Nerve survival rendering

Abstract

Presented herein are techniques for generating a neural survival map of nervous tissue adjacent to a body cavity of a recipient of an implantable medical device that includes an implantable stimulation assembly. For example, during insertion of the implantable stimulation assembly into a recipient, the implantable medical device captures a plurality of evoked responses of nervous tissue adjacent to a body cavity, and a plurality of intra-operative measurements associated with the implantable stimulation assembly. The computing device is configured to determine a plurality of position estimates of the implantable stimulation assembly relative to the body cavity using the plurality of intra-operative measurements. The computing device generates a neural survival map of nervous tissue adjacent to the body cavity using the plurality of evoked responses and the plurality of position estimates.

Description

background Technical Field

[0001] This paper presents techniques for generating neural survival maps. Background Art

[0002] In recent decades, medical devices have provided a wide range of therapeutic benefits to recipients. Medical devices can include internal or implantable components / devices, external or wearable components / devices, or combinations thereof (e.g., devices having external components that communicate with implantable components). Medical devices, such as traditional hearing aids, partially or fully implantable hearing prostheses (e.g., bone conduction devices, mechanical stimulators, cochlear implants, etc.), pacemakers, defibrillators, functional electrical stimulation devices, and other medical devices, have been successful for many years in performing life-saving and / or lifestyle-improving functions and / or recipient monitoring.

[0003] Over the years, the types of medical devices and the range of functions performed by them have increased. For example, many medical devices, sometimes referred to as "implantable medical devices," now typically include one or more instruments, devices, sensors, processors, controllers, or other functional mechanical or electrical components that are permanently or temporarily implanted in a recipient. These functional devices are often used to diagnose, prevent, monitor, treat, or manage disease / injury or its symptoms, or to study, replace, or modify anatomical structures or physiological processes. Many of these functional devices utilize power and / or data received from an external device that is part of or operates in conjunction with the implantable component. Summary of the Invention

[0004] In one aspect, a method is provided. A first method includes: obtaining a plurality of evoked responses from a cochlea during insertion of a stimulation assembly into the cochlea; obtaining a plurality of position estimates of the stimulation assembly within the cochlea during insertion of the stimulation assembly into the cochlea; and generating a neural viability map of the cochlea based on the plurality of evoked responses and the plurality of position estimates.

[0005] In another aspect, a method is provided. The method includes: performing a plurality of intraoperative neural response measurements of the cochlea during insertion of a stimulation assembly into the cochlea; iteratively estimating a position of the stimulation assembly within the cochlea relative to a multidimensional geometric model of the cochlea during insertion of the stimulation assembly into the cochlea; and analyzing the intraoperative neural response measurements relative to the estimated position of the stimulation assembly within the cochlea to generate a neural viability map of the cochlea.

[0006] In another aspect, a method is provided that includes obtaining a neural viability map of a cochlea, wherein a stimulation assembly is at least partially inserted into the cochlea; determining a selected placement of the stimulation assembly within the cochlea based on the neural viability map of the cochlea; obtaining an estimated position of the stimulation assembly within the cochlea; and determining, based on the estimated position of the stimulation assembly within the cochlea, a position adjustment of the stimulation assembly to achieve the selected placement of the stimulation assembly within the cochlea.

[0007] In another aspect, one or more non-transitory computer-readable storage media are provided. The one or more non-transitory computer-readable storage media include instructions that, when executed by a processor, cause the processor to: obtain a plurality of evoked responses during insertion of a stimulation assembly into a body cavity of a recipient; obtain a plurality of position estimates of the stimulation assembly within the body cavity during insertion of the stimulation assembly into the body cavity of the recipient; and generate a neural viability map of the body cavity based on the plurality of evoked responses and the plurality of position estimates.

[0008] In another aspect, a system is provided. The system includes: a display screen; a memory storing computer-readable instructions; and at least one processor operably coupled to the display screen and the memory, wherein the at least one processor is configured to: obtain a plurality of intraoperative neural response measurements captured during insertion of a stimulation assembly into a body cavity, obtain a plurality of position estimates of the stimulation assembly within the body cavity captured relative to a multi-dimensional geometric model of the body cavity; and analyze the intraoperative neural response measurements relative to the estimated positions of the stimulation assembly within the body cavity to generate a neural viability map of the body cavity. BRIEF DESCRIPTION OF THE DRAWINGS

[0009] Embodiments of the present invention are described herein with reference to the accompanying drawings, in which:

[0010] Figure 1A is a schematic diagram illustrating a cochlear implant system with which aspects of the technology presented herein may be implemented;

[0011] Figure 1B It is wearable Figure 1A A side view of a recipient of a cochlear implant system's sound processing unit;

[0012] Figure 1C yes Figure 1A A schematic diagram of components of a cochlear implant system;

[0013] Figure 1D yes Figure 1A Block diagram of the cochlear implant system;

[0014] Figure 1E is a schematic diagram illustrating a computing device with which aspects of the techniques presented herein may be implemented;

[0015] Figure 2 is a flow chart illustrating a method for implementing the generation of a neural survival map according to the techniques presented herein;

[0016] Figure 3 is a graphical view of a neural survival map according to an exemplary embodiment;

[0017] Figure 4 is a flow chart illustrating a method for implementing determination of position adjustments for a stimulation assembly according to the techniques presented herein;

[0018] Figure 5 is a graphical view of a neural survival map having a representation of a position adjustment to adjust a stimulation component from a current estimated placement to a selected placement according to an exemplary embodiment;

[0019] Figure 6 is a schematic diagram illustrating an implantable stimulator system with which aspects of the technology presented herein may be implemented;

[0020] Figure 7 is a schematic diagram illustrating a vestibular stimulator system with which aspects of the technology presented herein may be implemented; and

[0021] Figure 8 is a flow chart illustrating a generalized method for generating neural survival maps according to the techniques presented herein. DETAILED DESCRIPTION

[0022] Presented herein are techniques for generating a neural survival map of neural tissue of a body region / body cavity of a recipient adjacent to an implantable medical device, the implantable medical device including an implantable stimulation assembly. For example, during insertion of the implantable stimulation assembly into a body cavity, the implantable medical device captures a plurality of evoked responses of neural tissue adjacent to the body cavity, as well as a plurality of intraoperative measurements associated with the implantable stimulation assembly. The computing device is configured to use the plurality of intraoperative measurements to determine a plurality of position estimates of the implantable stimulation assembly relative to the body cavity. The computing device generates a neural survival map of neural tissue adjacent to the body cavity using the plurality of evoked responses and the plurality of position estimates. In some embodiments, the implantable stimulation assembly is an intracochlear stimulation assembly configured to be inserted into the cochlea of ​​the recipient (e.g., the body cavity is the cochlea of ​​the recipient), and the neural survival map is a map of the recipient's surviving spiral ganglion cells (e.g., nerve cells adjacent to the cochlea).

[0023] In some aspects, the same or a different computing device uses the neural viability map to determine a selected placement (e.g., optimal location / positioning) for an implantable stimulation assembly associated with a body cavity (e.g., the recipient's cochlea). The selected placement can be used to generate positional adjustments to the implantable stimulation assembly that, for example, help align electrodes of the implantable stimulation assembly with an area of ​​relatively high neural viability.

[0024] For ease of description only, the technology presented herein is primarily described with reference to a specific medical device in the form of a cochlear implant system and the generation of a neural survival map of the inner ear (i.e., the cochlea) of a recipient. However, it should be understood that the technology presented herein can be implemented in / with many different types of medical devices to generate neural survival maps of different neural tissue regions adjacent to different body cavities of a recipient. For example, the technology presented herein can also be implemented in part or in whole by a device / system including a hearing aid, a middle ear hearing prosthesis, a bone conduction device, a direct acoustic stimulator, an electro-acoustic hearing prosthesis, an auditory brainstem stimulator, a dual-mode hearing prosthesis, a bilateral hearing prosthesis, a dedicated tinnitus treatment device, a tinnitus treatment device system, a vestibular device (e.g., a vestibular implant), a visual device (i.e., a bionic eye), a sensor, a pacemaker, a drug delivery system, a defibrillator, a functional electrical stimulation device, a catheter, an epileptic seizure device (e.g., a device for monitoring and / or treating epileptic events), a sleep apnea device, an electroporation device, combinations or variations thereof, and the like.

[0025] With particular reference to the inner ear, the recipient's cochlear organ comprises a three-dimensional spiral cavity within the bony labyrinth of the temporal bone. The scala tympani and scala vestibulocochlear canals wind around the spiral axis from base to apex, and nerve cells (e.g., spiral ganglion cells) are distributed throughout them. The cochlea is topologically mapped so that nerve cells toward the base of the cochlea transmit high-frequency auditory signals, and cells toward the apex transmit low-frequency auditory signals. Cochleas with associated hearing loss, depending on the disease state, typically have an irregular or "patchwork" distribution of nerve cells. Placement of the stimulation assembly inside the cochlea may not necessarily stimulate portions of the cochlea where nerve cells are more concentrated.

[0026] After surgery, x-rays or computed tomography (CT) scans can be used to confirm the placement of the stimulation assembly within the recipient's cochlea. However, during or after the insertion of the stimulation assembly, surgeons are typically unable to confirm the placement of the stimulation assembly relative to the internal structure of the cochlea without performing intraoperative imaging (e.g., fluoroscopy, intraoperative x-rays, or intraoperative CT scans). This article presents a technique for measuring and estimating neural survival in real time during the placement of the stimulation assembly within the cochlea, such as within the cochlea. That is, the technology presented herein maps neural survival throughout the cochlea, and in some examples, determines a selected (optimal) placement of the stimulation assembly that maximizes coverage of healthy / active / responsive cells (and / or minimizes coverage of unhealthy / inactive / unresponsive cells) in order to obtain the maximum possible coverage of stimulation of the nerve cells. Using this information, the technology presented herein can generate an output that, for example, can recommend to the surgeon how to change the placement of the stimulation assembly and / or control the surgical robot to change the placement of the electrode array to achieve the selected placement. Achieving the selected placement can produce better hearing and quality of life results.

