Neurosurgery is the medical specialty concerned with the diagnosis and treatment of patients with injury to the brain, spinal cord, spinal column and peripheral nerves. Founders of neurosurgery are Dr. Victor Horsley in England, Sir William MacEwan in Scotland and Dr. Harvey Cushing in the United States of America. Modern neurosurgery uses various computer-enhanced technologies. It pioneered the organ system surgery that uses robotic-assisted neurosurgery. Robot-assisted technology helped neurosurgeons to be more precise and accurate. Several computer-aided systems are already in use. These technologies provide the neurosurgeons many advantages. These assists in performing small scale surgery or microsurgery, increased accuracy and precision in stereotactic surgery, access to small corridors during minimal invasive surgery, ability to process large amount of data during image-guided surgery, ability to telesurgery and reduce tremor by ten times.
The main purpose of laser and robots in performing complex neurosurgical procedures is the preciseness and dexterity of the technology in comparison with humans. The new systems in neurosurgery bring forth the upgraded surgical care to the patients. This provides precise trajectory and motion to minimize side effects that will aggravate the condition of the patients. Most importantly, this new technology helped surgeons do quality job with little incision as possible that also bring great comfort to the patients. Even a slightest mistake on the procedure will bring disaster to the lives of the patients.
One of the first technologies is the PUMA or Programmable Universal Machine for Assembly. This PUMA uses a head-frame to the patient and uses fiducial markers to record the brain’s image. This is the first ever robot used in surgery. However, the first commercially used and approved by the Food and Drug Administration (FDA) is the NeuroMate. This NeuroMate is an image-guided, robotic-assisted system that is used for stereotactic procedures. It has a sufficient accuracy for a range of functional neurosurgical procedures including movement disorder surgeries. Another highlight in the field of neurosurgery is the invention of the Minerva. This system is the first to provide neurosurgeons real-time guidance allowing them to change the trajectory of the brain as it moves. Intracranial images are now visible in relations to the position of the surgical tools used during a procedure. Robotic arm is placed inside a computed tomography (CT) scanner to compensate the movements of the intracranial shifts and deformations. This improved the 3D localization and accuracy. This system also has a safety device unlike previous technologies used. However, this system can only perform single dimension incursions leading to discontinuity of its usage in 1993. After which a robotic surgical suite was invented, the RAMS or the Robot Assisted Microsurgery System. This was the first system compatible with the MRI or the magnetic resonance imaging. It is able to filter out electromagnetic fields that distort images. This works like an extension of the surgeons’ hands. It has robotic arms; the master arm that works as a joystick and the operating arm that performs the surgery. RAMS serves as the tool that mediates the surgeon and the surgical tools. This filters any slight tremors in the hands of the surgeon. Still, this system is under further development because it is still not perfect due to lack of tactile feedback and limited degrees of freedom of robot hands in comparison with human hands. The NeuRobot which was developed in Japan uses endoscope to perform surgical procedures. It is a tele-manipulation surgical operation device. It consist of twin-tissue forceps, camera, light source and laser. It houses 3-dimensional endoscopes, irrigation and suction channels, and three robotic arms with three degrees of freedom (rotation, swing of neck, forward/backward). The SpineAssist robot is the first spinal surgery system approved by the FDA. This system minimizes the risk of working free hand in the sensitive parts of the spinal cords. It reduces surgery time and invasiveness, expedites recovery and reduces infection and blood loss. Recently, FDA approved the first completely robotic surgery device, daVinci surgical system. This system composed of surgeon’s console, patient-side cart, high-performance vision system and proprietary instruments. The system also translates the surgeon’s movement into real-time movement of the surgical instrument. It also provides the surgeons intuitive control, range of motion, fine-tissue manipulation capability and 3D visualization characteristics. Another latest technology in the field of neurosurgery is the PathFinder. This system uses high resolution imaging and in targeting intracranial lesions. It uses simple fiducial marker that will not use stereotactic frames at all. The superiority of this new system is due to its accuracy from biopsies to electrode implantation. Another state-of-the art invention is the Intraoperative MRI or the PoleStar N-10. This allows detailed picture of the brain during the entire surgical procedure. This shows the the exact location of lesions, ensure the entire removal and assist the surgeon in avoiding healthy tissues. Using this technology minimizes the probability for follow-up surgeries.
