Did you spot Renishaw's neuromate stereotactic robot that featured in an episode of the BBC drama Holby City? During the episode, neuromate assists with the treatment of an Obsessive-Compulsive Disorder (OCD) patient who undergoes a stereotactic Deep Brain Stimulation (DBS) procedure.
In the storyline, neurosurgeons use advanced MRI technology and Renishaw’s neuroinspire software to identify the region of the brain responsible for generating the OCD symptoms. A carbothane neuroguide guide tube kit is used to create tracts for the insertion of thin and flexible specialist electrodes.
Powered by a battery pack implanted in the patient’s chest, the electrodes deliver a series of persistent electric impulses to stimulate the symptom-generating region of the brain. DBS can have remarkable therapeutic effects in the treatment of OCD, and other neuro-disorders such as Parkinson’s disease. To be effective, the electrical stimulation must be delivered at a high frequency, typically greater than 130Hz.
The success of DBS depends on careful mapping and targeting of brain anatomy. Accurate positioning of electrodes is essential. The Renishaw range of products for stereotactic neurosurgery are designed to integrate into a comprehensive system for improved efficiency and safety at each stage of the DBS procedure, from planning through to verification and delivery.
Renishaw’s neuroinspire software provides neurosurgeons with a platform for target identification and trajectory planning. The software fuses MRI and CT datasets into a 3D volume, enabling neurosurgeons to explore the best available approach to the target, avoiding key anatomy and blood vessels.
Whilst the neurosurgeon remains in complete control of the procedure, neuromate can assist by providing a stable base and accurately aligning the surgical tools in accordance with the neurosurgeon’s pre-planned trajectory. The ergonomic functionality of the neuromate robot combined with pre- and intra-operative imaging technology can improve chances of accurate electrode placement.
The neuroguide electrode delivery system, designed for use in DBS, is a long term implant which facilitates electrode implantation by acting as a conduit, preventing the electrode from bending off target. The neuroguide system includes a radio-opaque stylette which can be used for target verification prior to electrode implantation.
The patient undergoing surgery in Holby City is kept awake during the DBS procedure. Historically, this would have been necessary to allow the neurosurgeon to monitor the patient’s response to treatment. A typical DBS procedure lasts six to eight hours, which can be grueling for both patient and neurosurgeon. The prospect of remaining awake has often acted as a bottle-neck on the number of patients receiving the benefit of this treatment.
However, improvements in surgical imaging and supporting technology, including the products from Renishaw described above, means that DBS is increasingly available as an asleep procedure.
Increasing confidence in the ability of medical technology to support accurate delivery reduces the need for the patient to be conscious for verification, greatly reducing stress and improving the patient experience.