Surgical navigation system and navigation method

Abstract

The present disclosure relates to a surgical navigation system (1) for intraoperative guidance at a patient (P) with the aid of a surgical map (L), comprising: a first acquisition modality (2) which is adapted to acquire at least one predefined region of a tissue of the patient (P) as first recording (8) with recording position data; a second acquisition modality (10) which differs from the first acquisition modality and which is adapted to acquire the predefined region of the tissue of the patient (P) as second recording (16) with recording position data; a memory unit (18) in which the two-dimensional or three-dimensional surgical map (L) relating to the patient (P) is stored, with both a first numerical pathological value and a second numerical functional value of the tissue being stored for each position in the surgical map (L); a control unit (20) which is adapted to do the following: for the first acquisition modality (2), analyze and determine the first recording (8) to the effect of a pathological value and / or a functional value being assigned to at least one portion of the tissue in the first recording (8), with these pathological or functional values being supplemented at the associated position in the surgical map (L); for the second acquisition modality (10), analyze and determine the second recording to the effect of a pathological value and / or a functional value being assigned to at least one portion of the tissue in the second recording, with these pathological or functional values being supplemented at the associated position in the surgical map (L); and visually output a view of the surgical map (L) for navigation assistance purposes via a display device (22). The disclosure also relates to a navigation method and to a computer-readable storage medium and computer program according to the alternative independent claims.

Description

[0001] Surgical navigation system and navigation procedure

[0002] Description

[0003] Technical area

[0004] The present disclosure relates to a surgical navigation system for intraoperative guidance, for example of a surgical instrument, during a surgical procedure to remove a tumor in a patient using a surgical map. For this purpose, the navigation system has a first acquisition modality, in particular a CT imaging device and / or an MRI imaging device, which is adapted to acquire at least a predefined region of a patient's tissue preoperatively and / or intraoperatively as a first image with image position data on the basis of a first acquisition modality and to provide said image in a computer-readable format. This means that a position of the image relative to a patient is also available as data for the first image, so that the image can also be spatially assigned relative to the patient. For example, in an MRI image, the position of the tissue is also provided as image position data.In addition, the present disclosure relates to a navigation method for intraoperative guidance, a computer-readable storage medium and a computer program according to the preambles of the independent claims.

[0005] Technical background of the present disclosure

[0006] In brain surgery, neurosurgeons are often faced with the decision of determining the boundaries of pathological tissue, especially tumor tissue, in order to remove as much tumor as possible while preserving as much healthy tissue (functional tissue) as possible and minimizing functional damage. To this end, various modalities are used intraoperatively to either identify pathological tissue or detect critical structures (functional tissue) that need to be protected.

[0007] Magnetic resonance imaging (MRI) or computed tomography (CT) scans, for example, can be used to identify both pathological structures and critical structures that must be preserved during the procedure. The same applies to intraoperative microscopy (Z-scans). Detection can be performed automatically, for example, by a trained AI system, or manually by a physician.

[0008] Fluorescence imaging, such as 5-ALA, is used to identify tumor tissue, i.e. pathological tissue.

[0009] Intraoperative electrophysiological signals, on the other hand, are used to identify important functional tissue to be preserved, such as important nerves.

[0010] Intraoperative histological data collected from samples are used to identify (pointwise or region-wise) both pathological and healthy tissue, depending on the analysis result.

[0011] The imaging modalities mentioned above, such as MRI / CT, ​​microscopy, or fluorescence, unfortunately have the disadvantage that they are not always precise in distinguishing between pathological and healthy tissue. Furthermore, these techniques have the disadvantage that they are generally not spatially assigned or correlated, i.e., they are not provided in a comprehensive map. Electrophysiological and histological data are more precise and differentiated, but are only available for individual regions of the anatomy. These limitations mean that the surgeon does not receive a homogeneous image of the surgical field to reliably distinguish between pathological and healthy tissue. Although surgeons use different modalities, uncertainty remains as to where the boundaries of the pathological tissue should actually be defined.

