Full Text:   <514>

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On-line Access: 2023-04-10

Received: 2022-11-03

Revision Accepted: 2022-12-23

Crosschecked: 2023-04-14

Cited: 0

Clicked: 584

Citations:  Bibtex RefMan EndNote GB/T7714

 ORCID:

Elena ROCA

https://orcid.org/0000-0002-2314-7000

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Journal of Zhejiang University SCIENCE B 2023 Vol.24 No.4 P.326-335

http://doi.org/10.1631/jzus.B2200557


An expandable chamber for safe brain retraction: new technologies in the field of transcranial endoscopic surgery


Author(s):  Elena ROCA, Anna GOBETTI, Giovanna CORNACCHIA, Oscar VIVALDI, Barbara BUFFOLI, Giorgio RAMORINO

Affiliation(s):  Head and Neck Department, Neurosurgery, Istituto Ospedaliero Fondazione Poliambulanza, 25124 Brescia, Italy; more

Corresponding email(s):   rocaelena@gmail.com

Key Words:  Brain retraction, Spatula, Brain retractor design, Brain retraction injury, Retraction complication, Transcranial endoscopic surgery


Elena ROCA, Anna GOBETTI, Giovanna CORNACCHIA, Oscar VIVALDI, Barbara BUFFOLI, Giorgio RAMORINO. An expandable chamber for safe brain retraction: new technologies in the field of transcranial endoscopic surgery[J]. Journal of Zhejiang University Science B, 2023, 24(4): 326-335.

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author="Elena ROCA, Anna GOBETTI, Giovanna CORNACCHIA, Oscar VIVALDI, Barbara BUFFOLI, Giorgio RAMORINO",
journal="Journal of Zhejiang University Science B",
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number="4",
pages="326-335",
year="2023",
publisher="Zhejiang University Press & Springer",
doi="10.1631/jzus.B2200557"
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%A Elena ROCA
%A Anna GOBETTI
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%A Barbara BUFFOLI
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A1 - Giorgio RAMORINO
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Abstract: 
Neurosurgery is a highly specialized field: it often involves surgical manipulation of noble structures and cerebral retraction is frequently necessary to reach deep-seated brain lesions. There are still no reliable methods preventing possible retraction complications. The objective of this study was to design work chambers well suited for transcranial endoscopic surgery while providing safe retraction of the surrounding brain tissue. The chamber is designed to be inserted close to the intracranial point of interest; once it is best placed it can be opened. This should guarantee an appreciable workspace similar to that of current neurosurgical procedures. The experimental aspect of this study involved the use of a force sensor to evaluate the pressures exerted on the brain tissue during the retraction phase. Following pterional craniotomy, pressure measurements were made during retraction with the use of a conventional metal spatula with different inclinations. Note that, although the force values necessary for retraction and exerted on the spatula by the neurosurgeon are the same, the local pressure exerted on the parenchyma at the edge of the spatula at different inclinations varied greatly. A new method of cerebral retraction using a chamber retractor (CR) has been designed to avoid any type of complication due to spatula edge overpressures and to maintain acceptable pressure values exerted on the parenchyma.

一种用于大脑牵拉的可扩展腔:颅内窥镜手术领域的新技术

Elena ROCA1,2,Anna GOBETTI3,Giovanna CORNACCHIA4,Oscar VIVALDI1,Barbara BUFFOLI5,Giorgio RAMORINO3
1外科基金会脑外科头颈科,布雷西亚 25124,意大利
2布雷西亚大学卫生技术博士项目,布雷西亚 25124,意大利
3布雷西亚大学机械与工业工程系材料科学与技术,布雷西亚 25123,意大利
4布雷西亚大学机械与工业工程系冶金系,布雷西亚 25123,意大利
5布雷西亚大学临床与实验科学系解剖与病理生理科,布雷西亚 25123,意大利
概要:神经外科作为高度专业化领域,常涉及对精细结构的手术操作,其中大脑牵拉术常用于触及大脑深层病灶,但目前尚无可靠的方法预防系列牵拉并发症的发生。本研究拟设计一种适用于经颅内镜手术的新技术,以保证周围脑组织的安全牵拉。新技术设计将可扩展腔插入颅内病灶点附近,置于最佳位置后即可被打开,保证了神经外科手术中可观的操作空间。本研究涉及使用力传感器评估牵拉阶段施加在脑组织上的压力值试验。翼点开颅术后,在牵拉过程中使用不同倾角的传统金属抹刀测量压力,尽管牵拉和施加在抹刀上的力相同,但抹刀边缘以不同倾角施加在实质脑组织上的局部压力变化却很大。综上,本研究通过设计一种腔式牵开器,用于大脑牵拉,避免由于边缘超压引起牵拉并发症,以保持施加在实质脑组织上的压力值适宜。

