Clinical Trial: Evaluating the Pre-Positioning Frame for Robotic Acoustic Neuroma Removal Surgery
Study Status: Not yet recruiting
Recruit Status: Not yet recruiting
Study Type: Interventional
Official Title: Evaluating the Pre-Positioning Frame for Robotic Acoustic Neuroma Removal Surgery
Brief Summary: Otologic surgery often involves a mastoidectomy to safely access the inner ear. In this procedure, a portion of the mastoid part of the temporal bone is removed. The surgery is lengthy and challenging because many critical structures are embedded in the mastoid and are difficult to identify and accurately remove with a surgical drill. In previous work, the investigators developed a compact, bone-attached robot to automate mastoidectomy drilling for translabyrinthine acoustic neuroma removal (TANR). The robot does not attach directly to the bone. Instead, a rigid surgical fixture which the investigators call a prepositioning frame (PPF) is attached to the temporal bone, and the robot attaches to the PPF. Attaching the robot to the participant eliminates the need for an expensive image guidance system to compensate for participant motion, but requires a compact robot with a limited range of motion. The PPF supports the robot on the head such that a planned mastoidectomy volume is within the robot's range of motion. In this study, the investigators plan to test the PPF by attaching it to ten participants. By processing an intraoperative CT scan of the attached PPF, the investigators will measure the percentage of each planned mastoidectomy that would be reachable if the robot were attached. The investigators will also measure the time required to attach the PPF. The data the investigators acquire will enable further improvements to the PPF design, which would be advantageous before proceeding to robotic drilling experiments.
Detailed Summary:
Mastoidectomy is a common otologic surgical procedure in which all or part of the mastoid portion of the temporal bone is removed with a surgical drill. The procedure is performed to treat diseases and infections such as mastoiditis and cholesteatoma, and is also performed as one step of other surgeries, such as the facial recess approach for cochlear implantation (CI) or the translabyrinthine approach for acoustic neuroma removal (TANR). The investigators are working on a new medical device to assist specifically with the TANR procedure. The focus of this study is one component of this device, the pre-positioning frame (PPF).
TANR surgery is performed to remove benign tumors on the auditory nerve which can cause severe hearing and balance problems if not removed. The current standard of care is a mastoidectomy, followed by a labyrinthectomy (excision of the labyrinth of the inner ear) to gain access to the skull base, specifically the internal auditory canal (IAC), where tumors are located.
Several critical anatomical structures are embedded in the mastoid bone, including the facial nerve, which controls motion of the face, large blood vessels such as the carotid artery and intracranial continuation of the jugular vein, and the tegmen, which is the boundary between the mastoid and the brain. Surgeons are specially trained to recognize and avoid these structures when drilling. Drilling for TANR surgery often takes several hours due to slow advancement of the drill through hard bone in the labyrinth region. After this drilling is when the most delicate and critical portion of the surgery begins i.e. removal of the acoustic neuroma. The investigators hypothesize that a robot, guided by pre-operative images, can perform the drilling for TANR surgery while preserving safe margins around the critical structures thus enabling su
Sponsor: Vanderbilt University Medical Center
Current Primary Outcome:
- Time in minutes required to attach the PPF. [ Time Frame: From PPF anchored to temporal bone until bone screws are loosened and PPF removed, estimated 15-30 minutes. ]
- Percentage of planned mastoidectomy reachable by robot [ Time Frame: During the use of the PPF, estimated 15-30 minutes. ]
Original Primary Outcome: Same as current
Current Secondary Outcome:
Original Secondary Outcome:
Information By: Vanderbilt University Medical Center
Dates:
Date Received: February 15, 2017
Date Started: September 2017
Date Completion: July 2019
Last Updated: March 9, 2017
Last Verified: March 2017