[0012] Summary of the present disclosure

[0013] The objects and aims of the present disclosure are therefore to avoid or at least mitigate the disadvantages of the prior art and, in particular, to provide a navigation system, a navigation method, a computer-readable storage medium, and a computer program that provides visual assistance during the removal of pathological tissue, in particular tumor removal, to reliably and intuitively show the surgeon a resection area and to display an area of ​​particular caution, for example, an area of ​​functional, vital tissue such as nerves, in order to thus enable safe navigation and resection. A further sub-task may consist of displaying a resection boundary line directly in a view on a user-specific basis in order to visually show possible incision lines and thus assist the surgeon.

[0014] The objects are achieved according to the invention with regard to a generic navigation system by the features of claim 1, with regard to a generic navigation method by the features of claim 10, with regard to a computer-readable storage medium by the features of claim 11 and with regard to a computer program by the features of claim 12.

[0015] A basic idea of ​​the present disclosure therefore provides for providing a navigation system that uses various modalities such as microscopy, MRI images, CT images, electrophysiology and / or histology (or histological examinations) to create a central, homogeneous surgical map that has and defines areas / regions / zones with pathological tissue to be removed and tissue to be preserved (functional tissue; anatomy to be preserved) and, in particular, together with calculated boundary lines, provides the user with a visual view of this surgical map to assist him intraoperatively.

[0016] While each individual modality is already known in itself, but as described in the introduction this results in the corresponding disadvantages of an imprecise delimitation of areas, a solution is now provided to combine all available modalities and unite them in a single central surgical map that can define the boundaries of pathological tissue to be removed and healthy (functional) tissue to be preserved and can visually display them to a surgeon.By centrally combining data and converting the information into a uniform, homogeneous “metric” of the surgical map with the help of the two position-related numerical values, pathological-functional, such a central map can be created, which intuitively presents the surgeon with a view with superimposed pathological tissue areas and functional tissue areas, for example by overlaying this surgical map with other images such as MRI images.

[0017] The term "image" is to be understood quite broadly and refers to a point-by-point or small-area image, for example, by taking a biopsy at a specific location (the image location) and performing a corresponding histological assessment to determine whether pathological or functional tissue is present, or even a relatively large image, such as an MRI image of the patient, where, of course, the respective (three-dimensional) image position data is also available for the MRI image. In other words, for each image, the position of the image (or of the imaged tissue) relative to the patient is also recorded and provided, so that the various acquisition modalities can be supplemented in the (single) central surgical map with the appropriate determination of functional and pathological values.

[0018] The analysis and determination of whether functional or pathological tissue is present can be performed in different ways. In particular, such analysis and determination can be performed automatically, with computer support. For example, a trained AI system trained on tumors can be adapted to detect a tumor in an image, such as a CT scan, and identify this three-dimensional area as pathological tissue. Assigning a pathological value to this pathological tissue, for example, can be set in a range from 0 to 10, and the functional value in a range from -10 to 0. In this way, the intensity of a pathological tissue can also be determined.

[0019] Importantly, the navigation system of the present disclosure converts the many different acquisition modalities into a unified "system" with the pathological or functional values ​​at the respective positions (relative to the patient) in order to generate a homogeneous database of pathological and functional tissue. This unified database can then be used to perform further calculations and representations, such as a (standardized) calculation of a resection line to assist the surgeon during the resection.

