James M. Drake's research while affiliated with University of Toronto and other places
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Publications (498)
Objective: To present the design choices, modelling of bending stiffness and experimental validation of a novel notched Nitinol compliant wrist that enables tip articulation and suction during endoscopic and robotic middle ear surgery. Methods: The wrist consists of an inner wrist tube (IWT) assembled within an outer wrist tube (OWT). The OWT was s...
Objectives:
Minimally invasive MR-guided laser interstitial thermal therapy (MRgLITT) has been proposed as an alternative to open epilepsy surgery, to address concerns regarding the risk of open surgery. Our primary hypothesis was seizure freedom one-year after MRgLITT was noninferior to open surgery in children with drug-resistant epilepsy (DRE)....
Purpose:
Congenital cervicothoracic dissociation (CCTD) of the spine is a rare condition while having major impacts on stability and neurological function. Surgical treatment includes decompression and instrumented fusion. Only few cases of CCTD have been reported in children. This report intends to demonstrate the complexity of this condition and...
OBJECTIVE
Intraventricular hemorrhage (IVH) is a neurovascular complication due to premature birth that results in blood clots forming within the ventricles. Magnetic resonance–guided high-intensity focused ultrasound (MRgHIFU) has been investigated as a noninvasive treatment to lyse clots. The authors designed and constructed a robotic MRgHIFU pla...
Introduction
Children with craniopharyngiomas (CP) can experience significant morbidities caused by extensive surgery and/or radiation. Ommaya reservoir insertion (ORI) into cystic CP represents a minimally invasive approach allowing immediate decompression and aims to avoid additional injuries. The purpose of this study was to determine the surgic...
Introduction
Pediatric hemispherectomy is a technically demanding procedure with significant risk. There are relatively few opportunities for surgeon trainees to gain confidence in this nuanced surgery solely through traditional apprenticeship prior to independent practice. Surgeon confidence has been linked to better intraoperative performance and...
Purpose
Patients with pharmacoresistant refractory epilepsy may require epilepsy surgery to prevent future seizure occurrences. Conventional surgery consists of a large craniotomy with straight rigid tools with associated outcomes of morbidity, large tissue resections, and long post-operative recovery times. Concentric tube robots have recently bee...
In recent decades, improvements in neurosurgical care have been driven by technological advances such as frameless stereotaxy and endoscopy. Endoscopy enables navigation through the clear fluid-filled ventricular system of the brain instead of through healthy brain tissue enabling minimally invasive treatment of tumors, cysts, hydrocephalus and epi...
INTRODUCTION: Children with craniopharyngiomas (CP) can be subjected to significant morbidities caused by radical surgery and/or radiation with deleterious long-term consequences. Ommaya reservoir insertion (ORI) into cystic CP represents a minimally invasive procedure allowing immediate decompression and aims to avoid additional injuries. The purp...
BACKGROUND: Response-based radiation therapy has been the approach for germinoma after chemotherapy. However, the presence of residual lesions at the end of chemotherapy did not demonstrate a negative impact on progression-free survival (PFS). Similarly, resection of residual tumors after chemotherapy did not show a survival benefit. AIM: Our study...
OBJECTIVE
Early adaptors of surgical simulation have documented a translation to improved intraoperative surgical performance. Similar progress would boost neurosurgical education, especially in highly nuanced epilepsy surgeries. This study introduces a hands-on cerebral hemispheric surgery simulator and evaluates its usefulness in teaching epileps...
Introduction: Children with craniopharyngiomas (CP) can experience significant morbidities caused by extensive surgery and/or radiation. Ommaya reservoir insertion (ORI) into cystic CP represents a minimally invasive approach allowing immediate decompression and aims to avoid additional injuries. The purpose of this study was to determine the surgi...
Percutaneous needle-based interventions such as transperineal prostate brachytherapy require the accurate placement of multiple needles to treat cancerous lesions within the target organ. To guide needle placement, magnetic resonance imaging (MRI) offers excellent visualization of the target lesion without the need for ionizing radiation. To date,...
Background:
Low- and middle-income countries sustain the majority of pediatric cancer burden, with significantly poorer survival rates compared to high-income countries. Collaboration between institutions in low- and middle-income countries and high-income countries is one of the ways to improve cancer outcomes.
Methods:
Patient characteristics...
