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Cranial drill

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Cranial drill
High-speed pneumatic surgical drill with cranial drill bit
Occupation
Activity sectors
Surgery, Craniotomy, Craniectomy
Description
Fields of
employment
Hospitals, Clinics, Emergency Medicine

A cranial drill, also known as a craniotome, is a tool for drilling simple burr holes (trepanation) or for creating larger openings in the skull. This exposes the brain and allows operations like craniotomy and craniectomy to be done. The drill itself can be manually or electrically driven, and primarily consists of a hand piece and a drill bit which is a sharp tool that has the form similar to Archimedes screw, this instrument must be inserted into the drill chuck to perform holes and remove materials. The trepanation tool is generally equipped with a clutch which automatically disengages once it touches a softer tissue, thus preventing tears in the dura. For larger openings, the craniotome is a surgical instrument that has replaced manually pulled saw wires in craniotomies from the 1980s.

History

Cranial drill

See also: History of surgery

The oldest evidence of a hole being applied on a human’s brain with a drill dates from c. 4,000 B.C.[1] The oldest cranial drilling instrument was found in France, and subsequent use evidenced by the Ancient Romans, Egyptians, and in Trepanation in Mesoamerica. The practice of trepanning is also evidenced from Ancient Greece, North and South America, Africa, Polynesia and the Far East. The conceivable reasons why ancient humans developed the technique of drilling the head could be religious, ritual or medical factors.[2]. The first trepanning procedure consisted of different types or tools and techniques: at the beginning the only material that was available for use was a sharp and carved rock. The development of The Hippocratic Corpus, written in the fifth century B.C., is the first written source that can be found about trepanning. The aim of the procedure described in "on Wounds in the head" was to allow the stagnant blood to escape from the head through a hole. The drill that was used at the time is similar to the modern ones, but was operated by hand rotation.[3]

In the 15th century, people began to believe that drilling was a cure for mental problems due to a magical stone of madness or stone of folly in the head, which had to be removed. Paintings that portray this practice exist, the most significate ones include The Extraction of the Stone of Madness c. 1488-1516 by Hieronymus Bosch and A Surgeon Extracting the Stone of Folly by Pieter Huys. [4]

The exstraction of the stone of Madness, Hieronymus Bosch - Trepanation

From the Renaissance ages, cranial drilling continued to evolve and surgical practice was used less due to the high mortality rate. It was used only for some interventions, such as the treatment of hemorrhages, depressed fractures and penetrating the head. Also the name for the surgery changed from trepanning to craniotomy

In the late 1860s, E.G. Squier a well-educated man who was an expert in archaeology discovered a skull in an ancient Inca cemetery. This specific skull was anticipated to be of pre-Columbian era. The skull exhibited a large rectangle-shaped hole on the top. The skull was brought it back to the United States, and his findings presented to the New York Academy of Medicine. Squier argued that the brain was injected with a tool called a burin which was used on woods and metals before. Traces showed human hand prints. He concluded that the skull and brain evidenced recovery from prehistoric brain surgery, potentially prolonging the patients life.[5]

Metallurgy was a technique that allowed the use of saws and scalpels. Other cultures came about experimenting through the usage of glass.[4]

Dr Bart Hughes has declared that evolution caused a decrease in partial brain functions, mainly in the human consciousness. Whereas others increased, like speech and reasoning. The changes in performance are due to the enhancement of the extensiveness of blood. Which is located in the capillaries of the human brain.[6] These performances in the human brain are related to a higher level of vision. That a child still copes with because their membranes around the brain let them get in touch with dreams, imagination and intense perception. [6] To reach ones goal, to increase his level of vision one must decideto remove a part of there skull by cutting a small disc of its bone. Hughes, conducted his first operation in 1962 on himself using an electric drill,surgical knife and a hypodermic needle. [7] Amongst other surgeries on fellow collogues he operated. The medical and legal authorities declared that his discovery was awful and Hughes was sent to Dutch lunatic asylum. [6]

Craniontonomy set, 18th century; Germanic National Museum in Nuremberg

Improvements in technology are replacing the basic hand cranial drill by an robotic drill. The robotic drill is a high pace drill that will allow surgeons to experience performance over 50 times faster. The robotic drill is still not used in the point of time.[8]

