<p>Robotically Steered Needles: A Survey of Neurosurgical Applications and Technical Innovations</p>

Abstract

This paper surveys both the clinical applications and main technical innovations related to steered needles, with an emphasis on neurosurgery. Technical innovations generally center on curvilinear robots that can adopt a complex path that circumvents critical structures and eloquent brain tissue. These advances include several needle-steering approaches, which consist of tip-based, lengthwise, base motion-driven, and tissue-centered steering strategies. This paper also describes foundational mathematical models for steering, where potential fields, nonholonomic bicycle-like models, spring models, and stochastic approaches are cited. In addition, practical path planning systems are also addressed, where we cite uncertainty modeling in path planning, intraoperative soft tissue shift estimation through imaging scans acquired during the procedure, and simulation-based prediction. Neurosurgical scenarios tend to emphasize straight needles so far, and span deep-brain stimulation (DBS), stereoelectroencephalography (SEEG), intracerebral drug delivery (IDD), stereotactic brain biopsy (SBB), stereotactic needle aspiration for hematoma, cysts and abscesses, and brachytherapy as well as thermal ablation of brain tumors and seizure-generating regions. We emphasize therapeutic considerations and complications that have been documented in conjunction with these applications.

Infusion Mechanisms in Brain White Matter and Their Dependence on Microstructure: An Experimental Study of Hydraulic Permeability

“…It must be noted that another potential source of non-linearity could be the existence of flow along the needle/tissue interface. This form of "leakage", usually called backflow [7], cannot be completely ruled out in the absence of detailed localized flow measurements; this could be responsible for some of the larger values of β reported in this study. However, the fact that the non-linearity parameter is larger in the specimens characterized by parallel axon fibres (see Fig.…”

“…localised tissue damage) or suffer from limitations in passing through the blood-brain barrier (BBB) and distribution of therapeutic agents throughout the tissue by passive diffusion [3]- [5]. To overcome these challenges, applications of robotically steered needles in neurosurgery is gaining momentum [6], with important new solutions and strategies been developed and studied; further details on this topic can be found in the recent review article by Audette et al [7]. Convection-enhanced drug delivery [8], [9], an intra-tumoural infusion method for localised drug delivery, has emerged as a viable delivery technique and a promising solution to overcome some of the mentioned obstacles.…”

Insights into Infusion-Based Targeted Drug Delivery in the Brain: Perspectives, Challenges and Opportunities

“…In [ 9 ], the current state of open source for robotically steerable needles is presented, listing software tools that can be used for the planning of the operation and any computation required, such as 3D Slicer [ 210 ] or the Medical Imaging Interaction Toolkit (MITK) [ 211 ]. There are also open protocols that can be used to transfer medical images, transformations and parameters from different computational units, such as OpenIGTLink [ 212 ].…”

“…Recent advancements in medical robotics through technical innovations has led to significant improvements in CED-like technologies [ 9 , 10 ]; however, ultimate success in the clinical applications of these systems remains a goal to be accomplished [ 7 ]. Current embodiments suffer from a lack of precise information and reliable experimental data on the flow behaviour in the brain, which limits the development of precise numerical models and their implementation in automated surgical systems.…”

Computer Assisted Planning for Curved Laser Interstitial Thermal Therapy

“…Several surgical disciplines have seen significant advances in the last decade, with the introduction of novel robotic and endoscopic tools that have aided more extensive resections through minimally invasive corridors [1], [2]. Amongst these, steerable needle technologies have been tested for different neurosurgical applications.…”