[0027] In general, the systems and methods described herein relate to techniques for determining a neural viability map of the cochlea by repeatedly performing measurements while a stimulation assembly is inserted into the cochlea. In some exemplary embodiments, the determined neural viability map can be used to optimize the position of the stimulation assembly in the cochlea. As described below with reference to Figure 2 、 3 As further described in Figures 4, 5, and 8, the systems and methods described herein include a plurality of different functional components / subsystems. These functional components / subsystems may include, for example: (1) a subsystem for capturing intraoperative measurements of neural responses in real time during insertion of a stimulation assembly into the cochlea; (2) a subsystem for estimating the positioning of the stimulation assembly relative to a multi-dimensional geometric cochlear model; (3) a subsystem for generating a neural survival map; and (4) a subsystem for calculating a selected placement of the stimulation assembly and / or calculating positional adjustments to the stimulation assembly to achieve the selected placement.

[0028] Exemplary Systems

[0029] Figures 1A-1D An exemplary cochlear implant system 102 is shown with which aspects of the technology presented herein may be implemented. The cochlear implant system 102 includes an external component 104 configured to be attached directly or indirectly to a user's body, and an internal / implantable component 112 configured to be implanted in or worn on the user's head. Figures 1A-1D In the example of FIG. 1 , implantable component 112 is sometimes referred to as a “cochlear implant.” Figure 1A A cochlear implant 112 is shown implanted in a user's head 154, and Figure 1Bis a schematic diagram of the external component 104 worn on the head 154 of a user. Figure 1C is another schematic diagram of a cochlear implant system 102, and Figure 1D Further details of the cochlear implant system 102 are shown. For ease of description, the Figures 1A-1D .

[0030] exist Figures 1A-1D In one example, the external component 104 includes a sound processing unit 106, an external coil 108, and typically includes a magnet fixed relative to the external coil 108. The cochlear implant 112 includes an implantable coil 114, an implant body 134, and an elongated stimulation assembly 116 configured to be implanted in the cochlea of ​​a recipient. In one example, the sound processing unit 106 is an off-the-ear (OTE) sound processing unit, sometimes referred to herein as an OTE component, which is configured to send data and power to the implantable component 112. Generally speaking, the OTE sound processing unit is a component having a generally cylindrical housing 111 and configured to be magnetically coupled to the user's head 154 (e.g., including an integrated external magnet 150 configured to be magnetically coupled to an internal / implantable magnet 152 in the implantable component 112). The OTE sound processing unit 106 also includes an integrated external (head component) coil 108 (external coil 108) configured to be inductively coupled to the implantable coil 114.

[0031] It should be understood that the OTE sound processing unit 106 is merely illustrative of an external device that can operate with the implantable component 112. For example, in an alternative example, the external component 104 can include a behind-the-ear (BTE) sound processing unit that is configured to be attached to and worn adjacent to the recipient's ear. Generally speaking, a BTE sound processing unit includes a housing that is shaped to be worn on the user's outer ear and connected via a cable to a separate external coil assembly, wherein the external coil assembly is configured to be magnetically and inductively coupled to the implantable coil 114. It should also be understood that alternative external components can be located in the user's ear canal, worn on the body, etc.

[0032] Although cochlear implant system 102 includes sound processing unit 106 and cochlear implant 112, as described below, cochlear implant 112 can operate independently of sound processing unit 106 for at least some periods of time to stimulate the user. For example, cochlear implant 112 can operate in a first general mode (sometimes referred to as an "external listening mode"), in which sound processing unit 106 captures sound signals, which are then used as the basis for delivering stimulation signals to the user. Cochlear implant 112 can also operate in a second general mode (sometimes referred to as an "invisible hearing" mode), in which sound processing unit 106 is unable to provide sound signals to cochlear implant 112 (e.g., sound processing unit 106 is not present, sound processing unit 106 is powered off, sound processing unit 106 has malfunctioned, etc.). Thus, in the invisible hearing mode, cochlear implant 112 captures sound signals itself via an implantable sound sensor and then uses these sound signals as the basis for delivering stimulation signals to the user. Further details regarding the operation of cochlear implant 112 in the external listening mode are provided below, followed by details regarding the operation of cochlear implant 112 in the invisible listening mode. It should be understood that the reference to the external listening mode and the invisible listening mode is merely illustrative, and cochlear implant 112 may also operate in alternative modes.

[0033] exist Figure 1A and 1C In FIG, a cochlear implant system 102 is shown with an external device 110 configured to implement various aspects of the presented technology. Figure 1E 1 ) is a computing device, such as a personal computer (e.g., a laptop, a desktop computer, a tablet), a mobile phone (e.g., a smartphone), a remote control unit, etc. External device 110 and cochlear implant system 102 (e.g., sound processing unit 106 or cochlear implant 112) communicate wirelessly via a bidirectional communication link 126. Bidirectional communication link 126 may include, for example, short-range communication, such as a Bluetooth link, a Bluetooth Low Energy (BLE) link, a proprietary link, etc.

[0034] Return to Figures 1A-1DIn the example of the external component 104, the sound processing unit 106 of the external component 104 also includes one or more input devices configured to capture and / or receive input signals (e.g., sound signals or data signals) at the sound processing unit 106. The one or more input devices include, for example, one or more sound input devices 118 (e.g., one or more external microphones, audio input ports, telecoils, etc.), each located in, on, or near the sound processing unit 106, one or more auxiliary input devices 128 (e.g., an audio port, such as a direct audio input (DAI), a data port, such as a universal serial bus (USB) port, a cable port, etc.), and a short-range wireless transmitter / receiver (wireless transceiver) 120 (e.g., for communicating with the external device 110). However, it should be understood that the one or more input devices may include additional types of input devices and / or fewer input devices (e.g., the short-range wireless transceiver 120 and / or one or more auxiliary input devices 128 may be omitted).

[0035] The sound processing unit 106 also includes an external coil 108, a charging coil 130, a tightly coupled radio frequency transmitter / receiver (RF transceiver) 122, at least one rechargeable battery 132, and an external sound processing module 124. The external sound processing module 124 may be configured to execute a sound processor 133. Figure 1D The sound processor 133 may be formed of one or more processors (e.g., one or more digital signal processors (DSPs), one or more uC cores, etc.), firmware, software, etc., arranged to perform the operations described herein. That is, the sound processor 133 may be implemented as a firmware element, partially or completely with digital logic gates in one or more application specific integrated circuits (ASICs), partially or completely in software, etc. Although Figure 1D The sound processor 133 is shown as being implemented / executed at the external sound processing module 124, but it should be understood that this element (e.g., functional operation) may also or alternatively be implemented / executed as part of the implantable sound processing module 158, as part of the external device 110, etc.

[0036] exist Figures 1A-1DIn the example of FIG. 1 , the implantable component 112 includes an implant body (main module) 134, a lead region 136, and an intracochlear stimulation assembly 116, all configured to be implanted beneath the skin (tissue) 115 of a user. The implant body 134 generally includes an airtight sealed housing 138, which in some examples includes at least one power source 125 (e.g., one or more batteries, one or more capacitors, etc.) 125, within which an RF interface circuitry 140 and a stimulator unit 142 are disposed. The implant body 134 also includes an internal / implantable coil 114, which is generally external to the housing 138 but is electrically connected to the stimulator unit 142 via an airtight feedthrough ( Figure 1D ) is connected to the RF interface circuit system 140.

[0037] As mentioned, the stimulation assembly 116 is configured to be at least partially implanted in the cochlea of ​​the user. The stimulation assembly 116 includes a plurality of longitudinally spaced intracochlear electrical stimulation contacts (electrodes) 144 that collectively form a contact array (electrode array) 146 for delivering electrical stimulation (current) to the recipient's cochlea. The stimulation assembly 116 extends through an opening in the recipient's cochlea (e.g., a cochlear fenestration, a round window, etc.) and has a lead region 136 and an airtight feedthrough ( Figure 1D 144 is connected to the proximal end of the stimulator unit 142. The lead region 136 includes a plurality of conductors (wires) that electrically couple the electrodes 144 to the stimulator unit 142. The implantable component 112 also includes an electrode outside the cochlea, sometimes referred to as an extracochlear electrode (ECE) 139.

[0038] As described, the cochlear implant system 102 includes an external coil 108 and an implantable coil 114. An external magnet 150 is fixed relative to the external coil 108, and an internal / implantable magnet 152 is fixed relative to the implantable coil 114. The external magnet 150 and the internal / implantable magnet 152, which are fixed relative to the external coil 108 and the internal / implantable coil 114, respectively, facilitate operational alignment of the external coil 108 with the implantable coil 114. This operational alignment of the coils enables the external component 104 to transmit data and power to the implantable component 112 via a tightly coupled wireless link 148 formed between the external coil 108 and the implantable coil 114. In some examples, the tightly coupled wireless link 148 is a radio frequency (RF) link. However, various other types of energy transfer (e.g., infrared (IR), electromagnetic, capacitive, and inductive transfer) may be used to transfer power and / or data from the external component to the implantable component, and thus, Figure 1D Only one exemplary arrangement is shown.

[0039] As described above, the sound processing unit 106 includes an external sound processing module 124. The external sound processing module 124 is configured to process input audio signals received (received at one or more of the input devices (e.g., the sound input device 118 and / or the auxiliary input device 128)) and convert the received input audio signals into output control signals for stimulating the first ear of the recipient or user (i.e., the external sound processing module 124 is configured to perform sound processing on the input signals received at the sound processing unit 106). In other words, one or more processors (e.g., processing element(s) implementing firmware, software, etc.) in the external sound processing module 124 are configured to execute sound processing logic in memory to convert the received input audio signals into output control signals (stimulation signals) representing electrical stimulation for delivery to the recipient.

