Semiautomated robotic, CT-guided needle placement for postmortem CSF sampling - a Novel application of the Virtobot

Abstract

The sampling of cerebrospinal fluid (CSF) for chemical analysis is usually performed by a freehand lumbar puncture in a routine clinical procedure, while the suboccipital region is used for postmortem examinations. We introduce a new application for a semiautomated robotic, computed tomography (CT)-guided needle placement for postmortem lumbar and suboccipital CSF sampling. Postmortem computed tomography (PMCT) imaging was performed, and the data were sent to a custom-made Virtopsy Control Center and Virtopsy Planning and Navigation Station. Needle trajectories were planned for both suboccipital and lumbar approaches. Coaxial introducer needles were fully inserted automatically by the robotic system. PMCT was repeated to verify correct placement of the needles. Subsequently, CSF samples were taken using a syringe. By using this new application, the puncture of the spinal canal and cerebellomedullary cistern could be accurately performed to within a millimeter. Thus, failure of puncture and iatrogenic injury of the medulla oblongata may be prevented, and the risk of infection is significantly reduced. An early analysis of the CSF sample allows for a risk assessment in regard to the subsequent autopsy. Our application allows for minimally invasive, fast, efficient and safe CSF sampling prior to autopsy, enabling an analysis for metabolic imbalance, infection, etc.