Purpose
Magnetic resonance (MR) imaging detection of methemoglobin, a molecular marker of intraplaque hemorrhage (IPH), in atherosclerotic plaque is a promising method of assessing stroke risk. However, the multicenter imaging studies required to further validate this technique necessitate the development of IPH phantoms to standardize images acqui...
Objective:
Two previous Hydrocephalus Clinical Research Network (HCRN) studies have demonstrated that compliance with a standardized CSF shunt infection protocol reduces shunt infections. In this third iteration, a simplified protocol consisting of 5 steps was implemented. This analysis provides an updated evaluation of protocol compliance and eva...
Background:
Hands-on neurosurgical simulations, specifically techniques involving white matter disconnection, are underdeveloped owing to the paucity of low indentation materials that can adequately mimic brain dissection.
Objective:
To describe the discovery phase of developing a resective epilepsy surgery simulator by quantifying the physical...
Background:
Intraventricular Hemorrhage (IVH) is one of the most serious neurovascular complications resulting from premature birth. It can result in clotting of blood within the ventricles, which causes a buildup of cerebrospinal fluid that can lead to posthemorrhagic ventricular dilation and posthemorrhagic hydrocephalus. Currently, there are no...
Objective
To investigate differences and calculate pooled incidence of any intraventricular haemorrhage (IVH), severe IVH (Grade III/IV, sIVH) and ventriculoperitoneal shunt (VPS) placement in preterm infants across geographical, health and economic regions stratified by gestational age (GA).
Design
MEDLINE, Embase, CINAHL and Web of Science were...
OBJECTIVE
The objective of this study was to describe the management of hydrocephalus in a cohort of pediatric patients with germinoma.
METHODS
The authors conducted a retrospective chart review of patients with germinoma and symptomatic hydrocephalus treated at the Hospital for Sick Children between 2002 and 2020. Descriptive data included tumor...
Objective: In pediatric hydrocephalus, shunts tend to result in smaller postoperative ventricles compared with those following an endoscopic third ventriculostomy (ETV). The impact of the final treated ventricle size on neuropsychological and quality-of-life outcomes is currently undetermined. Therefore, the authors sought to ascertain whether trea...
Brain dissection, an intricate neurosurgical skill, is central to life-saving procedures such as intrinsic brain tumor excision and resective epilepsy surgery. The aims of this manuscript are to outline the selection process of a suitable material for the development of a dissectible brain simulator and to present the use of support material, SUP 7...
OBJECTIVE
The primary objective of this trial was to determine if shunt entry site affects the risk of shunt failure.
METHODS
The authors performed a parallel-design randomized controlled trial with an equal allocation of patients who received shunt placement via the anterior entry site and patients who received shunt placement via the posterior e...
OBJECTIVE
While intraventricular hemorrhage (IVH) is associated with posthemorrhagic ventricular dilation (PHVD), not all infants affected by high-grade IVH develop PHVD. The authors aimed to determine clot-associated predictors of PHVD in a porcine model by varying the amount and rate of direct intraventricular injection of whole autologous blood....
Background
Embryonal tumours with multi-layered rosettes (ETMRs) are a newly recognised, rare paediatric brain tumour with alterations of the C19MC microRNA locus. Due to varied diagnostic practices and scarce clinical data, disease features and determinants of outcomes for these tumours are poorly defined. We did an integrated clinicopathological...
Concentric tube robots are catheter-sized continuum robots that show dexterous movement for minimally invasive surgical procedures. However, one of the major challenges to the practical usage of concentric tube robots is their instability, which potentially leads to the risk of tissue rupture. The snapping problem is caused by tubes having a high b...
Cleft palate surgery is technically challenging to perform. There is delicate tissue handling required within the confines of the infant oral cavity workspace. A surgical robot provides improved visualization, access, and precision. Therefore, cleft palate surgery is a suitable environment for robotic application. A highly realistic cleft palate si...
Hypothesis:
This study compares the reaching ability of two classes of transcanal endoscopic ear surgery (TEES) instruments when operating on difficult to access anatomical targets; two novel instruments with steerable flexible tips (SFT-A and SFT-B) and suction capability are compared with standard commercially available tools.
Background:
TEES...
