A Disposable Robot for Intracerebral Hemorrhage Removal 1

Intracerebral hemorrhage (ICH) is a life-threatening condition that happens when a blood vessel in the brain ruptures causing blood to flow into the brain tissue and form a hematoma, compressing the brain. ICH affects around one in every 50 people in their lifetime, and approximately 40% of them will die within the first month after the ICH [1]. Treatment for ICH often involves the use of drugs, with surgical approaches sometimes employed to remove the hematoma. Since decompression is known to improve brain conditions [2], it is logical to assume that surgical decompression would lead to better surgical outcomes. However, surgery does not change mortality rates for typical patients. We hypothesize that this may be due to the damage to healthy tissue required to create an open corridor for conventional surgical tools to reach the hematoma. This process is currently similar to that used in open brain surgery for tumor removal in cancer patients. Based on this hypothesis, we seek to build a device that enables decompression of the brain with minimal damage to brain tissue. There have been some previous attempts to decompress ICH through less invasive approaches (see Ref. [3] for further discussion and references), but none of them has yet demonstrated significant clinical outcomes benefits for typical ICH patients. In this paper, we follow the steerable needle approach introduced by Burgner et al. [3], in which curved concentric tubes are used to aspirate the hematoma through a needle-sized entry path through the brain. The system described in Ref. [3] consists of a large, autoclavable robot that deploys one stiff, straight outer cannula, and a precurved inner Nitinol tube. By translating both tubes and rotating the inner tube (three total degrees-of-freedom), the robot is able to reach the surgical site through a needle-size opening in the brain. Our contribution in this paper is to design and build a new, disposable robot for controlling the inner cannula and Nitinol tube. The new robot is compact and low cost, following the general paradigm of Ref. [4] (though with a different mechanical design) which was originally introduced for thermal ablation of tumors and brachytherapy seed implantation, but has not been applied to ICH aspiration.