[0020] In other words, the present disclosure relates to a navigation system that integrates various surgical modalities into a central computer-assisted system. These modalities include, in particular, MRI / CT (navigation), microscopy, endoscopy, fluorescence, electrophysiological detection, and / or intraoperative histology (e.g., using Raman spectroscopy). The navigation system can also have a tracking system (e.g., an optical tracking system or a (robotic) kinematic tracking system) to determine the precise position of the corresponding modality data / modality images in or relative to (the anatomy) of the patient. This allows the spatial acquisition position to be provided in addition to the acquisition itself. When the images or data of the modalities used are captured and integrated into the navigation system, a surgical map can be created.This map contains an intensity map that defines an intensity (first numerical pathological value, second numerical functional value) either in a 2D image / view, in particular for specific pixels (2D), or in a 3D space, in particular for specific voxels (3D). There are therefore two opposing / contrasting values ​​or signal types: firstly, the pathological intensity and secondly, the functional intensity. The more pathological a particular pixel or voxel is (especially a tumor), the higher the pathological intensity. The more important a tissue is for preservation (for example, an important nerve), the higher the functional intensity.

[0021] In particular, a (computer-assisted) system with a display device and interfaces to different modalities can be provided, wherein for each modality position information is provided by a tracking system of the navigation system in order to be able to provide the (spatial) recording positions in addition to the recordings, wherein a surgical map is created in two-dimensional form (2D) or three-dimensional form (3D) and in particular a color map is used to visualize how pathological or how functional the tissue is in order to determine the limits for resection.

[0022] In other words, a surgical navigation system is provided for intraoperative guidance of a surgical instrument during a surgical procedure for tumor removal in a patient using a surgical map, comprising: a first acquisition modality, in particular a CT imaging device or an MRI imaging device, which is adapted to acquire at least one predefined region of a tissue of the patient preoperatively and / or intraoperatively as a first image with image position data on the basis of a first (acquisition) modality and to provide it in a computer-readable manner;a second acquisition modality different from the first acquisition modality, in particular fluorescence imaging or an electrophysiological recording, which is adapted to acquire the predefined region of the patient's tissue preoperatively and / or intraoperatively as a second image with acquisition position data based on a second (acquisition) modality and to provide it in a computer-readable format; a storage unit in which the two-dimensional or three-dimensional surgical map of the patient is stored, wherein for each (2D or 3D) position (pixel or Voxl) of the surgical map, at least in the predefined region of the tissue, a first numerical pathological value and a second numerical functional value of the tissue are stored;a control unit adapted to: - process the provided first image with image position data and the provided second image with image position data, - for the first acquisition modality, analyze the first image and determine that at least a partial area of ​​the tissue of the first image is assigned a pathological value and / or at least a partial area of ​​the tissue of the first image is assigned a functional value, and to supplement these pathological or functional values ​​in the associated position of the surgical map;- for the second acquisition modality, to analyze the second image and determine that at least a partial area of ​​the tissue in the second image is assigned a pathological value and / or at least a partial area of ​​the tissue in the second image is assigned a functional value, and to supplement these pathological or functional values ​​in the corresponding position of the surgical map; and - to visually output a view of the surgical map for navigation assistance via a display device, in particular a surgical monitor;

[0023] Advantageous embodiments are claimed in the subclaims and are explained in particular below.

[0024] In particular, the navigation system may be adapted to register the first images (of the first acquisition modality) in the form of CT images and / or MRI images and / or DTI data by tracking with the patient by a tracking system of the navigation system; and

[0025] - to spatially track a position of a surgical microscope (as a visualization system and further acquisition modality with a corresponding second (microscope) image) and / or of an endoscope (as a visualization system and further acquisition modality with a corresponding second (endoscope) image) by the navigation system; and / or

[0026] - Acquire and localize electrophysiological recordings or signals with a tracked probe using the navigation system; and / or - Acquire and spatially localize histological recordings or data with a tracked (biopsy) probe using the navigation system. This allows different images to be provided with the associated image position data, which can be transferred to the surgical map.

[0027] In particular, the navigation system can comprise a robot or a robot system (combined with a robot system), wherein the visualization system (in particular, a surgical microscope and / or endoscope) and / or the probes are moved and located using a robot arm of the robot system. In particular, the robot kinematics can be used as a tracking system to determine the position of the visualization system or the probe.