Objectives: Magnetic resonance-guided focused ultrasound (MRgFUS) is a non-invasive targeted tissue ablation technique that can be applied to the nervous system. Diffusion weighted imaging (DWI) can visualize and evaluate nervous system microstructure. Tractography algorithms can reconstruct fiber bundles which can be used for treatment navigation...
Objective
Drug-resistant epilepsy (DRE) during the first few months of life is challenging and necessitates aggressive treatment, including surgery. Because the most common causes of DRE in infancy are related to extensive developmental anomalies, surgery often entails extensive tissue resections or disconnection. The literature on “ultra-early” ep...
BACKGROUND
Trigeminal schwannoma (TS) is an uncommon and histologically benign intracranial lesion that can involve any segment of the fifth cranial nerve. Given its often impressive size at diagnosis and frequent involvement of critical neurovascular structures of the skull base, it represents a challenging entity to treat. Pediatric TS is particu...
Objective:
Chiari malformation type I (CM-I) involves the herniation of the cerebellar tonsils through the foramen magnum. CM-I is associated with both obstructive sleep apnea (OSA) and central sleep apnea (CSA) in children. The primary management of symptomatic CM-I remains surgical decompression. There is, however, a paucity of data evaluating t...
Objective:
Hydrocephalus may be seen in patients with multisuture craniosynostosis and, less commonly, single-suture craniosynostosis. The optimal treatment for hydrocephalus in this population is unknown. In this study, the authors aimed to evaluate the success rate of ventriculoperitoneal shunt (VPS) treatment and endoscopic third ventriculostom...
Cleft lip and palate surgery is technically challenging to perform with a steep learning curve. Surgical simulators provide a platform to practice surgical procedures to gain experience and competence before operating on patients. Cleft simulators have been developed for this purpose and now have the fidelity necessary to allow practicing cleft pal...
Objectives
The objectives of this manuscript were to review the literature concerning 3D printing of brain and cranial vault pathology and use these data to define the gaps in global utilization of 3D printing technology for neurosurgical education.
Methods
Using specified criteria, literature searching was conducted to identify publications descr...
Objective
Efforts directed at mitigating neurological disability in preterm infants with intraventricular hemorrhage (IVH) and post hemorrhagic hydrocephalus (PHH) are limited by a dearth of quantifiable metrics capable of predicting long-term outcome. The objective of this study was to examine the relationships between candidate cerebrospinal flui...
OBJECTIVE
There is no consensus on the optimal clinical management of ventriculomegaly and hydrocephalus in patients with diffuse intrinsic pontine glioma (DIPG). To date, the impact on survival in patients with ventriculomegaly and CSF diversion for hydrocephalus in this population remains to be elucidated. Herein, the authors describe their insti...
Background: Large hypothalamic hamartomas (HH) are often associated with difficult-to-treat, refractory seizures. Although magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has emerged as a useful tool to treat these challenging lesions, postoperative outcomes are variable and potentially related to differences in surgical targ...
Objective
To determine the relationship between timing of initiation of temporizing neurosurgical treatment and rates of ventriculoperitoneal shunting (VPS) and neurodevelopmental impairment in premature infants with post-hemorrhagic ventricular dilatation (PHVD).
Study Design
We searched MEDLINE, EMBASE, CINAHL, Web of Science, Cochrane Database...
ObjectTraumatic atlanto-occipital dislocation (AOD) is a relatively uncommon traumatic cervical spine injury characterized by disruption and instability of the atlanto-occipital joint. At many centers, management of pediatric AOD includes occipitocervical arthrodesis, but whether external immobilization without surgery is a viable treatment option...
Objective:
The primary objective of this study was to use the prospective Hydrocephalus Clinical Research Network (HCRN) registry to determine clinical predictors of fast time to shunt failure (≤ 30 days from last revision) and ultrafast time to failure (≤ 7 days from last revision).
Methods:
Revisions (including those due to infection) to perma...
Objective:
Analysis of temporal trends in patient populations and procedure types may provide important information regarding the evolution of hydrocephalus treatment. The purpose of this study was to use the Hydrocephalus Clinical Research Network's Core Data Project to identify meaningful trends in patient characteristics and the surgical manage...
INTRODUCTION
Children with craniopharyngiomas (CP) can be subjected to significant morbidities caused by radical surgery and/or radiation with severe long-term consequences. Ommaya reservoir Insertion (ORI) into cystic CP represents a minimally invasive procedure that aims to preserve endocrine, hypothalamic and neurocognitive function. The purpose...
