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. 2022 Sep 12:9:997413.
doi: 10.3389/frobt.2022.997413. eCollection 2022.

Advanced cutting strategy for navigated, robot-driven laser craniotomy for stereoelectroencephalography: An in Vivo non-recovery animal study

Fabian Winter  1 , Daniel Beer  2 , Patrick Gono  2 , Stefano Medagli  2 , Marta Morawska  2 , Christian Dorfer  1 , Karl Roessler  1
Affiliations

Advanced cutting strategy for navigated, robot-driven laser craniotomy for stereoelectroencephalography: An in Vivo non-recovery animal study

Fabian Winter et al. Front Robot AI. .

Abstract

Objectives: In this study we aimed to present an updated cutting strategy and updated hardware for a new camera system that can increase cut-through detection using a cold ablation robot-guided laser osteotome. Methods: We performed a preoperative computed tomography scan of each animal. The laser was mounted on a robotic arm and guided by a navigation system based on a tracking camera. Surgery was performed with animals in the prone position. A new cutting strategy was implemented consisting of two circular paths involving inner (full cylindric) and outer (hollow cylindric) sections, with three different ablation phases. The depth electrodes were inserted after cut-through detection was confirmed on either the coaxial camera system or optical coherence tomography signal. Results: A total of 71 precision bone channels were cut in four pig specimens using a robot-guided laser. No signs of hemodynamic or respiratory irregularities were observed during anesthesia. All bone channels were created using the advanced cutting strategy. The new cutting strategy showed no irregularities in either cylindrical (parallel walled; n = 38, 45° = 10, 60° = 14, 90° = 14) or anticonical (walls widening by 2 degrees; n = 33, 45° = 11, 60° = 13, 90° = 9) bone channels. The entrance hole diameters ranged from 2.25-3.7 mm and the exit hole diameters ranged from 1.25 to 2.82 mm. Anchor bolts were successfully inserted in all bone channels. No unintended damage to the cortex was detected after laser guided craniotomy. Conclusion: The new cutting strategy showed promising results in more than 70 precision angulated cylindrical and anti-conical bone channels in this large, in vivo non-recovery animal study. Our findings indicate that the coaxial camera system is feasible for cut-through detection.

Keywords: SEEG; cutting strategy; depth electrodes; epilepsy surgery; navigated; robotic.

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Conflict of interest statement

DB, PG, SM, and MM were currently employed by Advanced Osteotomy Tools. The remaining authors declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Planned trajectories for depth electrodes in a pig skull.
FIGURE 2
FIGURE 2
New cutting strategy for bone channels based on a centric pilot shot followed by a surrounding hollow-cylinder that shapes the contour of the hole.
FIGURE 3
FIGURE 3
Possible different angulations. (A) Anchor bolt planned at 90° with inserted electrode and (B) anchor bold planned at 60° with inserted electrode.
FIGURE 4
FIGURE 4
Time per hole by geometry and angulation.
FIGURE 5
FIGURE 5
Cut-through detection with the live-feed coaxial camera system.
FIGURE 6
FIGURE 6
Cut-through not yet achieved as shown on the (A) live-feed coaxial camera system and (B) optical coherence tomography image. Further laser pulses are needed to achieve cut through.
FIGURE 7
FIGURE 7
No unintended damage is observed in underlying tissue. Dura penetration can be seen only at the electrode insertion sites.
See this image and copyright information in PMC

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