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Pilot study of a new type of machine vision-assisted stereotactic neurosurgery for EVD placement



The usage of machine vision technologies for image-based analysis and inspection is increasing. With the advent of the ability to process high-dimension data instantly, the possibilities of machine vision multiply exponentially. Robots now use this technology to assist in surgery.


The aim of this study is to explore the efficacy of Surgical Navigation Robot NaoTrac (Brain Navi Biotechnology Co., Ltd.), which utilizes machine vision-inspired technology for patient registration and stereotactic external ventricular drainage (EVD) by the robotic arm.


Preoperative and postoperative computed tomography (CT) scans were acquired for each case. The surgeons planned the targets and trajectories with the preoperative CT images. The postoperative CT images were utilized in the accuracy measurements.


All 14 cases had cerebrospinal fluid drained through the catheter. The NaoTrac placed the catheter into the frontal horn in one attempt in 13 cases and was able to drain CSF in 12 cases. Not a single case had any bleeding or intraoperative complications. The average time spent on the patient registration was 142.8 s. The mean target deviation was 1.68 mm, and the mean angular deviation was 1.99°, all within the accepted tolerance for minimal tissue damage.


The results of this report demonstrate that machine vision-inspired patient registration is feasible and fast. NaoTrac has demonstrated its accuracy and safety in performing frameless catheter placement in 13 clinical cases. Other stereotactic neurosurgical operations such as stereotactic biopsy, depth electrode placement, deep brain stimulation electrode positioning, and neuroendoscopy may also be benefited from the assistance of NaoTrac.

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This project did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Correspondence to Chih-Yang Huang or Chieh-Hsiao Chen.

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The studies involving human participants were reviewed and approved by the Ethics Committee of Hualien Tzu Chi Hospital (IRB107-97-A) and registered with Taiwan Food and Drug Administration (TFDA- 1,096,604,197).

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For this type of study, formal consent is not required by our institution.

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The authors declare no conflict of interest.

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This article is part of the Topical Collection on Neurosurgical technique evaluation

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Chiu, TL., Lin, SZ., Ahmed, T. et al. Pilot study of a new type of machine vision-assisted stereotactic neurosurgery for EVD placement. Acta Neurochir 164, 2385–2393 (2022).

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  • Surgical navigation robot
  • Machine vision
  • Catheter
  • External ventricular drainage
  • Stereotactic neurosurgery
  • Accuracy
  • Safety