probes and a suction and irrigation channel for electrocauterizing the ICH, 2) Develop an intra-operative imaging algorithm for precise, real-time tracking of robotic cannula and to monitor the progress of ICH evacuation using low radiation dose锥束CT和3）证明了利基机器人在ICH临床相关模型中的安全性和功效。