Robot used to treat brain aneurysm for the first time

For the first time, surgeons have successfully used a robot to treat brain aneurysm, a study presented at ISC 2020 has shown. This would eventually allow for remote robotic surgery in patients with limited or no access to endovascular treatments currently.

“This is very exciting – to have robotic endovascular treatments available,” commented Dr Mitchell S.V. Elkind,  president-elect of the American Heart Association and professor of neurology and epidemiology at Columbia University in New York City, New York, US, but is not part of the study.  “It’s early yet, we don’t know exactly where this is gonna go. Robotic therapy and minimally invasive procedures have been around, of course, in general surgery and cardiothoracic surgery, but [these are] not applied yet as much to endovascular treatments, treatments for stroke, and vascular malformations ... So, this is very exciting to have a tool available to treat these patients remotely.”

Researchers in Toronto, Canada presented a case of a 64-year-old female patient who presented to their institution with an unruptured basilar aneurysm the size of 10mm. Endovascular intervention using the CorPath GRX robotic system was performed on the patient. A guide catheter was placed in the right vertebral artery, and an intermediate catheter advanced to the V4 segment.  A microcatheter was then connected to the robotic drive by a robotic technologist, with the presence of two neurointerventionalists, one of whom operated the robot from the control terminal. The same microcatheter was used to enter the aneurysm sac. Stent-assisted coiling of the aneurysm was done using the robot. [ISC 2020, abstract LB23]

“Our experience is the first step towards achieving our vision of remote neurovascular procedures,” said lead author Dr Vitor Mendes Pereira, a neurosurgeon and neuroradiologist at the Toronto Western Hospital and professor of medical imaging and surgery at the University of Toronto, both in Toronto, Canada.  “The ability to robotically perform intracranial aneurysm treatment is a major step forward in neuro-endovascular intervention.”

Since the first case, his team has successfully performed five additional aneurysm treatments using the robot, which included deploying flow-diverting stents.

“The expectation is that future robotic systems will be able to be controlled remotely. One day, I could be at my hospital and deliver therapy to a patient hundreds or even thousands of kilometres away,” said Mendes Pereira. “The ability to deliver rapid care through remote robotics for time-critical procedures such as stroke could have a huge impact on improving patient outcomes and allow us to deliver cutting-edge care to patients everywhere, regardless of geography.”

Elkind couldn’t be more excited. “It’s really like science fiction stuff. It sounds really exciting and it has great potential. One wonders whether there really will be an opportunity to have the tools themselves at the smaller centres where this might be performed … we’ll have to see how this develops.”

More work will have to be done, he said. But this is a first step in a very exciting direction.