Robotic external ventricular drain placement for acute neurosurgical care in low-resource settings: feasibility considerations and a prototype design

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Robotic external ventricular drain placement for acute neurosurgical care in low-resource settings: feasibility considerations and a prototype design


Journaljournal of Neurosurgery
Article typeJournal research article – Clinical research
Publication date – Jan – 2022
Authors – Alexander D. Smith, Alexander J. Teague, Anant Naik, Mika Janbahan, Emily J. Smith, David T. Krist, Sindhu Parupalli, Kevin Teal, Wael Hassaneen
Keywordsexternal ventricular drain, Global Health, hydrocephalus, inexpensive robot, neurosurgical navigation, traumatic brain injury
Open access – Yes
SpecialityNeurosurgery, Trauma surgery
World region Global

Language – English
Submitted to the One Surgery Index on January 13, 2022 at 6:02 am
Abstract:

OBJECTIVE
Emergency neurosurgical care in lower-middle-income countries faces pronounced shortages in neurosurgical personnel and infrastructure. In instances of traumatic brain injury (TBI), hydrocephalus, and subarachnoid hemorrhage, the timely placement of external ventricular drains (EVDs) strongly dictates prognosis and can provide necessary stabilization before transfer to a higher-level center of care that has access to neurosurgery. Accordingly, the authors have developed an inexpensive and portable robotic navigation tool to allow surgeons who do not have explicit neurosurgical training to place EVDs. In this article, the authors aimed to highlight income disparities in neurosurgical care, evaluate access to CT imaging around the world, and introduce a novel, inexpensive robotic navigation tool for EVD placement.

METHODS
By combining the worldwide distribution of neurosurgeons, CT scanners, and gross domestic product with the incidence of TBI, meningitis, and hydrocephalus, the authors identified regions and countries where development of an inexpensive, passive robotic navigation system would be most beneficial and feasible. A prototype of the robotic navigation system was constructed using encoders, 3D-printed components, machined parts, and a printed circuit board.

RESULTS
Global analysis showed Montenegro, Antigua and Barbuda, and Seychelles to be primary candidates for implementation and feasibility testing of the novel robotic navigation system. To validate the feasibility of the system for further development, its performance was analyzed through an accuracy study resulting in accuracy and repeatability within 1.53 ± 2.50 mm (mean ± 2 × SD, 95% CI).

CONCLUSIONS
By considering regions of the world that have a shortage of neurosurgeons and a high incidence of EVD placement, the authors were able to provide an analysis of where to prioritize the development of a robotic navigation system. Subsequently, a proof-of-principle prototype has been provided, with sufficient accuracy to target the ventricles for EVD placement.

OSI Number – 21435

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