Craniotome

The first invention of a craniotome was designed and created by John H. Bent, a mechanical engineer and owner of Standard Pneumatic Motor Company, under contract with Hall Air Instruments of Santa Barbara, California.[9] When Hall was subsequently acquired by 3M Company (which was then actively developing and marketing surgical instruments), the 3M Craniotome became widely used in neurosurgery, replacing the Gigli saw (manually pulled saw wires) as the primary means of opening the skull for access to the brain for surgical procedures. Bent designed the original Craniotome around a small, lightweight, very high speed (approximately 70,000 rpm) pneumatic turbine motor he had invented for use in industrial wire-wrapping tools and other air-powered hand-held devices. [9] While with 3M Company, Bent went on to design and create a number of additional air-powered surgical instruments, including the 3M Mini-Driver and 3M Maxi-Driver, for orthopedic procedures on small bones and large bones, respectively, using adaptations of his original high-speed pneumatic turbine motor. One of the first craniotomes ever used in surgery was applied on John Bent himself, who required life-saving neurosurgery for a brain abscess that was discovered around the time the tool was being put into production.

Application

A cranial drill is currently used for Neurosurgery operations. The procedure of trepanning is applied to patients who suffer for example a traumatic brain injury or a stroke. In these cases, it might be necessary to drill a hole in the skull to be able to access the dura mater or the brain itself, and to relieve brain pressure or blood clots.[10] With the use of modern types of cranial drills, surgeons are able to create holes in the bone structure without traumatizing underlying brain tissue.[11] The drill's working tool tip consists of a spiral blade that is framed by a guard device with an angled cranium guide that rests against the inner layer of the skull bone. The dura guard pushes the dura mater downward while the craniotome is moved forward thus preventing dural tearing.[12]

Types and design

A cranial drill is an essential instrument used by surgeons to drill in to the skull bone.[13] Various types of drills are used by surgeons from the craniotomy, or oral surgeries. The cranial drill can be differentiated by the examinations of what kind of surgery have to be performed. They can be manually operated, operated by electricity, or by pneumatic motors. Innovations include perforators that are used in thin skull areas, in areas of uneven bone, pediatric perforators, and a wide range of perforator sizes for every surgical application.

Manual cranial drill

Vilebrequin - Musée des Hospices civils de Lyon, Manual drill

The rotating crank is typically connected to several cogs that sets pressure on the skull. This specific drill is not connected to any external power, and is used very little in today's operations.[14] The manual cranial drill is the most used and predominant type of drill in surgery, and performs manually. Which, has a adjusted stopper based on the setting and where the bone is the most thickest to prevent plunging. Surgeons use this drill manually without any other procedures. Surgeons, that use a hand-cranked drill often are required to imply a lot of upper body strength. The core procedure of the operation is at times underestimated. Due to the fact that a lot of body strength and leaning their weight into the drill for it to function better is needed. Which, then the increase of pressure to the patient’s head, and allowing careful retraction to the skull. [15] [16]

Electric cranial drill

The electric cranial drill is powered either by a battery or by electricity via wall sockets. The electric cranial drill it is not able to reach rotation speed levels of a pneumatic drill, which implies that it is less expensive than other types of drills. [16]

Pneumatic cranial drill

The pneumatically driven drill is usually used for delicate surgeries such as oral and maxillofacial surgery. The pneumatic motor is known for its great speed, which makes surgery much easier and faster. It is driven by expanding compressed air. The use of this kind of mechanism has many advantages such as the ease of use through high peak velocities. Thanks to superior torque, this system has great performance and it is essential for complex revision operations. The surgical procedure is shorter than usual, so patients spend less time under anesthesia .[16] Pneumatic high-speed craniotomes usually run at 40,000 to 80,000 rpm and have greatly facilitated intracranial approaches in neurosurgery. They are also employed to temporarily remove the vertebral arch in laminotomy. [16]

Scientific progress

Technological progress to reduce surgery time and minimize risks for patients during surgery have been introduced in the field of cranial drills, primarily from machining.