[0040] As stated, Figure 1D An embodiment is shown in which the output control signal is generated by external sound processing module 124 in sound processing unit 106. In alternative embodiments, sound processing unit 106 may send less processed information (e.g., audio data) to implantable component 112, and the sound processing operations (e.g., conversion of input sound to output control signal 156) may be performed by a processor within implantable component 112.

[0041] exist Figure 1D In accordance with an exemplary embodiment, the output control signal (stimulation signal) is provided to the RF transceiver 122, which transmits the output control signal (e.g., in an encoded manner) transcutaneously to the implantable component 112 via the external coil 108 and the implantable coil 114. That is, the output control signal (stimulation signal) is received at the RF interface circuitry 140 via the implantable coil 114 and provided to the stimulator unit 142. The stimulator unit 142 is configured to utilize the output control signal to generate an electrical stimulation signal (e.g., a current signal) for delivery to the user's cochlea via one or more stimulation contacts (electrodes) 144. In this manner, the cochlear implant system 102 electrically stimulates the user's auditory nerve cells, thereby bypassing the missing or defective hair cells that normally convert acoustic vibrations into neural activity in a manner that causes the recipient to perceive one or more components of the input audio signal (received sound signal).

[0042] As detailed above, in the external listening mode, the cochlear implant 112 receives processed sound signals from the sound processing unit 106. However, in the invisible listening mode, the cochlear implant 112 is configured to capture and process the sound signals for electrical stimulation of the user's auditory nerve cells. Figure 1DAs shown in , an exemplary embodiment of a cochlear implant 112 may include a plurality of implantable sound sensors 165(1), 165(2) and an implantable sound processing module 158, the plurality of implantable sound sensors collectively forming a sensor array 160. Similar to the external sound processing module 124, the implantable sound processing module 158 may include, for example, one or more processors and a memory device (memory) including sound processing logic. The memory device may include any one or more of the following: non-volatile memory (NVM), ferroelectric random access memory (FRAM), read-only memory (ROM), random access memory (RAM), magnetic disk storage media devices, optical storage media devices, flash memory devices, electrical, optical or other physical / tangible memory storage devices. The one or more processors are, for example, a microprocessor or microcontroller that executes instructions of the sound processing logic stored in the memory device.

[0043] In the invisible hearing mode, the implantable sound sensors 165(1), 165(2) of the sensor array 160 are configured to detect / capture input sound signals 166 (e.g., acoustic sound signals, vibrations, etc.), which are provided to the implantable sound processing module 158. The implantable sound processing module 158 is configured to convert the input sound signals 166 received (received at one or more implantable sound sensors 165(1), 165(2)) into output control signals 156 for stimulating the first ear of the recipient or user (i.e., the implantable sound processing module 158 is configured to perform sound processing operations). In other words, one or more processors (e.g., processing elements implementing firmware, software, etc.) in the implantable sound processing module 158 are configured to execute sound processing logic in memory to convert the received input sound signals 166 into output control signals 156 provided to the stimulator unit 142. The stimulator unit 142 is configured to generate an electrical stimulation signal (eg, an electrical current signal) using the output control signal 156 for delivery to the user's cochlea, thereby bypassing missing or defective hair cells that normally convert acoustic vibrations into neural activity.

[0044] It should be understood that the above description of the so-called external listening mode and the so-called invisible listening mode is merely illustrative, and that cochlear implant system 102 may operate differently in different embodiments. For example, in an alternative embodiment of the external listening mode, cochlear implant 112 may use the signals captured by sound input device 118 and implantable sound sensors 165(1), 165(2) of sensor array 160 to generate stimulation signals for delivery to the user.

[0045] Figure 1Eis a block diagram illustrating an exemplary arrangement of an external computing device 110 configured to perform one or more operations according to certain embodiments presented herein. Figure 1E As shown in , in its most basic configuration, the external computing device 110 includes at least one processing unit 183 and memory 184. The processing unit 183 includes one or more hardware or software processors (e.g., central processing units) that can obtain and execute instructions. The processing unit 183 can communicate with other components of the external computing device 110 and control the performance of the other components. The memory 184 is one or more software or hardware-based computer-readable storage media that are operable to store information accessible by the processing unit 183. Among other things, the memory 184 can store instructions and other data that can be executed by the processing unit 183 to implement applications or enable the operations described herein. The memory 184 can be volatile memory (e.g., RAM), non-volatile memory (e.g., ROM), or a combination thereof. The memory 184 can include temporary memory or non-temporary memory. The memory 184 can also include one or more removable or non-removable storage devices. In an example, the memory 184 may include random access memory (RAM), read-only memory (ROM), EEPROM (electrically erasable programmable read-only memory), flash memory, optical disk storage, magnetic storage, solid-state storage, or any other storage medium that can be used to store information for later access. By way of example and not limitation, the memory 184 may include wired media (e.g., a wired network or direct wired connection), as well as wireless media (e.g., acoustic, RF, infrared, and other wireless media), or a combination thereof. In certain embodiments, the memory 184 includes neural survival analysis logic 195 that, when executed, enables the processing unit 183 to perform various aspects of the presented techniques.

[0046] exist Figure 1EIn the illustrated example, the external computing device 110 also includes a network adapter 186, one or more input devices 187, and one or more output devices 188. The external computing device 110 may include other components, such as a system bus, component interfaces, a graphics system, a power source (e.g., a battery), and other components. The network adapter 186 is a component of the external computing device 110 that provides network access (e.g., access to at least one network 189). The network adapter 186 can provide access to wired or wireless networks and can support one or more of a variety of communication technologies and protocols, such as Ethernet, cellular, Bluetooth, near-field communication, and RF (radio frequency), among others. The network adapter 186 may include one or more antennas and associated components configured to communicate wirelessly according to one or more wireless communication technologies and protocols. The one or more input devices 187 are devices through which the external computing device 110 receives input from a user. The one or more input devices 187 may include physically actuatable user interface elements (e.g., buttons, switches, or dials), a keypad, a keyboard, a mouse, a touch screen, a voice input device, and other input devices that can receive user input. One or more output devices 188 are devices through which computing device 110 can provide output to a user. Output devices 188 may include a display 190 (e.g., a liquid crystal display (LCD)) and one or more speakers 191, as well as other output devices for presenting visual or audible information to a recipient, clinician, audiologist, or other user.

[0047] It should be recognized that Figure 1E The arrangement of external computing device 110 shown in is illustrative only, and aspects of the techniques presented herein can be implemented at many different types of systems / devices (including any combination of hardware, software, and / or firmware configured to perform the functions described herein). For example, external computing device 110 can be a personal computer (e.g., a desktop or laptop computer), a handheld device (e.g., a tablet computer), a mobile device (e.g., a smartphone), a surgical system, and / or any other electronic device having the capability to perform the associated operations described elsewhere herein.

[0048] As described, this document presents methods for stimulating the patient via an implantable stimulation assembly (e.g., Figure 1D

[0014] The present invention relates to a technique for determining / generating and using a neural viability map based on objective measurements obtained / captured by components of the stimulation assembly 116. In certain embodiments, these objective measurements are combined with physical measurements of electrode placement to determine the neural health of the nerves stimulated by the stimulation assembly, as described below with reference to Figure 2 、 3In some embodiments, the neural survival map may be used to determine a selected placement of the stimulation assembly (and its respective electrodes), and to determine positional adjustments to the stimulation assembly to achieve the selected placement based on the current estimated placement of the stimulation assembly, as described below with reference to Figure 4 、 5 and 8 as further described.

[0049] Next, exemplary techniques for generating a multidimensional geometric model of the cochlea and for estimating the placement (position / location) of a stimulation assembly within the cochlea are described below, and then reference is made to Figure 2 、 4 and 8 of the programming flow chart (and also refer to Figure 3 and 5 The graphical view shown in ) describes various uses of these techniques.

[0050] Generate a multidimensional geometric cochlear model

[0051] Typically, the purpose of a multidimensional geometric model is to create a physical representation of the cochlea (or other area of ​​the recipient's body) for the purpose of creating a positioning reference for varying placement of stimulation components (electrode arrays) and areas with low or high neural survival.

[0052] As mentioned above, the cochlea is a three-dimensional spiral structure within the bony labyrinth. The scala tympani, scala vestibuli, and scala media twist around the central axis of the cochlea (modiolus, modiolus axis) from base to apex (molar aperture). The modiolus contains the cochlear nerve. The positioning of a point in the cochlea is described in polar coordinates, with the modiolus axis being the origin. At the base of the cochlea, on the scala tympani, is the round window. The chords from the round window that pass through the round window to the lateral wall and the orthogonal chords form the x-axis and y-axis, respectively. The origin of the angular coordinates is the vector from the modiolus axis to the round window, and the radial distance is measured from the modiolus axis.

[0053] The dimensions of the cochlea (length, width, and height) can be measured from preoperative medical imaging. The cochlear dimensions are input into an algorithm that estimates the geometry of the cochlear ducts (i.e., scala tympani, scala vestibuli, and scala media). Specifically, the first algorithm uses: (A) a hyperbolic helix to estimate the modiolar wall (Equations 1 and 2 below); (B) a hyperbolic helix to estimate the lateral wall (Equations 1 and 3 below); and (C) an ellipse to estimate the cochlear duct spanning from the modiolar wall to the lateral wall (Equations 4 and 5 below).

[0054] Equation 1:

[0055]

[0056] in is an estimate of the average height of the modiolar wall spiral or the lateral wall spiral at a given angular deviation θ, height is the measured height of the cochlea, βi is the i-th coefficient term of the model, and ε is the error term.

[0057] Equation 2:

[0058]

[0059] in is the distance from the modiolar axis to the modiolar wall at a given angular deviation θ, z θ is the average height of the modiolar wall spiral or lateral wall spiral at θ, A is the length of the cochlea, B is the width of the cochlea, β i is the u-th coefficient term of the model, and ε is the error term.

[0060] Equation 3:

[0061]

[0062] in is the distance from the modiolar axis to the modiolar wall at a given angular deviation θ, z θ is the average height of the modiolar wall spiral or lateral wall spiral at θ, A is the length of the cochlea, B is the width of the cochlea, β i is the i-th coefficient term of the model, and ε is the error term.

