Treatment of Glioma Using neuroArm Surgical System.

Yaser Maddahi,Liu Shi Gan,Sanju Lama,Christina Sutherland,Kourosh Zareinia,Garnette R Sutherland

doi:10.1155/2016/9734512

Abstract

The use of robotic technology in the surgical treatment of brain tumour promises increased precision and accuracy in the performance of surgery. Robotic manipulators may allow superior access to narrow surgical corridors compared to freehand or conventional neurosurgery. This paper reports values and ranges of tool-tissue interaction forces during the performance of glioma surgery using an MR compatible, image-guided neurosurgical robot called neuroArm. The system, capable of microsurgery and stereotaxy, was used in the surgical resection of glioma in seven cases. neuroArm is equipped with force sensors at the end-effector allowing quantification of tool-tissue interaction forces and transmits force of dissection to the surgeon sited at a remote workstation that includes a haptic interface. Interaction forces between the tool tips and the brain tissue were measured for each procedure, and the peak forces were quantified. Results showed maximum and minimum peak force values of 2.89 N (anaplastic astrocytoma, WHO grade III) and 0.50 N (anaplastic oligodendroglioma, WHO grade III), respectively, with the mean of peak forces varying from case to case, depending on type of the glioma. Mean values of the peak forces varied in range of 1.27 N (anaplastic astrocytoma, WHO grade III) to 1.89 N (glioblastoma with oligodendroglial component, WHO grade IV). In some cases, ANOVA test failed to reject the null hypothesis of equality in means of the peak forces measured. However, we could not find a relationship between forces exerted to the pathological tissue and its size, type, or location.

Highlights

The complexity of the central nervous system and neural network makes surgical intervention for neurosurgical disease somewhat complex [1, 2]
This paper reported the amount and range of interaction forces observed during performance of seven neurosurgical cases that were conducted to resect glioma
The tool-tissue interaction forces between the bipolar forceps tips and the brain tissue were quantified using two titanium Nano17 force sensors attached to each tool holder of the robot

Summary

Introduction

The complexity of the central nervous system and neural network makes surgical intervention for neurosurgical disease somewhat complex [1, 2]. Dissecting the tumour/brain interface may result in movement of glioma cells into the adjacent normal brain [9]. Using instrumented surgical tools to enhance tumour resection is fundamental to achieve optimal outcome in glioma surgery. Image-guided robotic technologies have been translated into neurosurgical procedures for increased precision and accuracy [12,13,14]. Robotic technology offers several advantages over conventional surgery including (i) combining decision-making capability of the human brain with the precision and accuracy of machine technology, (ii) facilitating surgery at smaller scale by providing access to narrower surgical corridors, (iii) eliminating the problem of brain shifting by combining surgery with imaging, either updated or in real time, and (iv) enhancing surgical performance through the provision of motion and force scaling, together with virtual fixtures

Objectives

Methods

Results

Discussion

Conclusion