Using a robot to treat brain aneurysms is feasible and could allow for improved precision when placing stents, coils and other devices, according to late breaking science presented today at the American Stroke Association’s International Stroke Conference 2020 .
The conference, Feb. 19-21 in Los Angeles, is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.
Robotic technology is used in surgery and cardiology, but not for brain vascular procedures. In this study, Canadian researchers report the results of the first robotic brain vascular procedures.
They used a robotic system specifically adapted for neurovascular procedures.
Software and hardware adaptations enable it to accommodate microcatheters, guidewires and the other devices used for endovascular procedures in the brain.
These modifications also provide the operator additional precise fine-motor control compared to previous system models.
“This experience is the first step towards achieving our vision of remote neurovascular procedures,” said lead researcher Vitor Mendes Pereira, M.D., M.Sc., a neurosurgeon and neuroradiologist at the Toronto Western Hospital, and professor of medical imaging and surgery at the University of Toronto in Canada.
“The ability to robotically perform intracranial aneurysm treatment is a major step forward in neuro-endovascular intervention.”
In the first case, a 64-year-old female patient presented with an unruptured aneurysm at the base of her skull.
The surgical team successfully used the robot to place a stent and then, using the same microcatheter, entered the aneurysm sac and secured the aneurysm by placing various coils. All intracranial steps were performed with the robotic arm.
Since this first case, the team has successfully performed five additional aneurysm treatments using the robot, which included deploying various devices such as flow-diverting stents.
Dr. Vitor Mendes Pereira views images from remote control stent placement for a brain aneurysm. The image is credited to Roger Boyle.
“The expectation is that future robotic systems will be able to be controlled remotely. For example, I could be at my hospital and deliver therapy to a patient hundreds or even thousands of kilometers away,” Mendes Pereira said.
“The ability to deliver rapid care through remote robotics for time-critical procedures such as stroke could have a huge impact on improving patient outcomes and allow us to deliver cutting-edge care to patients everywhere, regardless of geography.”
“Our experience, and that of future operators of this technology, will help develop the workflows and processes necessary to implement successful robotic programs, which will ultimately help establish remote care networks in the future,” Mendes Pereira said.
The list of study authors and disclosures are available in the abstract. The work reported was funded by institutional sources. Single patient-use cassettes were provided by Corindus, a Siemens Healthineers Company.
The research and development of nanorobots with embedded nanobiosensors and actuators is considered to provide a new possibility to provide health specialists with new highprecision
tools (Frist 2005).
In the same way that the development of microtechnology in the 1980s has led to new medical instrumentation, emerging nanotechnologies, such as the manufacturing of nanoelectronics (Chau et al. 2007), will similarly permit further advances in medicine, providing efficient methods and new devices for patient treatment (LaVan et al. 2003 Leary et al. 2006).
The use of microdevices in surgery and medical treatments is a reality which has brought many improvements in clinical procedures in recent years (Elder et al. 2008). For example,
among other medical instrumentation, catheterization has been used successfully as an important methodology for intracranial surgery (Ikeda et al. 2006).
Now the advent of biomolecular science and new manufacturing techniques is helping to advance the miniaturization of devices from microelectronics to nanoelectronics (Andrews 2007).
The three main approaches proposed in the current scientific literature for the future development of nanorobots are positional nanoassembly, DNA nucleic acid robots, and bacteriabased nanorobots.
Although such methods reported previously are quite interesting and important as initial stages for the study of nanomachines, they suffer from some serious limitations.
Positional nanoassembly is inadequate in terms of efficiency in building nanodevices, and such an approach is also not used in nanoelectronics manufacturing, which integrates the current ethodology in use towards the commercialization of high-performance nano-integrated circuits (ICs).
The DNA approach to build nucleic acid robots does not allow complex nanodevices, as required to enable precise instrumentation for medical applications etc., to be realized.
The third approach using bacteria-based nanorobots presents serious concerns and limitation: bacteria are living organisms and can self-replicate, making their use in medicine inappropriate
due to safety reasons.
In our work, we propose a new fourth approach to developing nanorobots for common use in medicine: the nanorobot should be achieved as an IC. The methodology requires hybrid materials, photonics, and wireless communication for nanorobot manufacturing and control. The present nanorobot architecture provides a medical nanorobotics model in accordance
with engineering, physics concepts, and current trends in nanoelectronics and extracellular proteomic signaling for device prototyping and biomedical instrumentation.
This nanorobot platform offers a practical architecture for in vivo instrumentation,
and is proposed for brain aneurysm.
A key factor to increase the chances for patients in having a satisfactory treatment from intracranial aneurysm relies on the detection of vessel deformation in the early stages of bulb development.
The current procedure is to monitor patients with some sort of history of aneurysm using ultrasound computer tomography (CT) every 6 to 12 months (Figure 1), requiring a regular basis of medical accompaniment. To visualize how stages of the actual and upcoming technologies can be applied to medicine, the nanorobots are used to detect NOS (nitric
oxide synthase) protein overexpression inside an intracranial blood vessel. Therefore, the implemented work provides a practical approach for a nanorobot control interface and equipment design analyses. As described in this paper, the model can be equally useful for other biomedical problems.
American Heart Association