Validation of Accurate Neuroregistration Using Telemanipulation for Robot-Assisted Neurosurgical Procedures

Abstract Telemanipulation in neuroregistration and neurosurgery can enhance the precision in surgical services and sterility of the operation theater. Accurate neuroregistration is crucial for high-precision neurosurgery. The aim is to validate telemanipulation-based neuroregistration and neuronavigation for their registration accuracy (0.34 mm) and effectiveness in robot-assisted neurosurgery. A 6 degree-of-freedom parallel kinematic mechanism (6D-PKM) based surgical robot is operated in telemanipulation mode to conduct neuroregistration and neurosurgical procedure. Phantoms affixed with markers were prepared to study varied cases. These phantoms were precisely registered in a telemanipulation mode as per the patient planning sequence. After the registration process, the coordinates of target points in real patient space were computed. The trajectory of navigation matches the path quite closely from entry to target point in real patient space, corresponding to the medical image space. Common and various cases representing highly unique and unusual postures are considered for registration. The registration is validated by considering surface and deep-rooted target points for surgical procedures. Further cases involving variation in entry hole size, depth, and target size are considered. All the case studies were conducted on transparent glass phantoms to visualize and monitor a telemanipulation-based neuroregistration and intercranial neurosurgical procedure. The phantoms were successfully registered with a maximum mean registration error of 0.34 mm and standard deviation of 0.08 mm. The registration accuracy was validated by the robot's capability to insert a surgical needle (2 mm diameter) into a target holes of 4 mm maximum diameter, ensuring a radial clearance less than 1 mm. The real space target error of 1 mm represents accurate registration. These glass phantoms' case studies demonstrate improved reliability in accuracy, repeatability, and time efficiency. These studies validate the feasibility of high-precision 6D-PKM robot-assisted telemanipulation-based neuroregistration and neuronavigation in neurosurgery.