Guo Ziyan, Leong Martin Chun-Wing, Su Hao, Kwok Ka-Wai, Chan Danny Tat-Ming, Poon Wai-Sang
Department of Mechanical Engineering, The University of Hong Kong, Hong Kong.
Department of Mechanical Engineering, City University of New York, New York, New York, USA.
World Neurosurg. 2018 Aug;116:77-87. doi: 10.1016/j.wneu.2018.04.155. Epub 2018 May 3.
The development of stereotaxy can be dated back 100 years. However, most stereotactic neurosurgery still relies on the workflow established about half a century ago. With the arrival of computer-assisted navigation, numerous studies to improve the neurosurgical technique have been reported, leading to frameless and magnetic resonance imaging (MRI)-guided/verified techniques. Frameless stereotaxy has been proved to be comparable to frame-based stereotaxy in accuracy, diagnostic yield, morbidity, and mortality. The incorporation of intraoperative MRI guidance in frameless techniques is considered an appealing method that could simplify workflow by reducing coregistration errors in different imaging modalities, conducting general anesthesia, and monitoring the surgical progress. In light of this situation, manually operated platforms have emerged for MRI-guided frameless procedures. However, these procedures could still be complicated and time-consuming because of the intensive manual operation required. To further simplify the procedure and enhance accuracy, robotics was introduced. Robots have superior capabilities over humans in certain tasks, especially those that are limited by space, accuracy demanding, intensive, and tedious. Clinical benefits have been shown in the recent surge of robot-assisted surgical interventions. We review the state-of-the-art intraoperative MRI-guided robotic platforms for stereotactic neurosurgery. To improve the surgical workflow and achieve greater clinical penetration, 3 key enabling techniques are proposed with emphasis on their current status, limitations, and future trends.
立体定向技术的发展可以追溯到100年前。然而，大多数立体定向神经外科手术仍然依赖于大约半个世纪前建立的工作流程。随着计算机辅助导航的出现，已经报道了许多旨在改进神经外科技术的研究，从而产生了无框架和磁共振成像（MRI）引导/验证技术。事实证明，无框架立体定向技术在准确性、诊断率、发病率和死亡率方面与基于框架的立体定向技术相当。在无框架技术中加入术中MRI引导被认为是一种有吸引力的方法，它可以通过减少不同成像模态中的配准误差、实施全身麻醉以及监测手术进展来简化工作流程。鉴于这种情况，已经出现了用于MRI引导的无框架手术的手动操作平台。然而，由于需要大量的手动操作，这些手术仍然可能复杂且耗时。为了进一步简化手术过程并提高准确性，引入了机器人技术。在某些任务中，机器人比人类具有更优越的能力，特别是那些受空间限制、对准确性要求高、强度大且繁琐的任务。最近机器人辅助手术干预的激增已经显示出临床益处。我们综述了用于立体定向神经外科手术的术中MRI引导机器人平台的最新技术。为了改进手术工作流程并实现更大的临床应用，提出了3项关键使能技术，并重点介绍了它们的当前状态、局限性和未来趋势。