[0063] Equation 4:

[0064] a=r 侧向 -r 蜗轴

[0065]

[0066] Where a is the length of the tube, is the distance from the center of the tube for a given angular deviation θ of the cochlea, is the angle along the ellipse, β i is the i-th coefficient term of the model, and ε is the error term.

[0067] The coefficients of the model can be estimated by algorithmically minimizing the difference between the model output and corresponding measurement points of many (hundreds to thousands) medically imaged cochleae (in vivo and in vitro). The many imaged cochleae are labeled (measurements of the positions of the cochlear structures) using imaging software with measurement tools and / or automated processing software. The algorithms used to estimate the coefficients can include recursive least squares and / or optimization (e.g., Nelder-Mead (simplex algorithm), Newton conjugate gradient method).

[0068] Equations 1 through 4 are used to estimate points from the base to the apex of the cochlea, which materialize the tube, based on height from the base and angular deviation. Voxels are created based on the positions of groups of points that are closely adjacent to each other. These voxels are assigned physical and / or mechanical properties to control the placement of the stimulation assembly. For example, the physical properties of the cochlea make it physically impossible for the stimulation assembly to pass through the modiolar wall and / or the lateral wall.

[0069] Estimation of the location / positioning of stimulus components

[0070] In some exemplary embodiments, the placement (position and / or location) of the stimulation assembly inside the cochlea during insertion is estimated based on one or more intraoperative measurements (e.g., two-point impedance measurements, four-point impedance measurements, transimpedance measurements, etc.) In some embodiments, the intraoperative measurements can be combined with accelerometer measurements and / or other sensor measurements.

[0071] For example, when the stimulation assembly is being inserted into the cochlea, the electrodes of the electrode array will sequentially contact the fluid (lymph) of the cochlea, which in turn forms an electrical circuit, where the impedance measured will indicate a closed circuit. That is, during insertion, when the electrodes are inserted into the cochlea (and contact the fluid), open circuits are no longer recorded, and given the known physical dimensions of the stimulation assembly, the length of the stimulation assembly positioned inside the cochlea relative to the insertion point (e.g., the round window or cochlear fenestration) can be determined. For example, if electrodes 18-22 do not record an open circuit and electrodes 1-17 record an open circuit, then it is determined that the length of the array starting from electrode 18 and onward is inside the cochlea.

[0072] Furthermore, when the stimulation assembly is fully inserted into the cochlea, the features of the current transimpedance measurement and the historical transimpedance measurement can be input into a probabilistic model (summarized by Equation 5 below) to estimate the positional features of the stimulation assembly, such as the depth and angle of electrode insertion adjacent to the modiolar wall. The value of the placement feature with the highest probability is selected as the placement feature. The probabilistic model can be presented as Bayes (Naive Bayes), Hidden Markov Model (Hidden Markov Model), Bayesian Network (Bayesian Network) and other forms.

[0073] Equation 5:

[0074]

[0075] Where P(place 特征 ) is the given current transimpedance characteristic transimpedance 特征,t and historical transresistance characteristics 特征,t-i The probability of a placement feature occurring, ti is the previous time step, tn is the maximum previous time step, and is the probability uncertainty item.

[0076] At a given time t, placement features are used as anchor points to locate the stimulation assembly within the cochlea, with each electrode assigned a location in epipolar space. This allows any measurement taken at a specific electrode to be associated with the same location in the cochlea. Multiple intraoperative measurements of the same type associated at the same point in space can be aggregated to improve measurement accuracy.

[0077] Specific transimpedance signatures are a product of physical anomalies of the recipient's cochlea at certain locations. As different electrodes pass through these locations, they will record similar transimpedance signature values. When the stimulation assembly is being inserted, the locations inside the cochlea have measurements associated with them. Each electrode has its measurements (as a time series) discretized, and each discretized portion is compared to measurements at locations throughout the cochlea. If multiple electrodes record a high correlation with a specific location, then given the physical properties of the stimulation assembly (i.e., the spacing between the electrodes), it is possible to estimate the distance the stimulation assembly has traveled. The distance traveled estimate can be combined with other placement feature estimates to improve precision and accuracy.

[0078] In some examples, an accelerometer can be attached to / incorporated into a medical device used to insert the stimulation assembly, or an accelerometer probe can be attached to the leads of the stimulation assembly to capture accelerometer data indicating movement of the stimulation assembly. During insertion, the captured accelerometer data indicates one of forward movement into the cochlea, no movement, or reverse movement out of the cochlea. This movement data can be used, for example, to correct estimates of electrode position changes if changes in the positioning of the stimulation assembly are inconsistent.

[0079] In some embodiments, the system records that insertion has ceased when impedance or transimpedance data recorded over a specified time period records a minimum change threshold. Alternatively, the system records that insertion has ceased when accelerometer data indicates no movement for that period. Detection of such cessation of insertion of the stimulation component triggers the system (e.g., via software, logic, computer-readable instructions, etc.) to generate a neural viability map.

[0080] Process flow for generating neural survival maps

[0081] Figure 2 FIG. 2 is a procedural flow chart illustrating an exemplary method 200 for generating a neural survival map according to certain embodiments presented. Figure 2As shown in , after method 200 begins, at operation 210, the system generates a multidimensional geometric model of the cochlea. In some exemplary embodiments, operation 210 may include retrieving user input data indicating dimensions of the cochlea (e.g., length, width, height), and generating a multidimensional geometric model approximating the cochlea based on the user input data. In some other exemplary embodiments, operation 210 may include retrieving preoperative medical imaging scan data (e.g., CT, MRI, etc.), which is processed by an algorithm to generate voxels that capture the multidimensional structure of the cochlea as described above.

[0082] In some exemplary embodiments, the flow of method 200 may optionally include retrieving manual input from a user (e.g., a surgeon or other medical professional) to record that insertion of the stimulation assembly into the patient's cochlea has been initiated, which triggers operation 220. Alternatively, operation 220 may be triggered automatically based on the captured data.

[0083] At operation 220, during the insertion of the stimulation assembly into the cochlea, the system performs a plurality of intraoperative neural response measurements at a high temporal frequency during the insertion of the stimulation assembly into the cochlea. For example, while the insertion is ongoing, the cochlear implant system performs an alternating scheme of intraoperative measurements including impedance measurements and stimulation-induced electrically evoked compound action potential (ECAP) measurements. The ECAP measurements are processed to form neural response telemetry (NRT) measurements. Thus, operation 220 may include performing impedance measurements, performing ECAP measurements, generating NRT measurements from the ECAP measurements, or a combination thereof. These neural response measurements are stored in a memory as they are recorded. Storing the neural response measurements in a memory can help reduce or eliminate the need to use, for example, trial and error techniques. In some exemplary embodiments, operation 220 may also include mapping the internal structure of the cochlea while performing the intraoperative neural response measurements.

[0084] In addition, during insertion of the stimulation assembly into the cochlea, at operation 230, the system iteratively estimates the real-time position of the stimulation assembly within the cochlea relative to a multi-dimensional geometric model of the cochlea. While insertion is ongoing and measurements are being taken, a model that captures the relationship between these measurements and physical positioning features is used to estimate the placement (e.g., position and / or location) of the stimulation assembly within the cochlea with respect to the cochlear model. The estimate of the physical placement (position, location) of the stimulation assembly in the cochlea is then used to register (or "pair") intraoperative neural response measurements (e.g., ECAP, NRT) to the corresponding position / location of the stimulation assembly (and / or its respective electrodes) within the cochlea. In some exemplary embodiments, operation 230 may include performing impedance measurements, performing transimpedance measurements, performing accelerometer measurements, or a combination thereof.

[0085] In some exemplary embodiments, at operation 240, the system may optionally determine whether the stimulation assembly is still being inserted into the cochlea or whether insertion has ceased. While the stimulation assembly is still being inserted (no at operation 240), operations 220 and 230 are iteratively repeated. When the system determines that insertion has ceased (yes at operation 240), for example, by detecting a minimum change in the value of the intraoperative neural response measurement as described above, the flow of method 200 may proceed to operation 250. In some other exemplary embodiments, operation 240 may not be performed, in which case the flow of method 200 proceeds directly from operation 230 to operation 250.

[0086] In operation 250, the system analyzes the intraoperative neural response measurements relative to the estimated position of the stimulation assembly within the cochlea to generate a neural survival map of the cochlea. For example, neural measurements that have been registered (matched) to various locations of the cochlear model are processed to form the neural survival map.

[0087] Throughout the insertion process, the positioning of the stimulation assembly has been periodically / continuously estimated, where the electrodes of the electrode array of the stimulation assembly are assigned associated polar coordinates. When intraoperative measurements are taken during insertion, the intraoperative measurements are associated with the estimated position of the electrodes at a specific time point. Measures of neural activity (e.g., ECAP, NRT, etc.) are measured throughout the insertion and are associated with the positioning in the cochlea. Using a set of standard stimulation levels, a neural response baseline is created. At a set stimulation level, parts of the cochlea with more remaining neural tissue will evoke a larger measured response, while parts of the cochlea with less neural tissue will evoke a smaller measured response. The measures of neural activity are normalized.

[0088] Thus, the system is configured to provide stimulation at known current magnitudes and measure neural responses, where larger magnitude neural responses indicate higher neural survival and smaller magnitude neural responses indicate lower neural survival. By estimating the physical location of the stimulation component, the system can match these neural response measurements to the physical location in a map (e.g., a 2D map or a 3D map).

[0089] As described herein, the neural survival map (referring to Figure 3 The example shown in FIG ) highlights, for example, areas of high and low neural activity. In some exemplary embodiments, the generation of a neural survival map may allow for adjustment of the position of the stimulation component after its initial placement, as described below with reference to FIG Figure 4 and 5 Further described.