Endoscopic transsphenoidal surgery is challenged by restricted visualization and dexterity, and the risk of internal carotid artery (ICA) injury. This study pursued two objectives: Development of a steerable, miniature multi-tool combining visualization and suction/irrigation, and development of a simulation model for ICA injury. The multi-tool fea...
This work presents the design of a novel compliant steerable tip (CST) instrument to facilitate transcanal (or totally) endoscopic ear surgery (TEES). The evolution of the instrument's design is shown, where prototypes were evaluated by surgeons and their feedback was used to inform the design changes for the next prototype iteration. The final pro...
Objective
Fetal myelomeningocele closure results in better infant outcomes than postnatal closure at the cost of potential prematurity and maternal morbidity. Our aim is to describe the setup of a fetal myelomeningocele closure program in Canada and document its outcomes.
Methods
We conducted a retrospective review of all open fetal myelomeningoce...
Background:
Given the morbidity and cost associated with cerebrospinal fluid shunt infections, many neurosurgical protocols implement "no-touch" technique to minimize infection. However, current surgical tools are not designed specifically for this task and surgeons often resort to using their hands to connect the shunt catheter to the valve.
Obj...
Objective:
Early surgical intervention for pediatric refractory epilepsy is increasingly advocated as surgery has become safer and data have demonstrated improved outcomes with early seizure control. There is concern that the risks associated with staged invasive electroencephalography (EEG) in very young children outweigh the potential benefits....
Background:
Open spina bifida (OSB) is one of the most common congenital central nervous system defects and leads to long-term physical and cognitive disabilities. Open fetal surgery for OSB improves neurological outcomes and reduces the need for ventriculoperitoneal shunting, compared to postnatal surgery, but is associated with a significant ris...
Worldwide, about 150 000 infants are born with spina bifida yearly, making this condition one of the most common fetal central nervous system anomalies compatible with life. Over the last decade, major changes have been introduced in the prenatal diagnosis and management of spina bifida. In this review, we provide a brief summary of the current man...
Robot-assisted minimally invasive surgical (MIS) techniques offer improved instrument precision and dexterity, reduced patient trauma and risk, and promise to lessen the skill gap among surgeons. These approaches are common in general surgery, urology, and gynecology. However, MIS techniques remain largely absent for surgical applications with narr...
Electrosurgery is used in the operating room on a daily basis as a means to cut tissue and maintain hemostasis. The principle of this technology lies in the transfer of electricity from an electrosurgical unit to the operating site on a patient's body and modifying the waveform of that electricity to achieve the desired surgical effect. Bipolar cau...
This paper presents a dynamic constraint formulation to provide protective virtual fixtures of 3D anatomical structures from polygon mesh representations. The proposed approach can anisotropically limit the tool motion of surgical robots without any assumption of the local anatomical shape close to the tool. Using a bounded search strategy and Prin...
This work presents the design of an articulate neuroendoscopic instrument (ANI), a handheld tool for use in minimally invasive neurosurgery. The instrument consists of a handle and a steerable tube-shaft with a distal end-effector. The design aims to increase the reach of surgeons operating through narrow channels within the center of the brain whe...
Objective
To test the feasibility of implementing a high-fidelity cleft palate simulator during a workshop in Santiago, Chile, using a novel video endoscope to assess technical performance.
Design
Sixteen cleft surgeons from South America participated in a 2-day cleft training workshop. All 16 participants performed a simulated repair, and 13 of t...
Remote-controlled minimally invasive neuroendoscopic robotic surgical tools can be miniaturized to a size of less than 2 mm while maintaining their dexterity and force required to perform operations in brain without an open-skull surgery. However, these platforms lack haptic information to be received by the surgeons, leading to loss of control ove...
Background:
Both genetic and methylation analysis have been shown to provide insight into the diagnosis and prognosis of many brain tumors. However, the implication of methylation profiling and its interaction with genetic alterations in pediatric low-grade gliomas (PLGGs) are unclear.
Methods:
We performed a comprehensive analysis of PLGG with...
