開顱手術(Craniotomy)是一種將病人部分頭骨暫時移除並對腦部進行治療的一種手術程序，而暫時移除的頭骨稱之為骨片(Bone flap)，在移除骨片時，外科手術醫生必頇先在病人頭骨上鑽數個孔(Burr hole)，再使用手術用鋸子沿孔鋸下，以便對大腦進行治療。傳統開顱程序需在手術進行中先後使用兩種手術器械，分別進行鑽孔與切削動作，因此手術過程中需要更換刀具，使用上較不便利。並且，若切削過程中發生斷刀情形，鑽頭更換麻煩且耗時。本研究提出一種整合鑽孔與切削功能之開顱手術刀具設計概念，該設計兼具開顱鑽孔與切削功能，不需於開顱過程中更換器械。並且該刀具附有一鑽頭快速拆卸機構，可提高鑽頭更換之效率。本文首先針對目前市售以及開發中的開顱刀具進行回顧，接著歸納開顱鑽孔及切削限制，定義本新型設計之設計需求與限制。然後，根據此設計規範，提出鑽孔切削兩用刀具以及鑽頭快拆機構之新型概念，並完成刀具中的彈簧與馬達參數設計。最後，利用CAD軟體進行此新型概念之具體設計，並製作出此開顱手術刀具的原型機，驗證本設計之可行性。

Craniotomy is a surgical operation in which a section of the skull, namely the “bone flap,” is temporarily removed in order to proceed with the following brain therapy. When doing such operation, the surgeon has to first of all drill several burr holes on the skull and then cut the skull to remove the bone flap along a designated cutting path that tracks each burr hole. So, to execute the overall produce, the surgeon will need to use two different surgical instruments for doing surgical drilling and sawing respectively. In this thesis, a new design concept that integrates the drilling and sawing motion in a single craniotomy instrument is proposed. By using this integrating design, the surgeon does not need to change surgical tool during craniotomy procedure. To come up with this design, we first review and compare the available craniotomy drilling and sawing tools. Then, according to the surgical needs, we summarize the design goals and limitation of the new design by which a new concept of an integrated surgical drilling and sawing tool for craniotomy is reached. We further present a rapid drill-changing mechanism for the new design to help reducing the tool changing time. Based on this design concept, we also demonstrate the selection of the motor and spring parameters. Last, we validate the proposed design concept by using CAD software and build a prototype of the design for verifying its feasibility.

[1] Lynnerup, N., 2001, “Cranial Thickness in Relation to Age, Sex and General Body Build in a Danish Forensic Sample,” Forensic Science International, 117(1–2), pp. 45-51.
[2] Caird, J. D., Choudhari, K. A., 2003, “„Plunging‟ During Burr Hole Craniostomy: A Persistent Problem Amongst Neurosurgeons in Britain and Ireland,” British Journal of Neurosurgery, 17(6), pp. 509-512.
[3] Verano, J. W., Finger, S., 2009, “Chapter 1: Ancient Trepanation,” Handbook of Clinical Neurology, 95, pp. 3-14.
[4] Lv, X., Wu, Z., 2012, “Prehistoric Skull Trepanation,” World Neurosurgery, In press.
[5] Lisowski, F. P., 1967, “Prehistoric and Early Historic Trepanation,” Disease in Antiquity, Brothwell, D., Sandison, A. T., Ed., Springfield, Massachusetts, pp. 651-672.
[6] Engelhardt, M., Uhlenbruch, S., Christmann, A., Miede, C., Eufinger, H., Scholz, M., Harders, A., Schmieder, K., 2005, “Accidential Dural Tears Occurring During Supratentorial Craniotomy-A Prospective Analysis of Predisposing Factors in 100 Patients,” Zentralblatt fur Neurochirurgie, 66(2), pp. 70-74.
[7] Integra Website, “Integra Cranial Access Kit,” December 2012. http://integralife.com/index.aspx?redir=detailproduct&product=53&ProductName=Integra%99%20Cranial%20Access%20Kit%20with%20Multiple%20Drill%20Bit%20Sizes&ProductLineName=Cranial%20Access&ProductLineID=13&PA=Neurosurgeon.
[8] Hsiao, M.-H., Kuo, C.-H., 2012, “A Review to the Powered Drilling Devices for Craniotomy,” Design of Medical Devices Conference, Minneapolis, Minnesota, USA, 10-12 April.
[9] ACRA-CUT, “Acra-Cut Smart Drill,” December 2012. http://www.acracut.com/images/pdf/smartdrill.pdf.
[10] DiMeco, F., Li, K. W., Mendola, C., Cantu, G., Solero, C. L., 2004, “Craniotomies Without Burr Holes Using an Oscillating Saw,” Acta Neurochirurgica, 146(9), pp. 995-1001.
[11] Shimizu, S., Miyazaki, T., Suzuki, S., Yamada, M., Utsuki, S., Oka, H., Fujii, K., 2008, “Supratentorial Craniotomy Using a Threadwire Saw-Technical Note,” Neurologia Medico-Chirurgica, 48(4), pp. 191-194.
[12] 林浩瑋，2000，精密定位與自動進給手術用骨骼鑽孔平台之研究，碩士論文，元智大學機械工程研究所，臺北，臺灣。
[13] Louredo, M., Diaz, I., Gil, J. J., 2012, “DRIBON: A Mechatronic Bone Drilling Tool,” Mechatronics, 22(8), pp. 1060-1066.