[0090] Figure 3 An exemplary neural survival map (or neural activity map) is shown in accordance with an exemplary embodiment. Figure 3The neural survival map 300 plots the neural health of the cochlea and can be used, for example, in Figure 2 310. Light shaded regions 314 and 318 adjacent to the modiolar wall 310 have measurements indicating low neural survival. Dark shaded regions 312 and 316 adjacent to the modiolar wall 310 have measurements indicating high neural survival. In other words, according to the mapping techniques described herein, regions 312 and 316 indicate good neural health in these regions, while regions 314 and 318 indicate poor neural health, with neuronal death in these regions. A particular region of high neural survival (region 316) is recorded between the angular deviations θ1 and θ2.

[0091] In some exemplary embodiments, the system can utilize one or more neural activity thresholds to distinguish between active regions of the cochlea (e.g., healthy / responsive / live regions 312, 316) that are targeted for alignment with the electrodes of the stimulation assembly and inactive regions of the cochlea (e.g., unhealthy / unresponsive / dead regions 314, 318) that are avoided from alignment with the electrodes of the stimulation assembly. In some exemplary embodiments, the system is configured to determine a selected placement of the stimulation assembly within the cochlea that maximizes coverage of active regions (e.g., healthy / responsive / live regions 312, 316) with high neural survival and / or minimizes coverage of inactive regions (e.g., unhealthy / unresponsive / dead regions 314, 318) with low neural survival.

[0092] Process flow for determining position adjustments to achieve selected placement

[0093] Figure 4 1 is a procedural flow chart illustrating an exemplary method 400 for determining positional adjustments to achieve a selected placement of a stimulation assembly within the cochlea, according to certain embodiments presented herein. Figure 4 As shown in FIG, at operation 410, the system obtains a neural survival map of the cochlea, wherein the stimulation assembly is at least partially inserted into the cochlea. The neural survival map can be obtained (e.g., retrieved) from memory, or can be obtained using, for example, Figure 2 The flow of the method 200 shown in is obtained, for example, by pairing intraoperative neural response measurements with, for example, an estimated position / location of a stimulation component within the cochlea.

[0094] Once the neural survival map is obtained at operation 410, the system determines a selected placement of the stimulation assembly within the cochlea based on the neural survival map at operation 420. For example, the selected placement can correspond to a selected placement of the stimulation assembly (and / or the location / positioning of its respective electrodes) calculated at operation 420 by employing an optimization algorithm to maximize coverage statistics (e.g., to maximize electrode alignment with active regions (healthy / responsive / live regions) and coverage of active regions) and / or to minimize electrode alignment with inactive regions (unhealthy / unresponsive / dead regions) and coverage of inactive regions (unhealthy / unresponsive / dead regions).

[0095] In certain embodiments, Figure 4 The selected placement (optimal position / location) of the stimulation assembly determined at operation 420 is the maximum collocation of the electrode with the area of ​​high or relatively high neural activity. For example, each electrode can have an associated collocation index, where the value of the collocation index is the amount of neural activity associated with the current positioning of the electrode in the cochlea. In some embodiments, the system attempts to maximize the summed collocation index by shifting the stimulation assembly to a hypothetical position in the cochlea, retrieving the collocation index for each electrode, and summing the collocation index.

[0096] As described, the frequency distribution of the cochlea is mapped according to the phoneme topology. In some examples, additional values ​​or weights are assigned to the summed collocation index of the hypothetical stimulation component positions based on the degree of coverage of multiple frequencies. Thus, the selected placement of the stimulation component (the calculated optimal position / location) corresponds to the hypothetical position / location of the stimulation component with the maximum summed collocation index.

[0097] In some exemplary embodiments, operation 420 includes determining a placement of the stimulation assembly that maximizes alignment of electrodes of the stimulation assembly with a population of surviving neural cells based on the neural survival map. In some exemplary embodiments, operation 420 includes identifying one or more "active regions" (regions with relatively high neural survival) of the cochlea having an amount of neural response activity above a threshold based on one or more intraoperative neural response measurements, and selecting a placement of the stimulation assembly that targets alignment of the one or more electrodes of the stimulation assembly with the one or more active regions of the cochlea. In some exemplary embodiments, operation 420 includes identifying one or more "inactive regions" (regions with low neural survival) of the cochlea having an amount of neural response activity above a threshold based on one or more intraoperative neural response measurements, and selecting a placement of the stimulation assembly that avoids alignment of the one or more electrodes of the stimulation assembly with the one or more inactive regions of the cochlea. In some exemplary embodiments, operation 420 may optionally include filtering possible placements of the stimulation assembly within the cochlea based on a multi-dimensional geometric model of the cochlea according to constraints that exclude physically unachievable locations using electrodes of a selected type of stimulation assembly.

[0098] At operation 430, the system obtains an estimated position of the stimulation assembly within the cochlea. In some exemplary embodiments, operation 430 includes estimating the current position of the stimulation assembly within the cochlea relative to a multi-dimensional geometric model of the cochlea. In some exemplary embodiments, operation 430 includes capturing one or more measurements (e.g., impedance measurements, transimpedance measurements, accelerometer measurements, or a combination thereof), and estimating the current position of the stimulation assembly within the cochlea based on the one or more measurements.

[0099] At operation 440, the system determines an adjustment to the position of the stimulation assembly within the cochlea to achieve the selected placement based on the estimated position of the stimulation assembly within the cochlea. For example, the system can determine a position / positioning difference between the current placement of the stimulation assembly and the selected placement (optimal position / positioning) of the stimulation assembly.

[0100] In some exemplary embodiments, operation 440 may include comparing the estimated position of the stimulation assembly within the cochlea to the selected placement of the stimulation assembly, and determining a direction (e.g., inward / distal / apical versus outward / proximal / basal) and magnitude (amount, distance, length, angular insertion depth, etc.) of the position adjustment based on the comparison.

[0101] In some exemplary embodiments, at operation 450, the system may generate an output representing positional adjustments to the stimulation assembly to achieve the selected placement (optimal position / position) of the stimulation assembly. In some examples (e.g., in the case of manual operation by a surgeon), operation 450 may include generating an output that displays a neural survival map and a representation of the positional adjustments to the stimulation assembly to achieve the selected placement (optimal position / position) of the stimulation assembly within the cochlea on a display device (e.g., for viewing by the surgeon). In other examples (e.g., in the case of automated operation by a robotic surgical device), operation 450 may include generating an output that controls the robotic surgical device to adjust the positioning of the stimulation assembly within the cochlea based on the positional adjustments to the stimulation assembly. After generating the output at operation 450 (e.g., displaying the output on a display device or transmitting the output to a surgical robot), the flow of method 400 may loop back to repeat operations 430 and 440 (e.g., to update the calculation results after the surgeon or surgical robot makes corresponding positional adjustments to the stimulation assembly).

[0102] In certain embodiments, at operations 440 and 450, the system may determine and provide recommendations for changing the insertion of the stimulation assembly. On several key electrodes, the electrode position / location difference between the current placement (current estimated position / location) and the selected placement (calculated optimal position / location) is the degree to which the stimulation assembly should be changed by the surgeon or surgical robot. This position adjustment value is calculated (in Figure 4), and can then be displayed to, for example, a surgeon or transmitted to a surgical robot (at operation 440 of Figure 4 As mentioned above, in addition to a magnitude component, a position adjustment may also have a direction component.

[0103] In some exemplary embodiments, at operation 460, the system may optionally determine whether the selected placement (optimal position / location) of the stimulation component has been achieved. If the selected placement has not been achieved (no at operation 460), then at operation 450, the system may generate an output representing an adjustment to the position of the stimulation component and repeat operations 430 and 440. If the selected placement of the stimulation component has been achieved (yes at operation 460), then Figure 4 The process of the method 400 ends. However, in some other exemplary embodiments, operation 460 may not be performed.

[0104] In some embodiments, the system may verify or confirm the selected placement of the stimulation component at operations 440 and 460. Once (e.g., Figure 4 After displaying the neural survival map and the calculated position adjustments to the stimulation assembly at operation 450 of FIG. 4 ), a new placement (position / location) of the stimulation assembly has occurred, the system recalculates the current estimated position of the stimulation assembly (repeated Figure 4 430), and again compare this current estimated position to the selected placement (optimal position / location) of the stimulation component (repeated Figure 4 Thus, if the current placement of the stimulation component (estimated current position / location) is different from the selected placement of the stimulation component (calculated optimal position / location) (in Figure 4 If the result of operation 460 is no, the system recalculates the amount by which the stimulation component should be changed (repeated Figure 4 Operation 440) and present the recalculated amount to the user (repeated Figure 4 If the current placement of the electrode array is equivalent to the selected placement of the stimulation assembly (in Figure 4 460 is yes), then Figure 4 The process of method 400 ends.

[0105] Thus, the system is configured to make a final estimate of the placement of the stimulation assembly within the cochlea at the end of insertion and determine whether the current placement is optimally aligned with an area of ​​high neural survival. If not, the system is configured to estimate the extent to which the stimulation assembly should be manipulated or adjusted to move it to an optimal position in order to improve alignment of the stimulation assembly's electrodes with the area of ​​high neural survival.

[0106] As described herein, neural survival maps (which highlight areas of high and low neural activity) and representations of positional adjustments to the stimulation components (refer to Figure 5 ) may allow for optimized adjustment of the position / location of the stimulation assembly within the cochlea after the stimulation assembly has been initially placed at least partially within the cochlea.

[0107] Figure 5 FIG shows a neural survival map (or neural activity map) and a representation of position adjustment of a stimulation component according to an exemplary embodiment. Figure 4 At operation 450, Figure 5 The neural survival map 500 may be displayed on a display device. The neural survival map 500 indicates the current placement 512 of the stimulation component (e.g., Figure 4 430) will cause a position adjustment 516 (e.g., Figure 4 440 ) to achieve the selected placement 514 of the stimulation component (e.g., at Figure 4 4 (determined at operation 420 of FIG. 4 ) to achieve optimal alignment (or at least improved alignment) of the stimulation assembly's electrodes 144 (forming the electrode array 146) with the active regions (dark gray shaded regions) with higher neural viability (e.g., healthy / responsive / live regions 316). In this case, the position adjustment 516 indicates the difference in angular insertion depth (magnitude component) by which the stimulation assembly should be inserted further into the cochlea (direction component).

