title: A novel concept for smart trepanation.
abstract: Trepanation of the skull is a common procedure in craniofacial and neurosurgical interventions, allowing access to the innermost cranial structures. Despite a careful advancement, injury of the dura mater represents a frequent complication during these cranial openings. The technology of computer-assisted surgery offers different support systems such as navigated tools and surgical robots. This article presents a novel technical approach toward an image- and sensor-based synergistic control of the cutting depth of a manually guided soft-tissue-preserving saw. Feasibility studies in a laboratory setup modeling relevant skull tissue parameters demonstrate that errors due to computed tomography or magnetic resonance image segmentation and registration, optical tracking, and mechanical tolerances of up to 2.5 mm, imminent to many computer-assisted surgery systems, can be compensated for by the cutting tool characteristics without damaging the dura. In conclusion, the feasibility of a computer-controlled trepanation system providing a safer and efficient trepanation has been demonstrated. Injuries of the dura mater can be avoided, and the bone cutting gap can be reduced to 0.5 mm with potential benefits for the reintegration of the bone flap.
authors.affiliation: Department of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Follmann
authors.forename: Alexander
authors.initials: A
authors.lastname: Korff
authors.forename: Tobias
authors.initials: T
authors.lastname: Fuertjes
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Kunze
authors.forename: Kirsten
authors.initials: K
authors.lastname: Schmieder
authors.forename: Klaus
authors.initials: K
authors.lastname: Radermacher
mesh_terms: D001921:Brain / Q000033:anatomy & histology; D003399:Craniotomy / Q000295:instrumentation / Q000379:methods; D004388:Dura Mater / Q000033:anatomy & histology / Q000293:injuries; D004548:Elasticity; D004867:Equipment Design; D004869:Equipment Safety; D005240:Feasibility Studies; D005246:Feedback; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007431:Intraoperative Complications / Q000517:prevention & control; D053685:Laser Therapy / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008328:Man-Machine Systems; D008422:Materials Testing; D019300:Medical Errors / Q000517:prevention & control; D008953:Models, Anatomic; D059745:Piezosurgery / Q000295:instrumentation / Q000379:methods; D012371:Robotics / Q000295:instrumentation; D012886:Skull / Q000033:anatomy & histology; D013314:Stress, Mechanical; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D013718:Tensile Strength; D014057:Tomography, X-Ray Computed / Q000379:methods; D014207:Trephining / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D014465:Ultrasonics / Q000295:instrumentation; D014732:Vibration