CAD/CAM

CAD/CAM stands for computer-aided design/computer-aided manufacturing. The beginnings of computer-aided design can be dated back to the year 1957, where the first CNC programming system was invented [17]. Its uses are diverse and therefore used in many different fields; recentely in the medical field as well. It is used by surgeons to simplify and ease surgeries: in the case of trepanning, a processor collects information from 2D images, and then turns them into 3D images. The processor codifies this information so that the drill can, without any trouble, pierce the correct portion of the skull. [18]

Robotic cranial drill

In 2017, the University of Utah has discovered that use of a robotic drill can reduce time during the craniotomy, replacing human surgeons in at least one critical part of the operation. In the majority of cranial surgeries, surgeons use manual hand drills to carefully open up the skull. This procedure isn't much different from using a hand drill in a regular workshop setting. The surgeon bores through the skull using a milling drill bit to avoid sensitive nerves and blood vessels damages. Opening the skull can take hours based on the complexity of the procedure. The more time a procedure takes, the greater the risk of infection, and complications can occur through anesthesia or surgeon fatigue. The new automated cranial drill system can reduce especially the time factor. From a conventional intervention, that can take up to several hours, they achieved the result in only a few minutes, according to the Utah research team. Testing results confirmed that a regular hands on drill can take up to two-hours. Whereas, the robotic "surgeon" will replace its time frame to a quick two-and-half minutes procedure. The robotic cranial drill is a device that enables non-neurosurgical personal to safely apply the drill through the skull without the risk of any brain damage, guided by CAD/CAM. The experts carried out the robotic drill from the ground up providing support to the neurosurgical unit.[8] Before surgery, the patient is analyzed by specialists who monitor the exact locations of nerves, major veins and arteries. The analysis also gives surgeons relevant information on the composition and intensity of the bone. The technology lets the surgeon choose the best path from point A to point B. The surgeon can also avoid obstacles by programming safety barriers along the cutting path within 1 millimeter of sensitive structures. If the drill gets too close, an automatic shut-off switch stops the drill. The product's sale is planned to be in 2019. The system has been tested on a wide range of materials which vary from wax, composites, engineered cancellous and cortical bone, prototyped skulls, and human cadavers .[19]

Safety

The robotic drill can contribute to fast, clean and safe cuts. This leads to a significant decrease in time when the wound is opened, and shortens the anesthetic period of the patient. This reduces the risk for infection, human error and surgical cost. The software of a robotic drill was developed to make the drill itself safer and quicker to get to the cutting point of the skull. To do the surgery safer a CT scan is made to collect bone data and identify precise location of sensitive structures like nerves, major veins, and arteries to avoid during the surgery. The robot drill can also have a software program to include safety barriers during the cutting path, which is a threshold of 1mm from the sensitive structure point. The robot drill turns off automatically when an irritation near the nerves is discovered.[8] This drill is also designed to be as safe and efficient as possible. [20] A bi-stable mechanism supports the drill when force is applied. [21]

Appearances in media

The usage of cranial drills has been featured in a variety of films, TV series and novels throughout history.

In movies

  • Saw 3 : A craniotomy has been performed on John in order to relieve the pressure on his brain. The drill used in one of the scenes is not the one applied in surgeries.
  • Autopsy : The surgeons attempts to cut into a girl's skull with a manual drill, while classical music is played in the back by a turntable.
  • Frankenhooker : In one of the scenes, one of the characters drills a hole in his skull by himself with a conventional drill( not with a normal cranial drill).
  • Pi : In the final scene, Max performs a trepanation on him self, towards the end of the act blood splatters all over the mirror.
  • Prison Break : During the fourth episode of the TV series Michael, one of the main characters, becomes ill. In order to cure his illness a operation to the skull is much need. The surgical operation is being operated with help of advanced, high end technologies. The intervention is shown during the 15th episode Going Under (Prison Break). [22]
  • Grey's Anatomy: During the episode Almost Grown (Grey's Anatomy) Meredith performs a craniotomy without any assistance from others around her on a patient. That same patient was previously cured by Lexie.
  • House M.D.: In one of the scenes to be specific, season 3, episode 14 a hole is drilled into the skull of one of the patients to examine her genetic defect. Which she didn't feel any pain while the producer.[23]