Pediatric low-grade gliomas (pLGG) are frequently driven by genetic alterations in the RAS-mitogen-activated protein kinase (RAS/MAPK) pathway yet show unexplained variability in their clinical outcome. To address this, we characterized a cohort of >1,000 clinically annotated pLGG. Eighty-four percent of cases harbored a driver alteration, while th...
Cleft palate is a congenital defect that affects approximately 1 in 800 births worldwide. A robotic approach for cleft palate repair is desired due to the potential ergonomic, vision and accessibility improvements in the small workspace of the oral cavity. This paper presents a 3 mm, 4-degree-of-freedom instrument for use with the widely available...
Children and adults with genetic generalized epilepsy may have focal clinical seizure symptoms as well as electroencephalographic (EEG) findings. This may pose a diagnostic challenge to clinicians, especially when concomitant focal neuroimaging findings exist and the epilepsy is medically refractory. We sought to highlight the challenges that clini...
Objective:
The number of children with complex medical conditions surviving to adulthood is increasing. A planned transition to adult care systems is essential to the health maintenance of these patients. Guidance has been established for the general health care transition (HCT) from adolescence to adulthood. No formal assessment of the performanc...
Background:
Awake craniotomy with direct cortical stimulation and mapping is the gold standard for resection of lesions near eloquent brain areas, as it can maximize the extent of resection while minimizing the risk of neurological damage. In contrast to the adult population, only small series of awake craniotomies have been reported in children....
Background: Open spina bifida (OSB) is one of the most common congenital central nervous system defects and leads to long-term physical and cognitive disabilities. Open fetal surgery for OSB improves neurological outcomes and reduces the need for ventriculoperitoneal shunting, compared to postnatal surgery, at the expense of increased prematurity....
Background: Open spina bifida (OSB) is one of the most common congenital central nervous system defects and leads to long-term physical and cognitive disabilities. Open fetal surgery for OSB improves neurological outcomes and reduces the need for ventriculoperitoneal shunting, compared to postnatal surgery, but is associated with a significant risk...
Study design:
Retrospective study.
Objective:
To define distinct KFS patient phenotypes that are associated with the need for surgical intervention.
Summary of background data:
Klippel-Feil Syndrome (KFS) is characterized by the congenital fusion of cervical vertebrae, however, patients often present with a variety of other spinal and extra-sp...
![Fig. 1: (a) shows the skull of a craniosynostosis patient [18], (b) the...](profile/John-Phillips-8/publication/338137939/figure/fig1/AS:839480294526976@1577159107432/a-shows-the-skull-of-a-craniosynostosis-patient-18-b-the-schematics-of-a-bandeau_Q320.jpg)
Craniosynostosis, a condition affecting 1 in 2000 infants, is caused by premature fusing of cranial vault sutures, and manifests itself in abnormal skull growth patterns. Left untreated, the condition may lead to severe developmental impairment. Standard practice is to apply corrective cranial bandeau remodeling surgery in the first year of the inf...
Objectives: The application of magnetic resonance-guided focused ultrasound (MRgFUS) for the treatment of neurological conditions has been of increasing interest. Conventional MR imaging can provide structural information about the effect of MRgFUS, where differences in ablated tissue can be seen, but it lacks information about the status of the ce...
OBJECTIVE
Cerebral palsy (CP) is the most common childhood physical disability. Historically, children with hypertonia who are nonambulatory (Gross Motor Function Classification System [GMFCS] level IV or V) were considered candidates for intrathecal baclofen (ITB) therapy to facilitate care and mitigate discomfort. Selective dorsal rhizotomy (SDR)...
Purpose
Diffusion magnetic resonance imaging and tractography has an important role in the visualization of brain white matter and assessment of tissue microstructure. There is a lack of correspondence between diffusion metrics of live tissue, ex vivo tissue, and histological findings. The objective of this study is to elucidate this connection by...
INTRODUCTION
Approximately one-third of epilepsy patients are medically refractory and could benefit from surgery. Currently, it is difficult to predict precisely the postoperative likelihood of seizure freedom. Here, we sought to develop a regression-based clinical score to predict the likelihood of postoperative seizure freedom separately for ped...
Recent studies on concentric tube robots (CTRs) have shown that they are well-suited for minimally invasive endoscopic surgeries. However, typical surgical procedures require the use of multiple tools simultaneously which has led to the development of dual-arm CTRs that are susceptible to self-collision. In this paper, a closed-loop control system...