[0028] According to one embodiment, the control unit can be adapted to assign a first color to the first numerical pathological value and a second, different, in particular complementary, color to the second numerical functional value of the tissue, wherein an intensity of the color is proportional to the numerical value, so that when the view is output via the display device, a surgical map with a color background is output. Colors can therefore be used to distinguish between pathological and functional intensity. In particular, a pathological intensity can be displayed in red and a functional intensity in blue. In particular, the colors of the pathological values ​​are complementary colors to the functional values.The result is a color map created as a surgical map, where higher red intensity means more resection is recommended, and blue means less resection. Since non-image-based modalities do not have data (such as electrophysiological signals or histology data) available for each pixel or voxel, color mapping enables extrapolation of the marking of pathological and functional areas based on a 3D point / position signal. This representation helps the surgeon decide where to resect tissue during surgery. A view can therefore also be individually adjusted based on the data of the central surgical map. In particular, a view can be created based on point (position-related) values, in which an extrapolation between the individual values ​​takes place in order to display a continuously differentiable surface.

[0029] According to a further embodiment, the control unit can be adapted to determine a gradient between the pathological value and the functional value and, based on the gradient, to display a boundary line in the view in order to indicate a boundary for resection to the user. In particular, the navigation system can be adapted to generate concrete boundary lines (in the case of 2D) or boundary surfaces (in the case of 3D) using image gradients. For example, between a red, pathological area of ​​the tissue and a blue, functional area of ​​the tissue, the position with the highest gradient is used to define the boundaries. As a result, not only color maps indicating pathological and functional tissue but also boundaries for resection can be defined and displayed. The navigation system can therefore also use image gradients to calculate and visualize clear boundaries.

[0030] Preferably, the navigation system can have an input unit, in particular the display device can be designed as a touch display to detect an input from the user, wherein the control unit is adapted to adjust a gradient setting based on the input in order to change a boundary of the resection in the view of the surgical map. In particular, a control (e.g., a slider) for setting the gradient can be displayed on the touch display, and the user can then change the setting by touching this control. Depending on the aggressiveness of the pathology (e.g., glioblastomy, for which aggressive resection is recommended), the gradient can be adjusted to meet the preferences of the surgeon and the needs of the patient. The adjustable gradient enables a more or less aggressive resection depending on the type of pathology.The navigation system can also use adjustable gradients to define the aggressiveness of the resection area. In particular, by inputting a maximum gradient or gradients, the user can move or set the boundary either in a "plus" direction (i.e., more pathology) to protect more functional tissue, or move or set the boundary from the maximum gradient in a "minus" direction (i.e., more function) to remove more aggressive pathological tissue. Thus, the aggressiveness of tissue removal can be set, particularly by "shifting" the boundary from a maximum gradient in a "plus" direction (i.e., a wider / larger boundary around or relative to the functional tissue) or in a "minus" direction (i.e., a smaller boundary around or relative to the functional tissue).The gradient reaches its maximum where the difference between pathological and functional tissue is greatest. For example, if an initial boundary is drawn at a gradient maximum, this boundary can be adjusted toward functional tissue for more aggressive removal or toward pathological tissue for less aggressive removal.

[0031] Preferably, the navigation system can have an input unit; in particular, the display device can be designed as a touch display to detect an input from the user. The control unit is adapted to manually define regions of a tissue based on the input, to which a first numerical pathological value and / or a second numerical functional value of the tissue is assigned by means of an input, in order to also manually mark regions. In addition to the at least two different detection modalities, surgeons can also manually define regions with important function or pathology that can be added to the surgical map, or additional regions can be added using image segmentation.

[0032] In particular, the following can be used as at least the first or second recording modality:

[0033] - an MRI scan and / or a CT scan and / or a DTI scan;

[0034] - a surgical microscope;

[0035] - an endoscope;

[0036] - an electrophysiology;

[0037] - a histology; and / or

[0038] - a fluorescence imaging device. Modalities can therefore include, in particular: CT / MRI / DTI with navigation, microscope, endoscope, electrophysiology, histology, and fluorescence imaging. These various acquisition modalities each have the advantages of precise determination of pathological or functional tissue and can be used specifically to combine and combine their advantages.

