1Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana; and.
2Department of Neurological Surgery, Neuroscience Institute, Carle Foundation Hospital, Urbana, Illinois.
Neurosurg Focus. 2022 Jan;52(1):E14. doi: 10.3171/2021.10.FOCUS21544.
Emergency neurosurgical care in lower-middle-income countries faces pronounced shortages in neurosurgical personnel and infrastructure. In instances of traumatic brain injury (TBI), hydrocephalus, and subarachnoid hemorrhage, the timely placement of external ventricular drains (EVDs) strongly dictates prognosis and can provide necessary stabilization before transfer to a higher-level center of care that has access to neurosurgery. Accordingly, the authors have developed an inexpensive and portable robotic navigation tool to allow surgeons who do not have explicit neurosurgical training to place EVDs. In this article, the authors aimed to highlight income disparities in neurosurgical care, evaluate access to CT imaging around the world, and introduce a novel, inexpensive robotic navigation tool for EVD placement.
By combining the worldwide distribution of neurosurgeons, CT scanners, and gross domestic product with the incidence of TBI, meningitis, and hydrocephalus, the authors identified regions and countries where development of an inexpensive, passive robotic navigation system would be most beneficial and feasible. A prototype of the robotic navigation system was constructed using encoders, 3D-printed components, machined parts, and a printed circuit board.
Global analysis showed Montenegro, Antigua and Barbuda, and Seychelles to be primary candidates for implementation and feasibility testing of the novel robotic navigation system. To validate the feasibility of the system for further development, its performance was analyzed through an accuracy study resulting in accuracy and repeatability within 1.53 ± 2.50 mm (mean ± 2 × SD, 95% CI).
By considering regions of the world that have a shortage of neurosurgeons and a high incidence of EVD placement, the authors were able to provide an analysis of where to prioritize the development of a robotic navigation system. Subsequently, a proof-of-principle prototype has been provided, with sufficient accuracy to target the ventricles for EVD placement.
中低收入国家的紧急神经外科护理面临着神经外科人员和基础设施明显短缺的问题。在创伤性脑损伤（TBI）、脑积水和蛛网膜下腔出血的情况下，及时放置外部脑室引流管（EVD）对预后有重要影响，并可以在转至能够进行神经外科手术的更高水平的治疗中心之前提供必要的稳定。因此，作者开发了一种廉价且便携的机器人导航工具，以使没有明确神经外科培训的外科医生能够放置 EVD。本文旨在强调神经外科护理方面的收入差距，评估世界各地 CT 成像的可及性，并介绍一种新型、廉价的 EVD 放置机器人导航工具。
通过将神经外科医生、CT 扫描仪和国内生产总值与 TBI、脑膜炎和脑积水的发病率相结合，作者确定了发展廉价、被动机器人导航系统最有益和可行的地区和国家。使用编码器、3D 打印部件、机械加工部件和印刷电路板构建了机器人导航系统的原型。
全球分析显示，黑山、安提瓜和巴布达以及塞舌尔是实施和测试新型机器人导航系统的主要候选地区。为了验证该系统进一步开发的可行性，通过准确性研究对其性能进行了分析，结果表明其精度和重复性在 1.53±2.50mm（平均值±2×标准差，95%置信区间）范围内。
通过考虑缺乏神经外科医生和需要频繁放置 EVD 的世界区域，作者能够分析出优先开发机器人导航系统的地区。随后，提供了一个原理验证原型，其准确性足以定位脑室进行 EVD 放置。
