Percutaneous intracerebral navigation by duty-cycled spinning of flexible bevel-tipped needles.
BACKGROUND
Intracerebral drug delivery using surgically placed microcatheters is a growing area of interest for potential treatment of a wide variety of neurological diseases, including tumors, neurodegenerative disorders, trauma, epilepsy, and stroke. Current catheter placement techniques are limited to straight trajectories. The development of an inexpensive system for flexible percutaneous intracranial navigation may be of significant clinical benefit.


OBJECTIVE
Utilizing duty-cycled spinning of a flexible bevel-tipped needle, the authors devised and tested a means of achieving nonlinear trajectories for the navigation of catheters in the brain, which may be applicable to a wide variety of neurological diseases.


METHODS
Exploiting the bending tendency of bevel-tipped needles due to their asymmetry, the authors devised and tested a means of generating curvilinear trajectories by spinning a needle with a variable duty cycle (ie, in on-off fashion). The technique can be performed using image guidance, and trajectories can be adjusted intraoperatively via joystick. Fifty-eight navigation trials were performed during cadaver testing to demonstrate the efficacy of the needle-steering system and to test its precision.


RESULTS
The needle-steering system achieved a target acquisition error of 2 ± 1 mm, while demonstrating the ability to reach multiple targets from one burr hole using trajectories of varying curvature.


CONCLUSIONS
The accuracy of the needle-steering system was demonstrated in a cadaveric model. Future studies will determine the safety of the device in vivo.
Engh
Johnathan A
JA
Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA. enghja@upmc.edu
Minhas
Davneet S
DS
Kondziolka
Douglas
D
Riviere
Cameron N
CN
D002102:Cadaver; D016503:Drug Delivery Systems / Q000295:instrumentation* / Q000379:methods*; D004867:Equipment Design / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D009339:Needles