[0039] In particular, the first and / or second acquisition modality can be connected to a robot as an end effector, in particular a surgical microscope and / or an endoscope and / or a fluorescence imaging device can be mounted on a robot arm as an end effector. In other words, the microscope, the endoscope and / or the fluorescence imaging device (imager) can be mounted on a robot arm and actuated, moved, or positioned by the robot arm.

[0040] Preferably, a probe that measures data, for example a biopsy probe, can be attached to the robot arm.

[0041] According to one embodiment, the navigation system may comprise a navigation camera as an optical camera and be adapted to track fiducial trackers, or the navigation system may comprise a navigation camera as an optical camera and use a machine-learning image processing system to spatially track objects. In particular, the navigation system may use an optical (navigation) camera with fiducial trackers or a (machine) image processing system.

[0042] With regard to a navigation method for intraoperative guidance of a surgical instrument during a surgical procedure to remove a tumor in a patient using a surgical map, the objects are achieved by the steps: - capturing at least one predefined region of a patient's tissue preoperatively and / or intraoperatively as a first image with image position data using a first acquisition modality, in particular a CT imaging device or an MRI imaging device; - capturing the predefined region of the patient's tissue preoperatively and / or intraoperatively as a second image with image position data using a second acquisition modality that is different from the first acquisition modality, in particular fluorescence imaging or an electrophysiological recording;- analyzing and determining for the first acquisition modality of the first image such that at least a partial area of ​​the tissue of the first image is assigned a pathological value and / or at least a partial area of ​​the tissue of the first image is assigned a functional value, and supplementing these pathological or functional values ​​in the associated position of a surgical map in which, for each (2D or 3D) position (pixel or Voxl), at least in the predefined area of ​​the tissue, a first numerical pathological value and a second numerical functional value of the tissue are stored;- Analyzing and determining, for the second acquisition modality, that at least a partial area of ​​the tissue in the second image is assigned a pathological value and / or at least a partial area of ​​the tissue in the second image is assigned a functional value, and supplementing these pathological or functional values ​​in the associated position of the surgical map; and - Outputting a view of the surgical map for navigation assistance via a display device, in particular a surgical monitor.

[0043] With regard to a computer-readable storage medium and a computer program, the objects are achieved in that the latter comprises instructions which, when executed by a computer, cause the computer to carry out the method steps of the navigation method according to the present disclosure.

[0044] The application described here in brain surgery can, of course, also be used for other indications where different modalities are used intraoperatively to distinguish the boundaries between pathological and functional tissue. Brief description of the figures

[0045] The present disclosure will be explained in more detail below using preferred embodiments with reference to the accompanying figures. They show:

[0046] Fig. 1 is a schematic view of a navigation system of a first embodiment of the present disclosure with various detection modalities;

[0047] Fig. 2 is a schematic view of a merging of pathological values ​​and functional values ​​for defining the color maps and calculating the resection margins;

[0048] Fig. 3 shows an exemplary surgical map with adjustable boundaries or border lines;

[0049] Fig. 4 shows an exemplary surgical map as a color map with red and blue intensity maps, where red is used for pathological tissue and blue for important functional tissue;

[0050] Fig. 5 is a two-dimensional plan view of the surgical map of Fig. 5; and

[0051] Fig. 6 is a schematic flow diagram of a navigation method according to a preferred embodiment.

[0052] The figures are schematic in nature and are intended only to aid understanding of the present disclosure. Like elements are provided with the same reference numerals. The features of the various embodiments may be interchanged. Detailed Description of Preferred Embodiments

[0053] Figure 1 shows a schematic view of a surgical navigation system

[0054] 1 (hereinafter referred to as system) for intraoperative guidance of a surgical cutting instrument during a surgical procedure for tumor removal in a patient P using a surgical map L.