[14] Follmann, A., Jans, A., Korff, A., Schmieder, K., Radermacher, K., 2009, “User-Interaction of a Semiautomatic Trepanation System,” World Congress on Medical Physics and Biomedical Engineering, Dossel, O., Schlegel, W., Eds., Munich, Germany, 7-12 September, Vol. 25/6, pp. 173-176.
[15] Korff, A., Follmann, A., Winter, L., de la Fuente, M., Schmieder, K., Radermacher, K., 2010, “Real-Time Determination of Skull Thickness for a Manually-Navigated Synergistic Trepanation Tool,” International Conference of the IEEE Engineering in Medicine and Biology Society, 31 August-4 September, pp. 2300-2303.
[16] Korff, A., Follmann, A., Furtjes, T., Habor, D., Kunze, S. C., Schmieder, K., Radermacher, K., 2011, “Concept and Evaluation of a Synergistic Controlled Robotic Instrument for Trepanation in Nneurosurgery,” IEEE International Conference on Robotics and Automation, Shanghai, China, 9-13 May, pp. 6258-6263.
[17] Follmann, A., Korff, A., Fuertjes, T., Kunze, S. C., Schmieder, K., Radermacher, K., 2012, “A Novel Concept for Smart Trepanation,” The Journal of Craniofacial Surgery, 23(1), pp. 309-314.
[18] Loschak, P., Xiao, K., Pei, H., Kesner, S. B., Thomas, A. J., Walsh, C., 2012, “Cranial Drilling Tool with Retracting Drill Bit Upon Skull Penetration,” Design of Medical Devices Conference, Minneapolis, Minnesota, USA, 10-12 April.
[19] Walsh, C. J., Meskers, A. J. H., Slocum, A. H., Gupta, R., 2012, “CT-Compatible Medical Drilling Stylet,” ASME Journal of Medical Devices, 6(4), pp. 041001(1-8).
[20] B. Braun, “Microspeed uni,” 2010. http://www.knoglemekanik.dk/Vejledninger/Micro_speed_uni_2010.pdf.
[21] Kane, G., Eggers, G., Boesecke, R., Raczkowsky, J., Worn, H., Marmulla, R., Muhling, J., 2009, “System Design of a Hand-Held Mobile Robot for Craniotomy,” Medical Image Computing and Computer-Assisted Intervention-MICCAI, Yang, G.-Z., Hawkes, D., et al., Eds., London, UK, 20-24 September, pp. 402-409.
[22] Shen, W., Gu, J., Shen, Y., 2006, “Using Tele-robotic Skull Drill for Neurosurgical Applications,” IEEE International Conference on Mechatronics and Automation, Luoyang, China, 25-28 June, pp. 334-338.
[23] Shen, W., Gu, J., Shen, Y., 2006, “Trajectory Planning for Tele-Robotic Skull Drill System,” IEEE International Conference on Information Acquisition, Veihai, China, 20-23 August, pp. 1497-1501.
[24] MAYFILED Clinic for Brain and Spine, “Craniotomy,” February 2013. http://www.mayfieldclinic.com/PE-Craniotomy.htm.
[25] Raza, S. M., Quinones-Hinojosa, A., 2011, “The Extended Retrosigmoid Approach for Neoplastic Lesions in the Posterior Fossa: Technique Modification,” Neurosurgical Review, 34(1), pp. 123-129.
[26] Franceschini, G., 2006, The Mechanics of Human Brain Tissue, Master Thesis, Department of Mechanical and Structural Engineering, University of Trento, Trento, Italy.
[27] National Cancer Institute, “Structure of Bone Tissue,” June 2011. http://training.seer.cancer.gov/anatomy/skeletal/tissue.html.
[28] Belingardi, G., Chiandussi, G. Gaviglio, I., 2005, “Development and Validation of a New Finite Element Model of Human Head,” International Technical Conference on the Enhanced Safety of Vehicles, Washington DC, U.S.A, 6-9 June, pp. 1-9.
[29] Glauser, D., Flury, P., Villotte, N., Burckhardt, C. W., 1991, “Conception of a Robot Dedicated to Neurosurgical Operations,” Fifth International Conference on Advanced Robotics, Pisa, Italy, 19-22 June, Vol. 1, pp. 899-904.
[30] Ong, F. R., Bouazza-Marouf, K., 1999, “The Detection of Drill Bit Break-Through for the Enhancement of Safety in Mechatronic Assisted Orthopaedic Drilling,” Mechatronics, 9(6), pp. 565-588.
[31] Hillery, M. T., Shuaib, I., 1999, “Temperature Effects in the Drilling of Human and Bovine Bone,” Journal of Materials Processing Technology, 92–93, pp. 302-308.
[32] Besdia, “Diamond and CBN Tools,” 2013. http://www.besdia.com/index.asp?lang=1.
[33] 林紀穎、李乾耀，2010年，馬達簡介與直流馬達控制，「機械系統設計與實務」教學講義，國立臺灣科技大學機械工程系，臺北，臺灣。
[34] 黎靖，2009年，機械負載計算與伺服馬達之選用，「控制電子學」教學講義，南臺科技大學電子系，臺南，臺灣。
[35] Shayang, “DC Micro Motor,” 2013. http://www.shayye.com.tw/pdf/IG22C-03&04-Model.pdf.