关键词:牵拉;抹刀;脑牵拉器设计;脑牵拉损伤;牵拉并发症;经颅内镜手术

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article

Reference

[1]AggraviM, de MomiE, DiMecoF, et al., 2016. Hand‍‒‍tool‒‍tissue interaction forces in neurosurgery for haptic rendering. Med Biol Eng Comput, 54(8):1229-1241.

[2]AndrewsRJ, BringasJR, 1993. A review of brain retraction and recommendations for minimizing intraoperative brain injury. Neurosurgery, 33(6):1052-1064.

[3]AssinaR, RubinoS, SarrisCE, et al., 2014. The history of brain retractors throughout the development of neurological surgery. Neurosurg Focus, 36(4):E8.

[4]BanderED, JonesSH, KovanlikayaI, et al., 2016. Utility of tubular retractors to minimize surgical brain injury in the removal of deep intraparenchymal lesions: a quantitative analysis of FLAIR hyperintensity and apparent diffusion coefficient maps. J Neurosurg, 124(4):1053-1060.

[5]BekenyJR, SwaneyPJ, WebsterIII RJ, et al., 2013. Forces applied at the skull base during transnasal endoscopic transsphenoidal pituitary tumor excision. J Neurol Surg B Skull Base, 74(6):337-341.

[6]BertelsenA, MeloJ, SánchezE, et al., 2013. A review of surgical robots for spinal interventions. Int J Med Robotics Comput Assist Surg, 9(4):407-422.

[7]BlancoRGF, BoaheneK, 2013. Robotic-assisted skull base surgery: preclinical study. J Laparoendosc Adv Surg Tech, 23(9):776-782.

[8]BuddayS, NayR, de RooijR, et al., 2015. Mechanical properties of gray and white matter brain tissue by indentation. J Mech Behav Biomed Mater, 46:318-330.

[9]CarrauRL, PrevedelloDM, de LaraD, et al., 2013. Combined transoral robotic surgery and endoscopic endonasal approach for the resection of extensive malignancies of the skull base. Head Neck, 35(11):E351-E358.

[10]ChenXS, 2017. Numerical Models of Blunt Dissection and Brain Retraction for Neurosurgery Simulations. PhD Dissemination, Hokkaido University, Hokkaido, Japan.

[11]de RooijR, KuhlE, 2016. Constitutive modeling of brain tissue: current perspectives. Appl Mech Rev, 68(1):010801.

[12]DevaiahAK, AndreoliMT, 2009. Treatment of esthesioneuroblastoma: a 16-year meta-analysis of 361 patients. Laryngoscope, 119(7):1412-1416.

[13]EichbergDG, DiL, ShahAH, et al., 2020. Use of tubular retractors for minimally invasive resection of deep-seated cavernomas. Oper Neurosurg, 18(6):629-639.

[14]EloyJA, ViveroRJ, HoangK, et al., 2009. Comparison of transnasal endoscopic and open craniofacial resection for malignant tumors of the anterior skull base. Laryngoscope, 119(5):834-840.

[15]FuTS, MonteiroE, MuhannaN, et al., 2016. Comparison of outcomes for open versus endoscopic approaches for olfactory neuroblastoma: a systematic review and individual participant data meta-analysis. Head Neck, 38(S1):E2306-E2316.

