Objective: To develop a system that permits remotely navigated curved trajectories of stereotactic electrodes

Background: Stereotactic neurosurgery is restricted to linear trajectories. This limits flexibility in (i) planning surgical trajectories and (ii) steering flexibility and degrees of fredom at the respective target structure. To overcome this limitation, we have developed probes that permit remotely navigated curved trajectories using magnetic technology (1-8). Several proof-of-concept studies are shown in in-vitro and ex-vivo models, in which curved trajectory enabling probes were tested for deep brain stimulation (DBS), spinal cord stimulation (SCS) and laser ablation.

Method: A magnetic needle prototype was developed with a 1.3 mm diameter tip and a 0.7 mm diameter shaft and designed to allow pairing with commercially available DBS, SCS and laser ablation electrodes. The probe was remotely navigated using a joystick. The tip orientation was controlled by applying torques to the embedded neodymiumiron-boron permanent magnets with a clinically-sized magnetic manipulation system. Gelatine-filled skull models and customized models of the spinal epidural spaces were used to mimick the environments of the desired target structures. In these environments, magnetic forces were applied to steer an electrode that followed a predrawn curved path and the accuracy between the pre-drawn path and the actual path was measured in the respective model.

Results: Trajectories consisting of straight, single constant two different curvatures were tested. A a root mean square error of 0.64 mm in the X-axis, 0.13 mm in the Y-axis and 0.14 mm in the Z-axis between the were noted on average. The final tip position was measured off by 0.48 mm to the target position on average. With the single constant curvature trajectory, the initial heading direction was off by 7.47◦ from the Y-axis, which is the suspected cause of the errors at the beginning of the insertion and the increased root mean square error.

Conclusion: We describe a novel prototype of a magnetically navigated probe tip that can be paired with DBS, SCS and laser ablation electrodes. We demonstrate safe and accurate steering of the remotely navigated probe in in-vitro models mimicking brain and spine environments. Future research is required to determine the extent of shearing injury and probe this technology in humans.

References: 1. Nelson BJ, Gervasoni S, Chiu PWY, Zhang L, Zemmar A. Magnetically Actuated Medical Robots: An in vivo Perspective. Proceedings of the IEEE, vol. 110, no. 7, pp. 1028-1037, July 2022, doi: 10.1109/JPROC.2022.3165713.
2. Zemmar, A., Lozano, A.M. & Nelson, B.J. The rise of robots in surgical environments during COVID-19. Nature Machine Intelligence 2, 566–572 (2020). https://doi.org/10.1038/s42256-020-00238-2
3. Torlakcik H, Sarica C, Bayer P, Yamamoto K, Iorio-Morin C, Hodaie M, Kalia SK, Neimat JS, Hernesniemi J, Bhatia A, Nelson BJ, Pané S, Lozano AM, Zemmar A. Magnetically Guided Catheters, Micro- and Nanorobots for Spinal Cord Stimulation. Frontiers in Neurorobotics. 2021 Oct 20;15:749024. doi: 10.3389/fnbot.2021.749024. PMID: 34744678; PMCID: PMC8565609.Mar31;6(52):eabf1462. doi: 10.1126/scirobotics.abf1462. PMID: 34043552.
4. Hong A, Petruska AJ, Zemmar A, Nelson BJ. Magnetic Control of a Flexible Needle in Neurosurgery. IEEE Trans Biomed Eng. 2021 Feb;68(2):616-627. doi: 10.1109/TBME.2020.3009693. Epub 2021 Jan 20. PMID: 32746060.
5. Zemmar A, Nelson BJ, Neimat JS. Laser thermal therapy for epilepsy surgery: current standing and future perspectives. Int J Hyperthermia. 2020 Jul;37(2):7783. doi: 10.1080/02656736.2020.1788175. PMID: 32672124
6. Hong A, Boehler Q, Moser R, Zemmar A, Stieglitz L, Nelson BJ. 3D path planning for flexible needle steering in neurosurgery. Int J Med Robot. 2019 Aug;15(4):e1998. doi: 10.1002/rcs.1998. Epub 2019 May 9. PMID: 30945791.
7. Petruska A, Ruetz F, Hong A, Regli L, Sueruecue O, Zemmar A*, Nelson BJ*. Magnetic Needle Guidance for neurosurgery: Initial design and proof of concept. Robotics and Automation Letters IEEE. 2016 May 16; 4392-4397. doi:10.1109/ICRA.2016.7487638. *equal senior authorship contribution
8. Gao A, Murphy RR, Chen W, Dagnino G, Fischer P, Gutierrez MG, Kundrat D, Nelson BJ, Shamsudhin N, Su H, Xia J, Zemmar A, Zhang D, Wang C, Yang GZ. Progress in robotics for combating infectious diseases. Science Robotics. 2021

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MDS Abstracts - https://www.mdsabstracts.org/abstract/curved-trajectories-in-stereotactic-neurosurgery/