In books

  • Uncertainties, Mysteries, Doubts: Romanticism and the analytic attitude: In this specific novel it states the importance of a cranial drill. In one specific an unexpected graphic animation and good nature came up which he becomes tense, full of miserable thoughts. Through his reasoning he looses hope and thinks " of all the devils of migraine" drilling and smashing into his brain or skull with a cranial. Right after the graphic and intense event occurred his head drops on his chests.[24]
  • Manual drill during the 18th century
    Manual drill during the 18th century
  • Edinburgh Skull, trepanning showing hole in back of skull
    Edinburgh Skull, trepanning showing hole in back of skull
  • A human skull showing signs of Trepanning
    A human skull showing signs of Trepanning
  • Engraving by Peter Treveris of a trepanation. From Heironymus von Braunschweig's Handywarke of surgeri
    Engraving by Peter Treveris of a trepanation. From Heironymus von Braunschweig's Handywarke of surgeri
  • Cranial trephine with two bits, Europe, 1601-1800
    Cranial trephine with two bits, Europe, 1601-1800
  • Decompressive Craniectomy
    Decompressive Craniectomy

See also

References

  1. ^ Cohut, Maria. "Skull-drilling: The ancient roots of modern neurosurgery". Medical News Today. Retrieved 28 September 2018.
  2. ^ Wylie, Robin. "Why our ancestors drilled holes in each other's skulls". BBC. Retrieved 10 November 2018.
  3. ^ Gross, Charles G. "Trepanation from the Paleolothic to the internet" (PDF). Retrieved 10 November 2018.
  4. ^ a b Ferreira, Becky. "Madness Stones to New Age Medicine: A History of Drilling Holes in Our Heads". Motherboard. Retrieved 10 November 2018.
  5. ^ Fawcett, Kristin. "Trepanation: The History of One of the World's Oldest Surgeries". MentalFloss. Retrieved 26 November 2018.
  6. ^ a b c Michell, John. "The People With Holes In Their Heads". MIT. Retrieved 22 November 2018.
  7. ^ "An illustrated history of trepanation". Science Blog. Retrieved 22 November 2018.
  8. ^ a b c Villaluz, Kathleen (2017-05-08). "This Robotic Drill Can Perform Complex Cranial Surgeries 50 Times Faster". INTERESTING ENGINEERING. Retrieved 1 November 2018.
  9. ^ a b Bent, John H. "Patent US4199160A". Google Patents. Retrieved 25 November 2018.
  10. ^ "Trepanation". Encyclopedia.com. Retrieved 10 November 2018.
  11. ^ Liss, Sam T. "Safe cranial drilling device". Harvard Office of Technology Development. Retrieved 10 November 2018.
  12. ^ Rogers, Laurel; Lancaster, Ron. "Patent US6506199B2". Google Patents. Retrieved 25 November 2018.
  13. ^ Whitlock, Jennifer. "Burr Hole Surgery Information". Verywellhealth. Retrieved 1 December 2018.
  14. ^ Treccani. "Trapano". Treccani enciclopedie on line. Retrieved 9 October 2018.
  15. ^ Thomas, Ajith J. "Assured Safety Drill With Bi-Stable Bit Retraction Mechanism". ResearchGate. Retrieved 19 November 2018.
  16. ^ a b c d SRM University. "Surgical driller" (PDF). Retrieved 10 November 2018.
  17. ^ "Computer-aided design/History, Present and Future". Wikiveristy. Retrieved 19 November 2018.
  18. ^ Couldwell, William T.; MacDonald, Joel D.; Thomas, Charles L.; Hansen, Bradley C.; Lapalikar, Aniruddha; Thakkar, Bharat; Balaji, Alagar K. "Computer-aided design/computer-aided manufacturing skull base drill". JNS - Journal of Neurosurgery. Retrieved 19 November 2018.
  19. ^ McDonald, Glenn. "The Future of Brain Surgery Might Be This Automated Drill". Seeker. Retrieved 19 November 2018.
  20. ^ "evo_drill" (PDF). evonos. evonos. Retrieved 12 November 2018.
  21. ^ Liss, Sam T. "Safe cranial drilling device". HARVARD Office of Technology Development. Retrieved 12 November 2018.
  22. ^ "Going Under (episode)". FANDOM. Retrieved 30 November 2018.
  23. ^ Insensitive. House, Season 3, Episode 14. Air date 13 February 2007
  24. ^ Snell, Robert. Uncertainties, Mysteries, Doubts: Romanticism and the analytic attitude. Routledge,2012. p. 153. ISBN 1136205195.
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