[16]GanlyI, PatelSG, SinghB, et al., 2005. Complications of craniofacial resection for malignant tumors of the skull base: report of an international collaborative study. Head Neck, 27(6):445-451.

[17]GargA, DwivediRC, SayedS, et al., 2010. Robotic surgery in head and neck cancer: a review. Oral Oncol, 46(8):571-576.

[18]GolahmadiAK, KhanDZ, MylonasGP, et al., 2021. Tool-tissue forces in surgery: a systematic review. Ann Med Surg, 65:102268.

[19]HannafordB, RosenJ, FriedmanDW, et al., 2013. Raven-II: an open platform for surgical robotics research. IEEE Trans Biomed Eng, 60(4):954-959.

[20]HoshideR, CalayagM, MeltzerH, et al., 2017. Robot-assisted endoscopic third ventriculostomy: institutional experience in 9 patients. J Neurosurg Pediatr, 20(2):125-133.

[21]IwataH, SatoK, TatewakiK, et al., 2011. Hypofractionated stereotactic radiotherapy with CyberKnife for nonfunctioning pituitary adenoma: high local control with low toxicity. Neuro Oncol, 13(8):916-922.

[22]KimY, ParadaGA, LiuSD, et al., 2019. Ferromagnetic soft continuum robots. Sci Robot, 4(33):eaax7329.

[23]Marenco-HillembrandL, PrevattC, Suarez-MeadeP, et al., 2020. Minimally invasive surgical outcomes for deep-seated brain lesions treated with different tubular retraction systems: a systematic review and meta-analysis. World Neurosurg, 143:537-545.e3.

[24]NelsonJH, BrackettSL, OluigboCO, et al., 2020. Robotic stereotactic assistance (ROSA) for pediatric epilepsy: a single-center experience of 23 consecutive cases. Children, 7(8):94.

[25]NicolaiP, BattagliaP, BignamiM, et al., 2008. Endoscopic surgery for malignant tumors of the sinonasal tract and adjacent skull base: a 10-year experience. Am J Rhinol, 22(3):308-316.

[26]O'MalleyBW, WeinsteinGS, 2007. Robotic anterior and midline skull base surgery: preclinical investigations. Int J Radiat Oncol Biol Phys, 69(2):S125-S128.

[27]RamorinoG, GobettiA, CornacchiaG, et al., 2022. Effect of static offsets on the nonlinear dynamic mechanical properties of human brain tissue. J Mech Behav Biomed Mater, 130:105204.

[28]RashidB, DestradeM, GilchristMD, 2013. Mechanical characterization of brain tissue in simple shear at dynamic strain rates. J Mech Behav Biomed Mater, 28:71-85.

[29]RawalRB, FarzalZ, FederspielJJ, et al., 2016. Endoscopic resection of sinonasal malignancy: a systematic review and meta-analysis. Otolaryngol Head Neck Surg, 155(3):376-386.

[30]RosenØrnJ, DiemerNH, 1988. The influence of intermittent versus continuous brain retractor pressure on regional cerebral blood flow and neuropathology in the rat. Acta Neurochir, 93:13-17.

[31]ShapiroSZ, SabacinskiKA, MansourSA, et al., 2020. Use of Vycor tubular retractors in the management of deep brain lesions: a review of current studies. World Neurosurg, 133:283-290.

[32]SiegelRL, MillerKD, FuchsHE, et al., 2021. Cancer statistics, 2021. CA Cancer J Clin, 71(1):7-33.

[33]SmithJA, JivrajJ, WongR, et al., 2016. 30 years of neurosurgical robots: review and trends for manipulators and associated navigational systems. Ann Biomed Eng, 44(4):836-846.

[34]SzoldA, BergamaschiR, BroedersI, et al., 2015. European association of endoscopic surgeons (EAES) consensus statement on the use of robotics in general surgery. Surg Endosc, 29(2):253-288.

[35]ZagzoogN, ReddyK, 2020. Modern brain retractors and surgical brain injury: a review. World Neurosurg, 142:93-103.

[36]ZhongJ, DujovnyM, PerlinAR, et al., 2003. Brain retraction injury. Neurol Res, 25(8):831-838.

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