Techniques for Stereotactic Neurosurgery: Beyond the Frame, Toward the Intraoperative Magnetic Resonance Imaging–Guided and Robot-Assisted Approaches

• Published in: World neurosurgery Vol. 116; pp. 77 - 87
• Main Authors: Guo, Ziyan, Leong, Martin Chun-Wing, Su, Hao, Kwok, Ka-Wai, Chan, Danny Tat-Ming, Poon, Wai-Sang
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2018
• Subjects: Image-guided intervention; Magnetic resonance imaging (MRI); Stereotactic neurosurgery; 3D; CT; DBS; MR; MRI; Image-guided intervention; Magnetic resonance imaging (MRI); EM; Stereotactic neurosurgery; DoF; LITT
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.04.155

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. •Vision and advantages of the new stereotactic neurosurgical workflow with real-time MRI-guided robot-assisted approach.•Three key enabling technologies are proposed: nonrigid image registration, MR-based tracking, and MRI-compatible actuation.•Nonrigid image registration compensates for the image discrepancies resulting from brain deformation and MRI distortion.•MR-based tracking unit provides real-time positional feedback with high resolution, low latency, and high sampling.•MR-safe hydraulic actuator can offer precise manipulation and maintain high MRI quality during robot operation.