The Robot-assisted Stereotactic Hematoma Puncture Using YL-1 Type Of Mental Needle In Experimental Intracerebral Hemorrhage Pigs

Part one:Development of intracerebral hemorrhage models of autologous blood influsion in piglets using medullo-puncture needle with relatively painless surgery for experimental animals.ObjectiveLarge animals and relatively large volume of intracranial hematoma are important for mimicking the aspiration and thrombloysis of clots (ATC) in patients with intracerebral hemorrhage (ICH). However, there are some slight flaws in the model of frontal hematoma in pigs reported by Wagner. In the present study, we explore to develop an simple, feasible ICH model of autologous blood influsion in piglets on the basis of Wagner'method, which can allay the pain as much as possible for experimental animals, to meet the need of further experiments.MethodsAutologous blood intermittently collected from carotid artery was injected twice using medullo-puncture needle. The position of stereotaxic coordinate was determined by the eye socket of pig. After CT scanning, the hematomas were examined with the method of imagelolgy and histology, and their relationship was analyzed.ResultsSatisfactory frontal lobe hematomas were developed in 7 piglets which all were the state of health after surgery. The border between the ovate hematoam inside which the blood clot was uniform and the normal brain tissue surrounding the hematoam was clear. The hematoma volumes examined by imageology (1.25±0.85ml) and histology (1.64±1.19ml) are close in value (P>0.05) and in relevance (r=0.931, P=0.002).ConclusionWith a high rate of success in modeling, the method of this modified ICH model is simple. This relative painless surgery well reflected the human caring for experimental animals. The hematoma volumes examined by CT-scanning can used to indicate the virtual hematoma volume.Part Two:The operational performance of robot-assisted stereotactic surgery system in guiding the experimental intracranial hematoma puncture.ObjectiveThe technique of aspiration and thrombolysis of clots (ATC) using YL-1 type of puncture needle has gained widely acceptance in mainland China. However, the placement of puncture needle is performed by free-hand. it can not accurately target the hemotoma and is not in line with the international norms. Therefore, the development of a stereotactic system which can guide this approach is urgent. A robot-assisted stereotactic surgery system (RSSS) for that has been developed by institute of mechanism and Tongji hospital affiliated to Huazhong University of science and technology, and its operational performance need to be evaluated. MethodsWith RSSS,7 experimental ICH pigs received the hematoma puncture by YL-1 type of needle to evaluate its safety, operational feasibility, manipulative connection, operational difficulty and operational time.ResultsRSSS has the characteristic of high safety, good feasibility, smooth manipulative connection and moderate operational difficulty. The regesteration time is 7.6±3.4min.ConclusionRASS possesses a reliable operational performance and can better guide the completion of intracranial hematoma puncture. However, its automation of manipulation should be further improved.Part Three:The accuracy evaluation of robot-assisted stereotactic surgery system in guiding the experimental intracranial hematoma puncture.ObjectiveThe application accuracy (APA) evaluation of stereotactic system is usually performed based on imageology. Studies in vivo experiments by histology are rare, and in which there are some methodological flaws. Moreover, the reports about the correlation between the APA of imageology and histology are lacking. In this study, we will assess the registration accuracy (REA) and the APA of imageology and histology for a robot-assisted stereotactic system (RSSS) developed by us, and explore the establishment of an appropriate method of accuracy evaluation for it. The correlation between the APA of imageology and histology will be also assessed. MethodsWith RSSS,7 experimental ICH pigs received the hematoma puncture by YL-1 type intracranial puncture needle to measure the registration accuracy by formula after recording the coordinates of fiducials which were formed by RSSS after registration and on CT-scanning. The CT-scanning data of pre-surgery and post-surgery were analyzed to measure the APA. With development of an intracranial hematoma model in pigs for evaluating the surgery accuracy using the method of histology, the distance in space between the point of centricity of hematoma and the extremity of compass tube was calculate to measure the APA of histology. Then, the correlation between the APA of imageology and histology is assessed by statistical method.ResultsIn the procedure of hematoma puncture using YL-1 type of mental needle guided by RSSS in 7 experimental ICH pigs, the registration accuracy, the APA of imageology and histology are 1.29±0.24mm (range 0.99～1.57mm),2.75±0.76mm (range 1.82-3.84mm) and 3.12±0.71mm (2.15-4.29mm) respectively, and which all reached the predetermined target. The APA of imageology and histology showed no significant difference (P>0.05) and significant correlation (r=0.868, P<0.05).ConclusionRSSS can accurately guide the completion of intracranial hematoma puncture. The value of registration accuracy and APA is at an intermediate level comparing to similar products. The model for assessing the APA of histology developed by us is simple, feasible and reproducible. It is an ideal model for evaluation APA of the stereotactic system. The good correlation between the APA of imageology and histology provided strong experimental evidence for assessing the APA of stereotactic system by the method of imageology.