[0108] Thus, the system described herein is configured to generate a graphical user interface (GUI) element that displays an image of the cochlea, distinguishes areas with higher neural survival from areas with lower neural survival, and indicates the current placement (current position / positioning) of the stimulation assembly with respect to the selected placement (optimal position / positioning) of the stimulation assembly. Furthermore, the system can provide guidance on how to manipulate or adjust the stimulation assembly to actually achieve the best or ideal placement within the cochlea (e.g., insert 1 mm further, pull back 1 mm). The system can iteratively rerun the measurements and repeat the calculations in a loop until the system detects that the selected placement has been achieved.

[0109] Application in robot-assisted surgery

[0110] In some exemplary embodiments, the systems and techniques described herein can be applied to perform robotic-assisted surgery. Robotic-assisted surgery involves inserting a stimulation assembly into the cochlea using motions provided by electronically controlled actuators. Because the actuators are electronically controlled, the length of the stimulation assembly within the cochlea is known with high precision. This minimizes errors in the positional estimation of the stimulation assembly throughout the procedure and enables more accurate Monte Carlo stimulation assembly placement algorithms and subsequent neural survival mapping.

[0111] At the end of insertion, using a more accurate estimate of the current placement of the stimulation assembly within the cochlea (current estimated position / location), the neural survival map, and the selected placement (optimal position / location), the actuator can precisely change the position / location of the stimulation assembly to the selected placement (optimal position / location). Thus, in exemplary embodiments involving robotic-assisted surgery, the placement of the stimulation assembly can be controlled to a finer degree. Further constraints can be utilized to provide realistic motions to the surgeon and / or robot (e.g., some positions of the stimulation assembly or its respective electrodes within the cochlea may not be physically achievable using the selected type of electrode and, therefore, can be excluded from consideration by the system).

[0112] Other exemplary applications of systems and techniques

[0113] In some exemplary embodiments, the systems and techniques described herein can be combined with electrocochlear mapping (ECochG) technology, which is used to assess cochlear hair cell survival rather than neural survival. Mapping at the time of surgery provides information about nerve potentials, but may not necessarily correlate with neural survival post-implantation. Because the measurements are taken as the electrodes of the stimulation assembly pass through a certain area, some insertion trauma may not be accounted for in the systems and methods described above. Therefore, ECochG technology can be combined with the systems and methods described herein to provide more real-time information about electrode events that cause possible changes in neural survival.

[0114] In some exemplary embodiments, the systems and techniques described herein can be applied during a first fitting to generate a graph indicating "comfort levels" (C-levels) and "threshold levels" (T-levels). In certain embodiments, the magnitude of neural survival is inversely correlated with the degree of electrical stimulation required at a given sound presentation level. For a given electrode, if neural survival is high, a lower degree of electrical stimulation is required, meaning that the electrode has a relatively low comfort level (or "C-level") and a low threshold level (or "T-level"). If neural survival is low for a given electrode, a greater degree of electrical stimulation is required, and thus the C-level and T-level will be relatively high for that electrode. The techniques described above can also include generating a graph of T-levels and C-levels for the electrode array. In some exemplary embodiments, a transformation algorithm relies on an inverse correlation to derive an initial estimate of the C-level. A neural survival indicator is retrieved for each electrode based on positional collocation in a mathematical cochlear model. The transformation algorithm first derives the C-level based on the inverse of the magnitude of neural survival. Each set of C-levels is rescaled in range and magnitude based on the standard magnitude from the first fitting. The T-level is derived from the C-level by subtracting the standard magnitude difference. A map of the electrode's T-level and C-level is transmitted to the patient's clinic for the first fitting. The clinician can then use this map to adjust the T-level and C-level to better suit the patient during the first fitting after implantation of the electrode array.

[0115] Summary and illustrative advantages

[0116] Therefore, according to the above and with reference to Figure 2 、 3 , 4, 5 described (and also referred to below Figure 8 In certain exemplary embodiments described herein, the present invention provides new systems and techniques that utilize neural response measurements that are captured throughout the surgical implantation of a stimulation assembly into a recipient's cochlea to estimate the extent of neural survival, which are further combined with electrode position estimates to help match the placement of the stimulation assembly (e.g., electrodes of an electrode array) with areas of the cochlea with high neural survival by optimizing the electrode position / positioning within the cochlea based on the neural response measurements. The techniques involve registering neural activity measurements (e.g., NRT, etc.) to intra-cochlear positioning during insertion. The techniques also involve prompting the surgeon (or controlling a surgical robot) to adjust the position of the stimulation assembly to achieve better alignment with areas with heterogeneous neural survival. In some exemplary embodiments, intra-cochlear positioning can be obtained by impedance-based measurements (although other measurements can also be used). The present disclosure encompasses a range of inputs that can be used to provide a neural survival map and prompt optimization of the insertion of the stimulation assembly and the corresponding position / positioning of its individual electrodes.

[0117] Example use cases and applications

[0118] As previously stated, the technology disclosed herein can be applied to any of a variety of situations and used with a variety of different medical devices. Figure 6 and 7 Exemplary medical devices that may benefit from the techniques disclosed herein are described in greater detail in

[0010] As described below, reference medical devices may be configured according to the techniques described herein. Figure 6 and 7 The technology of the present disclosure can be applied to other medical devices, such as neurostimulators, pacemakers, defibrillators, sleep apnea management stimulators, epilepsy treatment stimulators, tinnitus management stimulators, and vestibular stimulation devices, as well as other medical devices that deliver stimulation to tissue to the extent that the operating parameters of such devices can be customized based on the posture of the user receiving the device. In addition, the technology described herein can also be applied to consumer devices. These different systems and devices can benefit from the technology described herein. For example, the operating technology of the present disclosure can be applied to consumer or commercial grade headphones or earbud products.

[0119] Figure 6 6 is a functional block diagram of an implantable stimulator system 600 that can benefit from the technology described herein. The implantable stimulator system 600 includes a wearable device 100 that acts as an external processor device and an implantable device 30 that acts as an implantable stimulator device. In an example, the implantable device 30 is an implantable stimulator device that is configured to be implanted beneath the user's tissue (e.g., skin). In an example, the implantable device 30 includes a biocompatible implantable housing 602. Here, the wearable device 100 is configured to be percutaneously coupled to the implantable device 30 via a wireless connection to provide additional functionality to the implantable device 30.

[0120] In the illustrated example, wearable device 100 includes one or more sensors 612, a processor 614, a transceiver 618, and a power supply 648. The one or more sensors 612 may be one or more units configured to generate data based on sensed activity. In the example where stimulation system 600 is a hearing prosthesis system, the one or more sensors 612 include a sound input sensor, such as a microphone, an electrical input for a frequency modulated (FM) hearing system, other components for receiving sound input, or a combination thereof. In the case where stimulation system 600 is a visual prosthesis system, the one or more sensors 612 may include one or more cameras or other visual sensors. In the case where stimulation system 600 is a cardiac stimulator, the one or more sensors 612 may include a cardiac monitor. Processor 614 may be a component (e.g., a central processing unit) configured to control the stimulation provided by implantable device 30. Stimulation may be controlled based on data from the one or more sensors 612, a stimulation schedule, or other data. In the case where stimulation system 600 is a hearing prosthesis, processor 614 may be configured to convert sound signals received from sensor(s) 612 (e.g., acting as sound input units) into signal 651. The transceiver 618 is configured to transmit a signal 651 in the form of a power signal, a data signal, a combination thereof (e.g., by interleaving the signal), or other signals. The transceiver 618 may also be configured to receive power or data. A stimulation signal may be generated by the processor 614 and transmitted to the implantable device 30 using the transceiver 618 for providing stimulation.

[0121] In the illustrated example, implantable device 30 includes a transceiver 618, a power source 648, and a medical device 611 including an electronics module 610 and a stimulation assembly 630. Implantable device 30 also includes a hermetically sealed biocompatible implantable housing 602 that encloses one or more of the components.

[0122] The electronic module 610 may include one or more other components to provide medical device functions. In many examples, the electronic module 610 includes one or more components for receiving the signal 651 and converting the signal 651 into a stimulation signal 615. The electronic module 610 may also include a stimulator unit. The electronic module 610 may generate the stimulation signal 615 or control the delivery of the stimulation signal to the stimulation component 630. In an example, the electronic module 610 includes one or more processors (e.g., a central processing unit or a microcontroller) coupled to a memory component (e.g., a flash memory) that stores instructions that, when executed, cause an operation to be performed. In an example, the electronic module 610 generates and monitors parameters associated with generating and delivering stimulation (e.g., output voltage, output current, or line impedance). In an example, the electronic module 610 generates a telemetry signal (e.g., a data signal) including telemetry data. The electronic module 610 may send the telemetry signal to the wearable device 100 or store the telemetry signal in a memory for later use or retrieval.

[0123] The stimulation component 630 can be a component configured to provide stimulation to the target tissue. In the example shown, the stimulation component 630 is an electrode assembly that includes an array of electrode contacts arranged on a lead. The lead can be arranged near the tissue to be stimulated. In the case where the system 600 is a cochlear implant system, the stimulation component 630 can be inserted into the user's cochlea. The stimulation component 630 can be configured to deliver the stimulation signal 615 (e.g., an electrical stimulation signal) generated by the electronic module 610 to the cochlea so that the user experiences hearing perception. In other examples, the stimulation component 630 is a vibration actuator that is arranged inside or outside the housing of the implantable device 30 and is configured to generate vibrations. The vibration actuator receives the stimulation signal 615 and generates a mechanical output force in the form of vibrations based on the stimulation signal. The actuator can deliver the vibrations to the user's skull in a manner that produces movement or vibration of the user's skull, thereby generating hearing perception by activating the hair cells in the user's cochlea through the movement of the cochlear fluid.

