Abstract
The design of mechanically clutched cranial perforators, used in craniotomy procedures, limits their performance under certain clinical conditions and can, in some cases, impose the risk of severe brain injury on patients undergoing the procedure. An additional safety mechanism could help in mitigating these risks. In this work, we examine the use of diffuse reflectance spectroscopy as a potential fallback mechanism for near real-time detection of the bone-brain boundary. Monte Carlo simulation of a two layer model with optical properties of bone and brain at 530 and 850nm resulted in a detectable change in diffuse reflectance signal when approaching the boundary. The simulated results were used to guide the development of an experimental drill control system, which was tested on 10 sheep craniums and yielded 88.1 % success rate in the detection of the approaching bone-brain boundary.
Highlights
C RANIOTOMY is a neuro-surgical procedure used to temporarily remove a section of the cranium, called the bone flap, in order to provide access to the brain for clinical assessment or treatment of brain lesions, traumatic brain injury or epilepsy[1], [2]
While a “Plunge Stop” result would not be acceptable in a clinical setting, for the purpose of the optical experiments it was deemed successful as the system did respond to a change in optical properties once the cranial perforator (CP) had broken through the cranial bone
This study has successfully showcased the potential of DRSintegrated cranial perforator
Summary
C RANIOTOMY is a neuro-surgical procedure used to temporarily remove a section of the cranium, called the bone flap, in order to provide access to the brain for clinical assessment or treatment of brain lesions, traumatic brain injury or epilepsy[1], [2]. The burr, termed the cranial perforator (CP) and described for the first time in 1950 [3], was designed to reduce the risk of plunging into the cranial cavity during neurosurgery and causing injury or death. This instrument is a clever, mechanically clutched cutting tool which prevents the surgeon from boring into the dura or the brain by automatically disconnecting the CP from the drill motor once the inner surface of the cranium is breached.
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