We have developed an image-guided robot system to provide mechanical assistance for skull base drilling, which is performed to gain access for some neurosurgical interventions, such as tumor resection. The motivation for introducing this robot is to improve safety by preventing the surgeon from accidentally damaging critical neurovascular structures during the drilling procedure.
We integrated a Stealthstation® navigation system, a NeuroMate® robotic arm with a 6 degree-of-freedom force sensor, and the 3D Slicer visualization software to allow the robotic arm to be used in a navigated, cooperatively-controlled fashion by the surgeon. We employed virtual fixtures to constrain the motion of the robot-held cutting tool so that it remains in the safe zone that was defined on a preoperative CT scan.
We performed experiments on both foam skull and cadaver heads. The results for foam blocks cut using different registrations yielded an average placement error of 0.6 mm and an average dimensional error of 0.6 mm. We drilled the posterior porus acusticus in three cadaver heads and concluded that the robot-assisted procedure is clinically feasible and provides some ergonomic benefits, such as stabilizing the drill. We obtained postoperative CT scans of the cadaver heads to assess the accuracy and found that some bone outside the virtual fixture boundary was cut. The typical overcut was 1-2 mm, with a maximum overcut of about 3 mm.
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| JHU Whiting School | JHU Hospital, Neurosurgery | Brigham & Women's Hospital, Harvard |
|---|---|---|
| Dr. Peter Kazanzides | Dr. Clint Baird | Dr. Nobuhiko Hata |
| Tian Xia | Dr. George Jallo | Kathryn Hayes |
| Tamas Haidegger | Nobuyuki Nakajima |
The authors gratefully acknowledge the contributions of Richard Clatterbuck, Mohammad Matinfar, Iulian Iordachita, Tamas Haidegger, Malcolm Jefferson, Kunal Tandon, Gary Rosenberg and Ali Batouli at the Johns Hopkins University. Haiying Liu, at the Brigham andWomen’s Hospital, assisted with 3D Slicer. The StealthStation navigation system and Stealthlink interface were donated by Medtronic Navigation and the NeuroMate robot and force sensor were donated by Integrated Surgical Systems. The eMax surgical drill was obtained on loan from the Anspach Effort, Inc.
The authors gratefully acknowledge the contributions of Richard Clatterbuck, Mohammad Matinfar, Iulian Iordachita, Tamas Haidegger, Malcolm Jefferson, Kunal Tandon, Gary Rosenberg and Ali Batouli at the Johns Hopkins University. Haiying Liu, at the Brigham andWomen’s Hospital, assisted with 3D Slicer. The StealthStation navigation system and Stealthlink interface were donated by Medtronic Navigation and the NeuroMate robot and force sensor were donated by Integrated Surgical Systems. The eMax surgical drill was obtained on loan from the Anspach Effort, Inc.