Through the precise positioning and verification of the robot "assistant" for many times before surgery, under the precise operation step by step, finally, the robot "assistant" accurately implanted two extremely fine microelectrodes into the deep brain target of a patient in a coma after cerebral hemorrhage, the central thalamic nucleus, according to the path planned by the doctor before surgery. According to the neurosurgery department of Tongji Hospital affiliated to Huazhong University of Science and Technology, Ms. Liu (Surnamed Hua), who has been in a coma for nearly half a year, has been treated with deep brain stimulation (DBS) assisted by neurosurgical robot, and her consciousness is improving. It is reported that the case of robot-assisted deep brain stimulation (DBS) is the first in Hubei Province.
【 Expert introduction 】
Jiang Wei, LIU De, M.D., postdoctoral fellow, expert in neural regulation. Associate professor, Associate chief physician, master tutor, Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. World neural regulation association member, Chinese medical association (INS) functional neurosurgery committee committee member, the Chinese medical doctor association professional committee of nerve regulation youth committee, the Chinese society of research-oriented hospital nerve regeneration and repair professional committee, the cranial nerve disease diagnosis and treatment group members, executive director of the association of neural regulation of hubei province, wuhan the functional neurosurgery group deputy team leader, Young and middle-aged medical backbone talents in Wuhan.
Committed to the concept of minimally invasive and neurological function protection, he has participated in thousands of neurosurgical operations, and can independently complete various complex neurosurgical operations, with rich clinical experience. He has completed a large number of microsurgeries for glioma, meningioma and spinal cord tumors, and is particularly good at DBS surgery for Parkinson's disease, essential tremor, dystonia, Major's syndrome, MVD surgery for trigeminal neuralgia, facial spasm, and resuscitation surgery for vegetated patients. Among them, hundreds of DBS surgeries such as Parkinson's have been performed by individuals, maintaining a high standard of surgical operations and excellent postoperative results, leading in Central China.
A 38-year-old woman has been left in a vegetative state after a brain vessel burst
Chronic consciousness disorder (DOC) is commonly known as the "vegetative state". According to incomplete statistics and estimates, there are about 200,000 to 300,000 vegetative people living in China, and at least 100,000 to 150,000 new patients are diagnosed every year. Traditional treatment methods such as drugs, hyperbaric oxygen, rehabilitation therapy, sensory and environmental stimulation are not effective. Due to the particularity of the patient's condition, the whole family and society have borne a huge economic and human burden.
Liu, 38, is one of them. Half a year ago, she was sent to the hospital for emergency treatment due to sudden cerebrovascular rupture complicated with brain stem hemorrhage. After that, she underwent cerebellar hematoma removal, bone flap decompression, tracheotomy and other emergency treatments. After the surgery, the patient's vital signs recovered slowly and she fell into a continuous coma. One month later, Ms. Liu underwent ventriculoperitoneal shunt for "hydrocephalus". Although she underwent rehabilitation treatment for more than 3 months after the operation, she did not see any improvement in consciousness. After five months of "deep sleep", liu's family, unwilling to give up, sent her to the Neurosurgery department of Tongji Hospital affiliated to Huazhong University of Science and Technology, hoping that the implanted electrodes would wake up her sleeping brain.
After sleeping for 5 months, the first robot-assisted DBS resuscitation operation in Hubei was performed
After admission, after nuclear magnetic resonance, CT, EEG and other related examinations, Ms. Liu was scored by coma recovery scale. All indicators were depressed, the patient was in a state of minimum consciousness, and the muscle strength of bilateral lower limbs was level 0, and the muscle tension was increased, showing a folding knife reaction. After analyzing the patient's medical history, CT, MRI imaging data and EEG manifestations after admission, Jiang Wei and his team decided to perform robot-assisted central thalamic DBS surgery according to the patient's condition, that is, electrodes were implanted in the brain of the patient to stimulate the target central middle thalamic nucleus parabundle complex.
On the day of the operation, Director Jiang Wei's team performed a robot-assisted DBS resuscitation operation for Ms. Liu in Tongji Hospital. Intraoperative, by robot "assistant" precise positioning and verify for many times, under the fine step by step down to poor operation, robot "assistant" under the path and route of Jiang Wei director of planning, accurate positioning the puncture point and control puncture depth, planted two microelectrode precise liu deep brain central thalamic nuclei, electrode implantation precision are within 0.15 mm. The whole operation was successfully completed in about 2 hours. This is the first Sinovation robot-assisted DBS wake-up operation for vegetative patients in Hubei province and even in China.
Director Jiang Wei introduced that the patient was taken off the ventilator on the second day after surgery and turned on three days after surgery. The patient's consciousness showed a trend of continuous improvement, the muscle tension of the extremities decreased significantly compared with that before surgery, and the hemiplet-like reaction of the lower limbs disappeared. MRI reexamination showed that the electrode had a high degree of coincidence with the preoperative target, accurate positioning, and significantly enhanced brain electrical activity. At present, the patient is still undergoing further rehabilitation treatment.
DBS surgery, exorobot surgery 'diamond in the crown'
In 2007, Nature reported a case of DOC who underwent deep brain stimulation (DBS) in the central thalamus and regained consciousness. At present, many domestic medical institutions have been trying to treat DOC with DBS, and positive progress has been made.
As one of the country's most important center of neurosurgery, huazhong university of science and technology, tongji medical school affiliated tongji hospital neurosurgery professor by fa-zu qiu academicians and Jiang Xianhui officially founded in 1955, the current director of thunder, a professor at the medical professor ShuKai attaches great importance to the robot of artificial intelligence, deputy director of neural control technology for bright spots, guide the functional neurosurgery booming. The number of DBS operations performed by Professor Jiang Wei's team is in the leading position in the whole central China region.
Director Jiang Wei introduced that DBS, also known as cerebral pacemaker implantation, is one of the most advanced nerve regulation technologies in the world. It is a minimally invasive operation to implant electrodes into the specific nucleus of the brain and send electrical pulses of a certain frequency to regulate the functional nucleus and neural circuits, so as to achieve the purpose of improving or treating diseases. At present, DBS is mainly used in the treatment of Parkinson's disease, in addition to dystonia, essential tremor, chronic disorder of consciousness, epilepsy and other diseases.
"DBS surgery is the most delicate and complicated operation with the highest requirement for precision in neurosurgery. What DBS 'targets' are nerve nuclei hidden deep in the brain, often only a few millimeters in diameter." Doctors need to implant electrodes accurately without opening the skull, so DBS positioning errors are allowed within submillimeters, Jiang said.
It is reported that since the introduction of surgical robots, the functional neurosurgery department of Tongji Hospital in Wuhan has routinely carried out a large number of intracranial lesions biopsy, stereoscopic hematoma extraction stereoscopic electroencephalography (SEEG), DBS surgery, which has accumulated rich theoretical and practical experience for the implementation of DBS surgery for patients in vegetative state.
"In the era of pursuing precise minimally invasive surgery and gradually stepping into the era of intelligent medical treatment, robotic surgery is a manifestation of the level and grade of a hospital. Among neurosurgical robotic surgery, DBS surgery represents the highest accuracy at present and is the 'diamond in the crown' of neurosurgical robotic surgery." However, in jiang Wei's opinion, neurosurgical robot, as an accurate and efficient "assistant", still has some bottlenecks and problems. For example, surgical robot cannot really achieve high artificial intelligence at present. Therefore, the accuracy of the preoperative planning path made by doctors is particularly important, and it also requires doctors to pay special attention to the surgical operation specifications when using it. Do not take it lightly because it is a highly intelligent product.
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