Surgical robots are classified into three categories. First, is the supervisory-controlled system wherein the robot was programmed on the exact motion during the surgical procedure. The surgeon supervised to ensure that there are no errors during the surgical procedure. Next. is telesurgical systems wherein the surgeon performs the operation with haptic interface. The surgeon carries out motion that the surgical manipulator replicates. Real-time intraoperative images can be seen in the cranial framework. Lastly, is the shared-control system wherein the surgeon controls the whole procedure and the robot undergoes steady hand manipulations of the surgical instruments.
New technologies of clinical procedure in the field of neurosurgery has its advantages and disadvantages. In terms of the deep brain stimulation (DBS) procedure which treat diseases like Parkinson’s, primary tremor, thalamic pain, etc., that uses stereotactic procedures, has its advantages and disadvantages. The advantages of this procedure are: the validity of the procedure since its introduction in the 70s, provide accurate and rigid support during needle insertion and inexpensive in comparison with other systems. The disadvantages of this are: the need to insert pre-operative screws in the head under local anesthesia that leads to discomfort, manual adjustment and head immobilization during surgery, manual computation of frame coordinates and do not provide real-time feedback and validation of needle position. The navigation systems is best because of it provides continuous real-time position of the surgical tools and liberated in selecting target points during surgery. However, this system is very expensive, head immobility during the process, need of line sight of camera and other instruments and very time consuming since it needs manual manipulation of the passive arm. On the other hand, robotic system, like the NeuroMate and the PathFinder, provides frame less integration solution, rigid and accurate and allow intra-operative adjustments. But robotic system is bulky that has the high probability of risks, very expensive and requires head immobility. The interventional imaging system provides real-time positioning of surgical instruments and brain shifts. The only disadvantage of this system is the limited availability and the operational cost. Another recent system that is being used in neurosurgery is the PoleStar which is compact and mobile, allows intra-operational navigation and low cost. But still this new system has its disadvantage like it does not provide mechanical support, the quality of images is poor compared to others and the operating room must be customized.
Works Cited
Joshowicz, Leo. ‘Advances in Image-Guided Targeting for Keyhole Neurosurgery’ Hebrew University of Jerusalem (2007). (Online). Available: http://touchbriefings.com/pdf/2928/Joskowicz_reference.pdf
Kazuhiro, Hongo, et.al. “Developmental and Clinical Usage of Neurosurgical Robot (NeuRobot)” Advances in Neurological Sciences (2004). (Online). Available: http://www.sciencelinks.jp/j-east/article
Li, QH, et.al. ‘The Application Accuracy of the NueroMate Robot’ Computer Aided Surgery (2002). (Online). Available: http://www.ncbi.nlm.nih.gov
‘Moving Magnets Unlock the Future of Neurosurgery.’ 2001. University of Medicine and Dentistry of New Jersey. Available: http://www.umdnj.edu/umcweb/marketing_and_communications/publications/umdnj_magazine/hstate/winter_spring01/pulse/pulse04_magnets.htm
PathFinder. (On line). Available: http://www.prosurgics.com/prosurgics_pathfinderkey.htm
‘Robot Assisted Brain Surgery is Feasible Says Penn Researcher Surgical System Designed for Space is Practical for Earthbound Use.’ 13 March 2001. University of Pennsylvania Health System. Available: http://www.uphs.upenn.edu/news/News_Releases/march01/RAMS.shtml
Robotic Surgery. (Online). Available: http://biomed.brown.edu/Courses/BI108/BI108_2005_Groups/04/neurology.htm
Schaaf, Tracy A. ‘Robotic Surgery: The Future is Now.’ March 2001. Medical Device Link. (Online). Available: http://www.devicelink.com/mx/archive/01/03/0103mx024.html
Varma, TR and P. Eldrigde. ‘Use of the NeuroMate Stereostatic Robotin a Frameless Mode for Functional Neurosurgery’ Computer Aided Surgery (2002). (Online). Available: http://www.ncbi.nlm.nih.gov
Versweyveld, Leslie. ‘Miniature SpineAssist Robot for Spinal Surgery Receives FDA Approval’ Virtual Medical Worlds (2004). (Online). Available: http://www.hoise.com/vmw/04/articles/vmw/LV-VM-07-04-28.html