Surgery that will relieve the damaging pressure caused by brain hemorrhaging is a perfect job for a robot. At least, this is the hope as a new image guided system is under development at Vanderbilt University.

The new system employs steerable needles, about the size of those used for biopsies, to penetrate the brain with minimal amounts of damage and suction away blood clots that have formed.

As described in an article published in the journal IEEE Transactions on Biomedical Engineering, the system is a product of an ongoing collaboration between a team of engineers and physicians headed by Assistant Professor Robert J. Webster III and Assistant Professor of Neurological Surgery Kyle Weaver.

The odds of a person getting an intracerebral hemorrhage are one in 50 over a person’s lifetime. When it does occur, 40 percent of the individuals die within a month. Many of the survivors suffer serious brain damage.

“When I was in college, my dad had a brain hemorrhage,” said Webster. “Fortunately, he was one of the lucky few who survived and recovered fully. I’m glad I didn’t know how high his odds of death or severe brain damage were at the time, or else I would have been even more scared than I already was.”

Operations to remove intracerebral hemorrhages are not popular among neurosurgeons: The efforts are not likely to make a difference, except when the clots are small and lie on the brain’s surface where they are easy to reach. Surgeons generally agree that there is a clinical benefit from removing 25 to 50 percent of a clot, but that benefit can be offset by the damage that is done to the surrounding tissue when the clot is removed. Therefore, when a serious clot is detected in the brain, doctors take a “watchful waiting” approach, administering drugs that decrease the swelling around the clot in hopes that it will be enough to result in improvement without the need for surgery.

For the last four years, Webster’s team has been developing a steerable needle system for transnasal surgery, an operation to remove tumors in the pituitary gland and at the skull base that traditionally involve cutting large openings in a patient’s skull and face. Studies have shown that using an endoscope to go through the nasal cavity is less traumatic, but the procedure is so difficult that only a handful of surgeons have been able to master it.

The goal of a future project is to add ultrasound imaging combined with a computer model of how brain tissue deforms to ensure that all of the desired clot material can be removed safely and effectively.