Wang Tao, PEOPLE's Liberation Army 306 Hospital, Department of Neurosurgery
Disease profile
Neurocysticercosis is the most common parasitic infection of the central nervous system and is caused by the parasitism of the larvae (cysticercosis) of the pork tapeworm in the human brain. The incidence of neurocysticercosis is high, accounting for about 60% to 80% of cysticercosis, and the incubation period is long, ranging from months to decades. Neurocysticercosis often causes neurological dysfunction in the body, and the clinical manifestations include epilepsy, psychiatric symptoms, headache, nausea and vomiting, meningeal irritation symptoms, etc., which are complex and diverse.
In order to remove cysticercosis through surgical methods, how to accurately locate the lesion and choose the surgical path is an important problem faced by doctors.
Usually, the positioning accuracy obtained solely by visual observation of medical images and rough numerical calculations is not enough, resulting in a long craniotomy time, large wounds for patients, and many sequelae. In cases where the lesion is relatively deep, it is more difficult for doctors to use microscopy to observe and bipolar electrocoagulation to cut open the cerebral cortex to find the lesion.
The emergence of new methods
In 1983, Kelly first proposed the concept of stereotactic craniotomy, compared with traditional craniotomy, the accuracy of this method is improved, the incidence of neurological dysfunction can be reduced from 10% to 4%, the incidence of incisional complications can be reduced from 8% to 4%, and the number of days in hospital stay is correspondingly shortened.
With the development of science, the neurosurgical medical robot that has gradually developed in combination with computer technology, robotics and clinical needs can assist doctors with more accurate positioning and navigation according to CT, MRI and other medical imaging, and the mechanical arm directly reaches the best cranial entry point selected by the doctor on the three-dimensional model in the computer software, which means that the patient's craniotomy wound will be as small as possible, which is more conducive to postoperative rehabilitation.
Case analysis
On November 9, the first robot-assisted stereotactic brain cysticers removal operation in China was carried out at the 306 Hospital of the People's Liberation Army, the patient was a 44-year-old man, and the MRI image of the brain was as follows, and the cyst worm located in the patient's parietal lobe could be clearly seen. Because cysticercosis is located in the functional area, traditional craniotomy is prone to complications such as paralysis.
The chief surgeon of the operation is Zhao Quanjun, chief physician of the Department of Neurosurgery of the PLA 306 Hospital, who has been engaged in neurosurgical treatment for more than 30 years, in addition to common neurosurgical diseases, such as surgical resection of intracranial tumors and surgical treatment of cerebral hemorrhage, brain trauma, hydrocephalus and other surgical treatments, Dr. Zhao is particularly good at the surgical treatment of refractory epilepsy, stereotactic surgical treatment of brain functional diseases and robot-assisted unframed brain surgery.
The medical robot used in this operation is a Remebot neurosurgical robot developed by China itself. At about 9:00 a.m., the patient wears a Remebot marker point scan CT image, and after the file is imported into the robot's computer software, a three-dimensional model of the patient's head is automatically generated, and the doctor selects the best cranial point and angle of the cranial entry according to the location of the lesion shown in the model.
After completing the robot and patient registration steps, the relative relationship between the patient and the robotic arm is established, and the manipulator is controlled in the computer software to complete the step-by-step walk, and the doctor determines the specific location of the craniotomy wound according to the target position pointed at the end of the robotic arm, and marks the patient's scalp with a pen.
Subsequently, the patient's head and the end of the robotic arm operation platform are fully disinfected, and all preoperative preparations required for craniotomy are made. After the robotic arm is positioned again, after confirming that it has reached the lesion point, the doctor first uses the operating platform at the end of the robotic arm to drill a hole to determine the depth of the lesion, and then return the robotic arm to the position and begin to perform small wound craniotomy.
Ring drill to remove the skull as a small diameter bone window, cut open the epidural microscope along the cerebral sulcus back incision of the cerebral cortex, avoid important blood vessels and functional areas, find the brain cysticercosis lesion after complete removal, after repeated irrigation of the residual cavity, the compress can absorb hemostatic gauze, suture the meningeal dura with the skull lock to fix the skull flap, suture the scalp layer.
Successfully removed cysts are shown in the figure below
After the completion of this case, Dr. Zhao Quanjun was interviewed by the CCTV news column and introduced more possibilities for medical robots in telemedicine in the future.
Doctor Profile
Zhao Quanjun, Chief Physician, Professor, Ph.D., Graduate Supervisor. In 1981, he entered the Military Medical Department of the Second Military Medical University to study and join the army, and later studied under Master Liu Zonghui, one of the four founders of epilepsy surgery in China, graduated with a master's degree in medicine in 1992 and stayed in the Neurosurgery Department of the Naval General Hospital. From the end of 2012 to the beginning of 2013, as a hospital leader, he went to the Epilepsy Center of Cleveland Hospital and the Neurosurgery Department of Mayo Hospital in the United States to study, and returned to China on schedule, and is currently the chief physician of the Department of Neurosurgery of the PLA 306 Hospital.
Since 1998, when Remebot was developed at the Naval General Hospital, Dr. Zhao has participated in the development and clinical application of the robot system, and has performed more than 3,000 surgeries. In 2015, the Department of Neurosurgery of PLA 306 Hospital officially introduced the Remebot medical robot, and continued to cooperate with Remebot to carry out clinical research related to stereotactic minimally invasive surgery of the brain.