[0055] The system 1 has a first acquisition modality 2 in the form of a CT imaging device 4 and also an MRI imaging device 6 and is adapted to acquire at least one predefined region of a tissue of the patient P preoperatively as a first image 8 with associated image position data, i.e. information on the spatial position of the image in relation to the patient P, on the basis of this first acquisition modality and to provide it in computer-readable form.

[0056] In addition, System 1 also has another method of recording that is related to the first

[0057] 2 different, second acquisition modality 10 in the form of a surgical microscope 11 and is adapted to acquire the predefined area of ​​the tissue of the patient P preoperatively and / or intraoperatively as a second image 16 with image position data on the basis of the second (acquisition) modality and to provide it in a computer-readable manner.

[0058] Furthermore, the system 1 also has a further, third acquisition modality in the form of fluorescence imaging 12. With this acquisition modality, the recording is again carried out analogously to the first and second acquisition modalities 2, 10.

[0059] In addition, the system also has a fourth acquisition modality in the form of an electrophysiological recording system 14 and a fifth acquisition modality in the form of intraoperative histology, i.e. intraoperative sampling using a probe.

[0060] All five different acquisition modalities are centrally consolidated and processed. For this purpose, the system has a storage unit 18 in which the two-dimensional or three-dimensional surgical map L for the patient P is stored, wherein for each (2D or 3D) position (pixel or voxl) of the surgical map L, at least in the predefined area of ​​the tissue, a first numerical pathological value as well as a second numerical functional value of the tissue is stored or storable. In this embodiment, a three-dimensional surgical map L is stored, wherein for each position (X, Y, Z) a pathological value (P value) and a functional value (F value) are stored (here set to 0 before the images are taken). As a result, the system 1 can, after an image has been taken and the respective pathological or functional values ​​have been added,functional values ​​for a specific position (x1 , y 1 ,z1 ) read out an intensity of a pathological tissue and a functional tissue.

[0061] Furthermore, the system 1 comprises a central control unit 20, which is adapted to process the provided first image 8 with image position data and the provided second image 16 with image position data. Likewise, the control unit 20 is adapted to process the third image of the third acquisition modality, the fourth image of the fourth acquisition modality, and the fifth image of the acquisition modality with corresponding image position data. A tracking system 23 can also determine the position of the acquisition modality and thus of the image itself (for example, via a transformation).

[0062] The control unit 20 is further adapted to analyze the first image 8 for the first acquisition modality 2 and to determine that at least a partial area of ​​the tissue of the first image 8 is assigned a pathological value and / or at least a partial area of ​​the tissue of the first image is assigned a functional value, and to supplement these pathological or functional values ​​in the associated position of the surgical map L. In this embodiment, the acquired pathological value (here positive) is added to the pathological value of the surgical map depending on the position, and the acquired, here negative, functional value of the surgical map is also added.The analysis of the MRI image can be performed, in particular, by an artificial intelligence system (AI system) trained on tumors, which determines the areas of pathological tissue in the MRI image and evaluates them accordingly with the pathological values. In particular, the control unit 20 performs the analysis and determination and is adapted accordingly.

[0063] Likewise, for the second acquisition modality 10, the second image is analyzed and determined such that at least a partial area of ​​the tissue of the second image is assigned a pathological value and / or at least a partial area of ​​the tissue of the second image is assigned a functional value, and these pathological or functional values ​​are added to the associated position of the surgical map L.

[0064] Similarly, for the third, fourth and fifth acquisition modalities, a pathological and / or functional value is assigned for different respective spatial positions (when analyzed and determined) and each is added to the central (single) surgical map L.