[0124] The transceiver 618 may be a component configured to transcutaneously receive and / or transmit a signal 651 (e.g., a power signal and / or a data signal). The transceiver 618 may be a collection of one or more components that form part of a transcutaneous energy or data transmission system to transmit the signal 651 between the wearable device 100 and the implantable device 30. Various types of signal transmission, such as electromagnetic, capacitive, and inductive transmission, may be used to effectively receive or transmit the signal 651. The transceiver 618 may include or be electrically connected to the coil 20.

[0125] As shown, wearable device 100 includes coil 108 for transcutaneously transmitting signals with coil 20. As described above, transcutaneously transmitting signals between coil 108 and coil 20 may include transmitting power and / or data from coil 108 to coil 20 and / or transmitting data from coil 20 to coil 108. Power source 648 may be one or more components configured to provide operating power to other components. Power source 648 may be or include one or more rechargeable batteries. Power from the batteries may be received from the power source and stored in the batteries. The power may then be distributed to other components as needed for operation.

[0126] It should be understood that although the Figure 6 Although specific components are described, the technology disclosed herein can be applied to any of a variety of situations. The above discussion is not intended to imply that the disclosed technology is only suitable for use in situations similar to those in Figure 6 Generally speaking, the methods and systems herein may be practiced using additional configurations and / or some aspects described may be eliminated without departing from the methods and systems disclosed herein.

[0127] Figure 7 An exemplary vestibular nerve stimulator system 702 is shown, which can be used to implement the embodiments presented herein. As shown, the vestibular nerve stimulator system 702 includes an implantable component (vestibular stimulator) 712 and an external device / component 704 (e.g., an external processing device, a battery charger, a remote control, etc.). The external device 704 includes a transceiver unit 760. As such, the external device 704 is configured to transmit data (and possibly power) to the vestibular stimulator 712. The external device 704 may also include a controller that is connected to the external device 704. Figure 1D The inertial measurement unit 170 is similar to the inertial measurement unit.

[0128] The vestibular stimulator 712 includes an implant body (main module) 734, a lead region 736, and a stimulation assembly 716, all configured to be implanted beneath the skin (tissue) 715 of a user. The implant body 734 generally includes an airtight sealed housing 738 in which are disposed an RF interface circuit system, one or more rechargeable batteries, one or more processors, and a stimulator unit. The implant body 134 also includes an internal / implantable coil 714, which is generally external to the housing 738 but connected to the transceiver via an airtight feedthrough (not shown). The implant body 734 may also include a transceiver. Figure 1D The inertial measurement unit 180 is similar to the inertial measurement unit.

[0129] The stimulation assembly 716 includes a plurality of electrodes 744(1)-(3) disposed in a carrier member (e.g., a flexible silicone body). In this particular example, the stimulation assembly 716 includes three (3) stimulation electrodes, referred to as stimulation electrodes 744(1), 744(2), and 744(3). The stimulation electrodes 744(1), 744(2), and 744(3) serve as an electrical interface for delivering electrical stimulation signals to the vestibular system of the user.

[0130] The stimulation assembly 716 is configured so that a surgeon can implant the stimulation assembly near the user's otolith organ via, for example, the user's oval window. It should be understood that this particular embodiment with three stimulation electrodes is merely illustrative, and the techniques presented herein can be used with stimulation assemblies having different numbers of stimulation electrodes, stimulation assemblies having different lengths, etc.

[0131] In operation, the vestibular stimulator 712, the external device 704, and / or another external device can be configured to implement the techniques presented herein. That is, the vestibular stimulator 712, possibly in combination with the external device 704 and / or another external device, can include an induced bio-response analysis system as described elsewhere herein.

[0132] Figure 8 is a flow chart of an exemplary method 800 for generating a neural viability map of the cochlea, according to certain embodiments presented herein, which may be implemented using the systems described herein. Figure 8 As shown in , after the process starts, at operation 810, the system obtains a plurality of evoked responses during insertion of the stimulation assembly into the cochlea. In some exemplary embodiments, operation 810 includes iteratively delivering an electrical stimulation signal to the cochlea, and capturing an electrically evoked compound action potential (ECAP) in response to each iteration of the electrical stimulation signal delivered to the cochlea.

[0133] Furthermore, during insertion of the stimulation assembly into the cochlea, at operation 820, the system obtains an estimate of the position of the stimulation assembly within the cochlea. For example, operation 820 may include iteratively estimating the positioning of the stimulation assembly relative to a multi-dimensional geometric model of the cochlea. In some examples, operation 820 may include capturing multiple impedance measurements (e.g., two-point impedance measurements, two-point transimpedance measurements, or a combination thereof) and determining the position estimate based at least in part on the impedance measurements. In other examples, operation 820 may include capturing multiple accelerometer measurements and determining the position estimate based at least in part on the accelerometer measurements.

[0134] At operation 830, the system then generates a neural survival map of the cochlea based on the evoked responses and the position estimates. In some exemplary embodiments, each of the plurality of evoked responses is registered to (or paired with) a position estimate of the plurality of position estimates to generate the neural survival map.

[0135] In some exemplary embodiments, the neural survival map may be used to determine a selected placement (optimal position / location) of the stimulation assembly within the cochlea, and position adjustments to the stimulation assembly to achieve the selected placement are determined based on the current estimated position of the stimulation assembly.

[0136] In some exemplary embodiments, the position adjustments can be output (e.g., displayed to the surgeon on a display device, or transmitted to control a surgical robot) to allow manual or automatic positional adjustments of the stimulation assembly to achieve a selected placement (optimal position / location) of the stimulation assembly within the cochlea.

[0137] Additional variants and alternatives

[0138] It should be understood that while specific uses of the present technology have been illustrated and discussed above, the disclosed technology can be used with a variety of devices according to many examples of the present technology. The above discussion is not intended to indicate that the disclosed technology is only suitable for implementation within systems similar to those shown in the accompanying drawings. In general, the processes and systems herein can be practiced using additional configurations and / or some of the described aspects can be excluded without departing from the processes and systems disclosed herein.

[0139] This disclosure describes certain aspects of the present technology with reference to the accompanying drawings, which illustrate only some possible aspects. However, other aspects may be embodied in many different forms and should not be construed as limited to the aspects set forth herein. Rather, these aspects are provided so that this disclosure will be thorough and complete and will fully convey the scope of possible aspects to those skilled in the art.

[0140] It should be understood that the various aspects (e.g., parts, components, etc.) described herein with respect to the figures are not intended to limit the systems and processes to the specific aspects described. Therefore, additional configurations can be used to practice the methods and systems herein, and / or some of the described aspects can be excluded without departing from the methods and systems disclosed herein.

[0141] According to certain aspects, a system and non-transitory computer-readable storage medium are provided. The system is configured with hardware configured to perform operations similar to the methods of the present disclosure. One or more non-transitory computer-readable storage media include instructions that, when executed by one or more processors, cause the one or more processors to perform operations similar to the methods of the present disclosure.

[0142] Similarly, where process steps are disclosed, these steps are described for the purpose of illustrating the present methods and systems and are not intended to limit the present disclosure to a particular sequence of steps. For example, the steps may be performed in a different order, two or more steps may be performed simultaneously, additional steps may be performed, and disclosed steps may be eliminated without departing from the present disclosure. Furthermore, the disclosed processes may be repeated.

[0143] Although specific aspects are described herein, the scope of the present technology is not limited to these specific aspects. Those skilled in the art will recognize other aspects or improvements within the scope of the present technology. Therefore, specific structures, actions, or media are disclosed only as illustrative aspects. The scope of the present technology is defined by the following claims and any equivalents therein.

[0144] It should be understood that the embodiments presented herein are not mutually exclusive and that various embodiments can be combined with another embodiment in any of a variety of different ways.

Claims

1. A method comprising: obtaining a plurality of evoked responses from the cochlea during insertion of the stimulation assembly into the cochlea; obtaining a plurality of position estimates of the stimulation assembly within the cochlea during insertion of the stimulation assembly into the cochlea; as well as A neural viability map of the cochlea is generated based on the plurality of evoked responses and the plurality of position estimates.

2. The method of claim 1 , wherein generating the neural viability map of the cochlea based on the plurality of evoked responses and the plurality of position estimates comprises: Each evoked response in the plurality of evoked responses is paired with a position estimate in the plurality of position estimates.

3. The method according to claim 1, further comprising: generating a multidimensional geometric model of the cochlea, Wherein obtaining the plurality of position estimates of the stimulation component within the cochlea comprises: The positioning of the stimulation component relative to the multi-dimensional geometric model is iteratively estimated.

4. The method of claim 1 , wherein obtaining the plurality of evoked responses during insertion of the stimulation assembly into the cochlea comprises: iteratively delivering an electrical stimulation signal to the cochlea; as well as In response to each iteration of the electrical stimulation signal delivered to the cochlea, an electrically evoked compound action potential (ECAP) is captured.

5. The method of claim 1 , 2 or 3 , wherein obtaining the plurality of position estimates of the stimulation component within the cochlea comprises: Capture multiple impedance measurements; as well as The plurality of position estimates are determined based at least in part on the plurality of impedance measurements. The method of claim 5 , wherein the plurality of impedance measurements comprises two-point impedance measurements. The method of claim 5 , wherein the plurality of impedance measurements comprises transimpedance measurements.

8. The method of claim 1 , 2 or 3 , wherein obtaining the plurality of position estimates of the stimulation component within the cochlea comprises: Capture multiple accelerometer measurements; as well as The plurality of position estimates are determined based at least in part on the plurality of accelerometer measurements.

9. A method comprising: performing a plurality of intraoperative neural response measurements of the cochlea during insertion of the stimulation assembly into the cochlea; during insertion of the stimulation assembly into the cochlea, iteratively estimating a position of the stimulation assembly within the cochlea relative to a multi-dimensional geometric model of the cochlea; as well as The intraoperative neural response measurements are analyzed relative to an estimated position of the stimulation assembly within the cochlea to generate a neural viability map of the cochlea.

