197 Pre-clinical Ex-vivo Study of a 3D Neuronavigation With a Neurosurgical Microrobot

Abstract

INTRODUCTION: Access to deep brain structures for diagnostic and therapeutic purposes remains a challenge for neurosurgeons. To solve this obstacle, we are developing a micro-robot with the technology to navigate the brain with 3D curved trajectories that will open a new range of possibilities in the neurosurgical world (tumor identification, treatment of epileptic foci, DBS, targeted therapies, fenestration of membranes). The microrobot is tracked and navigated with a transcranial ultrasound system. METHODS: 10 cadaveric studies were performed using 4 adult swine and 6 human subjects using micro-robot models with diameters of 4.5 mm and 2.9 mm. The microrobotic base for injection and ultrasound tracking of the microrobot (CAP) was placed on the skull at the insertion hole. The micro-robot was remotely controlled, and the surgeries were performed in a hybrid operating room with 3D fluoroscopy, allowing us to validate the surgery feasibility and evaluate the accuracy of the transcranial tracking. RESULTS: 20 burr holes were performed with holes ranging from 4-9 mm in diameter. The microrobot was inserted successfully infall cases. The navigation was effective with straight or curved trajectories in 18 cases and the targeted points were reached in 16 cases. We observed a mean 3D tracking accuracy of 1.49mm with a S.D. of 0.58 mm, demonstrating a millimetric tracking accuracy, similar to the best stereotaxy performance. CONCLUSIONS: These results are a world first, proving the feasibility of intracerebral parenchymal microrobotic neuro-navigation with a millimetric ultrasound transcranial tracking. Future tests will allow testing new prototypes of 1.8mm diameter enabling clinical translation.