[0065] This results in a central surgical map L in which the various modalities are consolidated and integrated to provide a uniform, homogeneous, central map L (see, for example, Fig. 2), which can be integrated into various output modes. This surgical map L can, for example, be superimposed on a three-dimensional MRI image to highlight the regions and respective boundaries and provide a visual output to a surgeon.

[0066] The control unit 20 of the present embodiment is adapted to visually output a view of the surgical map L for navigation assistance via a display device 22 in the form of a surgical monitor, for example, a virtual perspective view at a specific position with a predetermined viewing direction of the tissue, with marked regions of pathological tissue and functional tissue, and a displayed boundary line 24 (see also Fig. 2). In contrast to the prior art, a single acquisition modality is not considered separately and in isolation; rather, the many different acquisition modalities are all used and centrally consolidated, standardized, and stored in the central surgical map L.

[0067] In particular, extrapolations can also be carried out in order to estimate the surrounding area from a point value, such as a pathological value determined by means of a biopsy.

[0068] Fig. 2 shows, in a schematic view for understanding the present disclosure, the combination of pathological values ​​and functional values ​​into a standardized map L which includes both values ​​to support navigation.

[0069] The top left of Fig. 2 shows, as an example, a so-called antagonist of a cold zone, which represents a risk structure and thus has a high functional value. This risk structure can be determined, in particular, via a first acquisition modality 2, particularly via DTI / fibers, segmentation of, for example, MRI or CT images, and neuromonitoring. This provides system 1 with a functional map of a risk structure (i.e., an anatomy to be preserved).

[0070] On the other hand, the bottom left of Fig. 2 shows an example of a so-called hot zone, which represents the target structure of the resection. This data can be obtained using a further, second acquisition modality 10, for example, an MRI image with tumor delineation, a biopsy / histology result, or fluorescence imaging to visualize and capture tumor structures. This provides system 1 with a pathological map of the structure to be removed.

[0071] Both maps—the functional map and the pathological map—are merged and combined in the central surgical map L. This map integrates both the functional structures and the pathological structures and provides them centrally. Should additional acquisition modalities be added, these new acquisition modalities can easily supplement the central surgical map with their information on functional or pathological tissue, positioned correctly relative to the patient (after all, the images contain the image position data). Thus, a dynamically growing surgical map L can be created that centrally and homogeneously consolidates and combines all information.

[0072] Finally, to assist the surgeon in his procedure, a so-called gradient volume can be generated, as shown in the right part of Figure 2. This volume displays a gradient between the functional area and the pathological area in a view, for example, on the surgical monitor. This already includes boundary lines 24, which represent a standardized calculated resection margin.

[0073] A setting of the gradient can be changed via a slider as an input unit 26, for example shown and operated in a touch display, in order to adjust the aggressiveness of the resection by changing the resection borders or the border lines 24.

[0074] A threshold can be set for gradient-defined contours (level sets). This can be particularly useful for orientation for the surgeon. A steep or high gradient, for example, can be difficult to distinguish because the pathological and functional areas are close together.

[0075] Fig. 3 shows such a gradient setting as an example for understanding. While in area A of Fig. 3 a gradient between a functional area and a pathological area is schematically shown, two different boundaries are visible. A first boundary or boundary line 24, which indicates a less aggressive resection of the tumor tissue (pathological tissue) and a second boundary of an aggressive resection in order to encompass and remove an area around the pathological tissue. By setting the gradient, it is therefore possible to move between these two boundary lines 24 of varying aggressiveness. Area B of Figure 3 shows an example of a boundary of a very defensive resection.

[0076] For illustrative purposes, Fig. 4 shows an exemplary representation of a surgical map L as a color map with red and blue intensity maps, with red used for pathological tissue and blue for important functional tissue (shown here with different shaded areas). The amplitudes represent the corresponding areas. Positive amplitudes represent the pathological area with the pathological values, while negative amplitudes represent the functional area to be protected. A continuous surface is shown between these areas as an example. Gradients can be used to set a boundary.