10. The method according to claim 9, further comprising: retrieving at least one of pre-operative medical imaging scan data or user input data describing dimensions of the cochlea, wherein the dimensions include a length, a width, and a height of the cochlea; as well as The multi-dimensional geometric model of the cochlea is generated based on the at least one of the pre-operative medical imaging scan data or the user input data describing the dimensions of the cochlea.

11. The method according to claim 9, further comprising: An internal structure of the cochlea is mapped while performing the plurality of intraoperative neural response measurements.

12. The method of claim 9, 10, or 11, wherein performing the plurality of intraoperative neural response measurements during insertion of the stimulation assembly into the cochlea comprises: Perform electrically evoked compound action potential (ECAP) measurements.

13. The method of claim 9, 10, or 11, wherein during insertion of the stimulation assembly into the cochlea, iteratively estimating the position of the stimulation assembly within the cochlea comprises at least one of: Perform two-point impedance measurements; Perform four-point impedance measurements; Perform a transimpedance measurement; or Perform accelerometer measurements.

14. The method according to claim 9, 10 or 11, further comprising: A determination is made as to whether the stimulation assembly is still being inserted into the cochlea or whether insertion has ceased.

15. The method according to claim 9, 10 or 11, further comprising: determining a selected placement of the stimulation assembly within the cochlea based on the neural viability map; as well as Based on the current estimated position of the stimulation assembly within the cochlea, a position adjustment of the stimulation assembly is determined for achieving the selected placement of the stimulation assembly within the cochlea.

16. The method of claim 15, wherein the stimulation assembly comprises a plurality of electrodes, and wherein determining the selected placement of the stimulation assembly comprises: A placement of the stimulation assembly that maximizes alignment of the plurality of electrodes with a population of viable neural cells is determined based on the neural survival map.

17. The method of claim 15, wherein determining the position adjustment of the stimulation component comprises: comparing a current estimated position of the stimulation assembly within the cochlea to the selected placement of the stimulation assembly; as well as A direction and magnitude of the position adjustment is determined based on the comparison.

18. The method according to claim 15, further comprising: An output is generated, the output representing at least the positional adjustment of the stimulation component to achieve the selected placement of the stimulation component.

19. The method according to claim 15, further comprising: estimating a comfort level for electrodes of the stimulation assembly based on the placement of the electrodes in the multidimensional geometric model of the cochlea and corresponding intraoperative neural response measurements; deriving a threshold level (T-level) for the electrodes of the stimulation assembly based on the comfort level; and A map of the comfort level and the threshold level for the electrodes of the stimulation assembly is generated.

20. A method comprising: obtaining a neural viability map of a cochlea in which a stimulation assembly is at least partially inserted; determining a selected placement of the stimulation assembly within the cochlea based on the neural viability map of the cochlea; obtaining an estimated position of the stimulation component within the cochlea; as well as Based on the estimated position of the stimulation assembly within the cochlea, a position adjustment of the stimulation assembly is determined for achieving the selected placement of the stimulation assembly within the cochlea.

21. The method of claim 20, wherein obtaining the neural survival map comprises: The neural survival map is obtained from a memory of a computing device.

22. The method of claim 20, wherein obtaining the neural survival map comprises: obtaining a multidimensional geometric model of the cochlea; While the stimulation assembly is being inserted into the cochlea, iteratively: performing a plurality of intraoperative neural response measurements while delivering electrical stimulation signals to the cochlea; as well as estimating a position of the stimulation component within the cochlea relative to the multidimensional geometric model of the cochlea; as well as The intraoperative neural response measurements are analyzed relative to an estimated position of the stimulation assembly within the cochlea to generate the neural viability map of the cochlea.

23. The method according to claim 22, further comprising: estimating a comfort level for electrodes of the stimulation assembly based on the placement of the electrodes in the multidimensional geometric model of the cochlea and corresponding intraoperative neural response measurements; deriving a threshold level for the electrodes of the stimulation assembly based on the comfort level; as well as A map of the comfort level and the threshold level for the electrodes of the stimulation assembly is generated.

24. The method of claim 20, 21, 22, or 23, wherein the stimulation assembly comprises a plurality of electrodes, and wherein determining the selected placement of the stimulation assembly comprises: A placement of the stimulation assembly that maximizes alignment of the plurality of electrodes with a population of viable neural cells is determined based on the neural survival map.

25. The method of claim 20, 21, 22, or 23, wherein determining the selected placement of the stimulation component comprises: identifying one or more active regions of the cochlea having an amount of neural response activity above a threshold based on one or more of a plurality of intraoperative neural response measurements; as well as The placement of the stimulation assembly is selected with the goal of aligning one or more electrodes of the stimulation assembly with the one or more active areas of the cochlea.

26. The method of claim 20, 21, 22, or 23, wherein determining the selected placement of the stimulation component comprises: identifying one or more inactive regions of the cochlea having an amount of neural response activity below a threshold based on one or more of the plurality of intraoperative neural response measurements; as well as A placement of the stimulation assembly is selected that avoids alignment of one or more electrodes of the stimulation assembly with the one or more inactive regions of the cochlea.

27. The method of claim 20, 21, 22, or 23, wherein determining the selected placement of the stimulation component comprises: Based on the multi-dimensional geometric model of the cochlea, possible placements of the stimulation assembly within the cochlea are filtered according to constraints that exclude physically unachievable positions of electrodes of the selected type using the stimulation assembly.

28. The method of claim 20, 21, 22, or 23, wherein obtaining the estimated position of the stimulation component within the cochlea comprises: A current position of the stimulation assembly within the cochlea is estimated relative to a multi-dimensional geometric model of the cochlea.

29. The method of claim 20, 21, 22, or 23, wherein obtaining the estimated position of the stimulation component within the cochlea comprises: capturing one or more measurements, wherein the one or more measurements include at least one of an impedance measurement, a transimpedance impedance measurement, an accelerometer measurement, or a combination thereof; as well as Based on the one or more measurements, a current position of the stimulation assembly within the cochlea is estimated.

30. The method of claim 20, 21, 22, or 23, wherein determining the position adjustment of the stimulation component comprises: comparing the estimated position of the stimulation assembly within the cochlea to the selected placement of the stimulation assembly; as well as A direction and magnitude of the position adjustment is determined based on the comparison.

31. The method of claim 20, 21, 22, or 23, further comprising: An output is generated, the output representing at least the positional adjustment of the stimulation component to achieve the selected placement of the stimulation component.

32. The method of claim 31 , wherein generating the output comprises: An output is generated that displays the neural viability map and a representation of the position adjustment to the stimulation assembly on a display device.

33. The method of claim 31 , wherein generating the output comprises: An output is generated that controls a robotic surgical device to adjust positioning of the stimulation assembly within the cochlea based on the positional adjustment of the stimulation assembly.

34. The method of claim 20, 21, 22, or 23, further comprising: A determination is made as to whether the selected placement of the stimulation component has been achieved.

35. One or more non-transitory computer-readable storage media comprising instructions that, when executed by a processor, cause the processor to: obtaining a plurality of evoked responses during insertion of the stimulation assembly into a body cavity of a recipient; during insertion of the stimulation assembly into the body cavity of the recipient, obtaining a plurality of position estimates of the stimulation assembly within the body cavity; as well as A neural viability map of the body cavity is generated based on the plurality of evoked responses and the plurality of position estimates.

36. The one or more non-transitory computer-readable storage media of claim 35, wherein the body cavity is an inner ear of the recipient.

37. The one or more non-transitory computer-readable storage media of claim 35, wherein the body cavity is a cochlea of ​​the recipient.

38. The one or more non-transitory computer-readable storage media of claim 35, 36, or 37, further comprising instructions operable to: Each evoked response in the plurality of evoked responses is paired with a position estimate in the plurality of position estimates.

39. The one or more non-transitory computer-readable storage media of claim 35, 36, or 37, further comprising instructions operable to: determining a selected placement of the stimulation assembly within the body cavity based on the neural viability map; and Based on the current estimated position of the stimulation assembly within the cochlea, a position adjustment of the stimulation assembly is determined for achieving the selected placement of the stimulation assembly within the body cavity.

40. A system comprising: Display screen; a memory storing computer-readable instructions; as well as at least one processor operably coupled to the display screen and the memory, wherein the at least one processor is configured to: obtaining a plurality of intraoperative neural response measurements captured during insertion of the stimulation assembly into the body cavity, obtaining a plurality of position estimates of the stimulation component within the body cavity relative to a multi-dimensional geometric model of the body cavity; as well as The plurality of intraoperative neural response measurements are analyzed relative to an estimated position of the stimulation assembly within the body cavity to generate a neural viability map of the body cavity.

41. The system of claim 40, wherein the body cavity is the cochlea of ​​the recipient.

42. The system of claim 40 or 41, wherein the at least one processor is configured to: retrieving at least one of pre-operative medical imaging scan data or user input data describing dimensions of the body cavity, wherein the dimensions include a length, a width, and a height of the body cavity; and The multi-dimensional geometric model of the body cavity is generated based on the at least one of the pre-operative medical imaging scan data or the user input data describing the dimensions of the body cavity.

43. The system of claim 40 or 41, wherein the at least one processor is configured to: determining a selected placement of the stimulation assembly within the body cavity based on the neural viability map; and Based on the current estimated position of the stimulation assembly within the body cavity, a position adjustment of the stimulation assembly is determined for achieving the selected placement of the stimulation assembly within the body cavity.

44. The system of claim 43, wherein the stimulation assembly comprises a plurality of electrodes, and wherein to determine the selected placement of the stimulation assembly, the at least one processor is configured to: A placement of the stimulation assembly that maximizes alignment of the plurality of electrodes with a population of viable neural cells is determined based on the neural survival map.

45. The system of claim 43, wherein the at least one processor is configured to: An output is generated, the output representing at least the positional adjustment of the stimulation component to achieve the selected placement of the stimulation component.

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