STS – Development of a Smart Trepanation System

The objective of this project is to develop an instrument allowing neurosurgeons a safe and less invasive access into the cranium, in order to reduce the complications of various neurosurgical interventions (e.g. brain swelling or tumour surgery).

This project has been awarded with the Innovationspreis zur Förderung der Medizintechnik 2007 and is funded by the German Ministry for Education and Research (BMBF).

The opening of the skull is one of the first steps of a neurosurgical procedure gaining access to the inner cranial structures in order to perform the further intervention. The dura mater, which protects the brain and is directly attached to the skull bone, is particularly endangered.

In close cooperation with the Neurosurgery Department of the Medical Faculty Mannheim, University of Heidelberg, and the SurgiTAIX AG, Aachen, within this project a smart sensor-integrated instrument for trepanation will be developed.

The Semiautomatic Trepanation System (STS) is supposed to protect the dura mater and to reduce the bone gap significantly, whilst its usage is integrated smoothly into the existing surgical workflow keeping the surgeon in full control of the process. The STS is based on two basic principles, a novel soft tissue preserving sawing tool and an autonomous control of the cutting depth.

As shown in the figure the surgeon manually maneuvers the semiautomatic instrument along an envisioned trajectory and the control system automatically adapts the cutting depth according to the local thickness of the skull bone. Using preoperative CT-data and position tracking, the skull thickness information is allocated to each coordinate on the skull. Alternatively, integrated sensors (e.g. ultrasound or electric impedance) can directly measure the local thickness and transmit this information to the control system. A redundant combination of these sensors might enhance the overall performance and safety.

The surgeon’s knowledge and experience complement in interaction with the semiautomatic trepanation system to an optimized neurosurgical workflow.


  • SurgitAIX AG, Aachen
  • Neurosurgery Department of the Medical Faculty Mannheim, University of Heidelberg


This work was supported by the German Federal Ministry of Education and Research under grant 01EZ0841.
(Project term: 7/2008-6/2010)


  • A. Follmann, S. Heger & K. Radermacher: Vorrichtung und Verfahren zur Materialbearbeitung. 2007 (DE 10 2007 050 017)


  • A. Korff: Synergistische Führung eines mechatronischen Osteotomieinstruments auf Basis multimodaler Informationen. In: S. Leonhardt, K. Radermacher & T. Schmitz-Rode (ed.): 22, Aachener Beiträge zur Medizintechnik (ISBN 978-3-8440-2816-4), Shaker, 2014, pp. 196
  • A. Follmann: Ein mechatronisches System zur semiaktiven Schädeltrepanation. In: S. Leonhardt, K. Radermacher & T. Schmitz-Rode (ed.): 12, Aachener Beiträge zur Medizintechnik (ISBN 978-3-8440-1164-7), Shaker, 2012, pp. 174
  • A. Follmann, A. Korff, T. Fuertjes, S.C. Kunze, K. Schmieder & K. Radermacher: A Novel Concept for Smart Trepanation. Journal of Craniofacial Surgery, 2012, 23(1), pp. 309-314 [DOI: 10.1097/SCS.0b013e318241dc53]
  • T. Fürtjes, A. Korff, A. Follmann, J. Benzenberg, K. Schmieder & K. Radermacher: Line of sight optimization for a hand-held tool for neurosurgery. Proceedings CARS (Suppl. 1), 6, 2011, pp. 190-192
  • A. Korff, A. Follmann, T. Fürtjes, D. Habor, S.C. Kunze, K. Schmieder & K. Radermacher: Concept and evaluation of a synergistic controlled robotic instrument for trepanation in neurosurgery. Proc. IEEE Int Robotics and Automation (ICRA) Conf, 2011, pp. 6258-6263 [DOI: 10.1109/ICRA.2011.5979623]
  • A. Follmann, W. Lauer, A. Korff, T. Fürtjes, S. Kunze, K. Schmieder & K. Radermacher: Benutzerinteraktion und Evaluierung eines semiautomatischen Trepanationssystems. In: O. Burgert, L. Kahrs, B. Preim & J. Schipper (ed.): 9. Jahrestagung der Deutschen Gesellschaft für Computer- und Roboterassistierte Chirurgie e.V., 2010, pp. 31-34
  • A. Follmann, A. Korff, T. Fuertjes, W. Lauer, S.C. Kunze, K. Schmieder & K. Radermacher: Evaluation of a synergistically controlled Semiautomatic Trepanation System for Neurosurgery. Proceedings of the 32nd Annual International Conference of the IEEE Engineering in Medicine and Biology Society, 2010, pp. 2304-2307
  • A. Follmann, A. Korff, S. Kunze, K. Schmieder & K. Radermacher: Protection of dura mater using a semiautomatic trepanation system. In: H.U. Lemke (ed.): International Journal of Computer Assisted Radiology and Surgery, 5(Supplement 1), 2010, pp. 311-312
  • A. Korff, R. Elfring, S. Lindhorst, A. Follmann, K. Schmieder & K. Radermacher: Hybrid position control for a synergistic trepanation tool. In: H.U. Lemke (ed.): Int J Comput assist Radiol Surg(Suppl), 2010, pp. 111-112
  • A. Korff, A. Follmann, L. Winter, M. de la Fuente, K. Schmieder & K. Radermacher: Real-Time Determination of Skull Thickness for a Manually-Navigated Synergistic Trepanation Tool. Proceedings of the 32nd Annual International Conference of the IEEE Engineering in Medicine and Biology Society, 2010, pp. 2300-2303
  • A. Follmann, A. Janß, A. Korff, K. Schmieder & K. Radermacher: User-Interaction of a Semiautomatic Trepanation System. In: O. Dössel & W.C. Schlegel (ed.): IFMBE Proceedings of 11th International World Congress on Medical Physics and Biomedical Engineering (WC2009), 25/VI, 2009, pp. 173-176
  • A. Follmann, J. Little, A. Korff, K. Schröder, M. Engelhardt & K. Radermacher: Synergistic Control - Semiautomatische Navigation eines neuartigen Trepanationsinstrumentes. In: D. Bartz, S. Bohn & J. Hoffmann (ed.): CURAC08 - Tagungsband, 2008, pp. 111-112