Robot-assisted brain surgery: Innovating to improve patient care

June 13, 2020

Alfredo Quinones-Hinojosa, M.D., chair of Neurosurgery at Mayo Clinic in Jacksonville, Florida, discusses Mayo's efforts to develop robotic technology for performing brain surgery. Mayo Clinic is committed to cutting-edge research and development that improve patient care through innovative technology in the Biotechnology and Research Innovation Neuroscience (B.R.A.I.N.) Laboratory.

What role does Mayo Clinic envision robotics playing in the future of brain surgery?

Robotics is a Mayo Clinic priority. Just as robotic technology is used to perform abdominal surgery, in the near future it will most likely be used to perform minimally invasive brain surgery. Mayo Clinic is developing the relationships and the technologies to enable us to perform robot-assisted surgery in the brain.

Robots will allow us to venture deep into the brain through very small incisions, park a robot at the skull base and remove a tumor. Instead of using an extensive, skull base approach in which large incisions are used with large portions of bone removal to minimize brain retraction, we will be able to bring our equipment to the relevant space through tiny holes in the skull.

For example, when treating a medial sphenoid wing meningioma, it is possible that future robotic technology will allow us to make only a small incision right above the eye and a small keyhole in the bone near the ear. We could then approach the tumor through tiny ports placed in those incisions, and be able to disconnect the tumor from nerves and blood vessels.

What are the challenges involved in using robot-assisted surgery in the brain?

The biggest challenge right now is the fact that our equipment is difficult to maneuver through small spaces. We need to be able to precisely locate arteries and nerves in the brain, but current navigation systems aren't 100% equipped to do this. As a result, the accuracy of intraoperative visualization and manipulation of tissue is suboptimal.

What efforts are underway at Mayo Clinic to develop the technology that will enable robot-assisted brain surgery?

To develop the tools for robot-assisted brain surgery, we first need highly realistic models of the human brain — just as animal models of disease are needed to study treatments in patients. Deceased donors are often used to study human anatomy. But in this case, technological development must utilize a model of the brain that begins to bleed when you touch it, has cerebrospinal fluid and allows the conduction of current so that we can stimulate the brain model.

Mayo Clinic has created the special B.R.A.I.N. Laboratory that is working to create dynamic 3D-printed models of the human brain. These models not only will have an accurate feel and consistency but also will "bleed," reproduce injury and conduct energy on a scale that duplicates nerves in the brain. These dynamic factors allow us to tell if we are risking injury to the brain, and possibly could predict patient recovery after minimally invasive treatment techniques.

We expect to develop this model within the next three years. That is very ambitious. But our B.R.A.I.N. team — led by myself, Aaron C. Damon, assistant professor of medical education, and William (Bill) E. Clifton III, M.D., Neurosurgery — thinks it's doable.

Why is Mayo Clinic committed to pursuing robotics in neurosurgery?

At Mayo Clinic, we encourage innovation that meets the needs of patients. When we identify a problem and a need, we support the innovation and research that will bring about a solution. We are very systematic in this approach because it has been part of our Mayo culture from the beginning.