[0077] Fig. 5 is an exemplary top view of Fig. 4 and shows in two-dimensional form the areas to be removed (red).

[0078] Fig. 6 shows a navigation method according to a preferred embodiment. The navigation method serves for intraoperative guidance of a surgical instrument during a surgical procedure for tumor removal in a patient using a surgical map, in particular for a navigation system 1 of the present disclosure.

[0079] In step S1, at least one predefined region of a tissue of the patient P is acquired preoperatively and / or intraoperatively as a first image with image position data by means of a first acquisition modality, in particular a CT imager or an MRI imager;

[0080] In step S2, the predefined region of the patient's tissue is then acquired preoperatively and / or intraoperatively as a second image with acquisition position data using a second acquisition modality different from the first acquisition modality, in particular fluorescence imaging or an electrophysiological recording;

[0081] In step S3, the analysis and determination for the first acquisition modality of the first image takes place in such a way that at least a partial area of ​​the tissue of the first image is assigned a pathological value and / or at least a partial area of ​​the tissue of the first image is assigned a functional value, and these pathological or functional values ​​are supplemented in the associated position of a surgical map in which, for each position, at least in the predefined area of ​​the tissue, a first numerical pathological value and a second numerical functional value of the tissue are stored.

[0082] In step S4, the second acquisition modality analyzes and determines that at least a partial area of ​​the tissue of the second image is assigned a pathological value and / or at least a partial area of ​​the tissue of the second image is assigned a functional value, and supplements these pathological or functional values ​​in the associated position of the surgical map.

[0083] Finally, in a step S5, a view of the surgical map is output for navigation assistance via a display device, in particular an operating room monitor.

[0084] List of reference symbols

[0085] 1 Surgical navigation system

[0086] 2 First recording modality

[0087] 4 CT scanner

[0088] 6 MRI scanner

[0089] 8 First recording

[0090] 10 Second recording modality

[0091] 11 Surgical microscope

[0092] 12 Fluorescence imaging

[0093] 14 Electrophysiological recording

[0094] 16 Second shot

[0095] 18 storage unit

[0096] 20 Control unit

[0097] 22 Display device

[0098] 23 Tracking system

[0099] 24 boundary line

[0100] 26 Input unit

[0101] 100 robots

[0102] P Patient

[0103] L Surgical map

[0104] 51 Step capture with first capture modality

[0105] 52 Step capture with second capture modality

[0106] 53 Step Analyze and determine pathological and / or functional value of first recording

[0107] 54 Step Analyze and determine pathological and / or functional value second image

[0108] 55 Step Output View surgical map via display device

Claims

Claims 1 . Surgical navigation system (1) for intraoperative guidance, for example of a surgical instrument, during a surgical procedure for tumor removal in a patient (P) with the aid of a surgical map (L), comprising: a first acquisition modality (2), in particular a CT imaging device (4) or an MRI imaging device (6), which is adapted to acquire at least one predefined region of a tissue of the patient (P) preoperatively and / or intraoperatively as a first image (8) with image position data on the basis of a first acquisition modality and to provide said image in a computer-readable manner;characterized by a second acquisition modality (10) which is different from the first acquisition modality (2), in particular a fluorescence imaging (12) or an electrophysiological recording (14), which is adapted to acquire the predefined region of the patient's (P) tissue preoperatively and / or intraoperatively as a second image (16) with image position data on the basis of a second acquisition modality and to provide the same in a computer-readable manner; a storage unit (18) in which the central two-dimensional or three-dimensional surgical map (L) relating to the patient (P) is stored, wherein for each position of the surgical map (L), at least in the predefined region of the tissue, a first numerical pathological value and a second numerical functional value of the tissue are stored or can be stored; a control unit (20) which is adapted for: - to process the provided first image (8) with image position data and the provided second image (16) with image position data, - for the first acquisition modality (2), to analyze the first image (8) and to determine that at least a partial area of ​​the tissue of the first image (8) is assigned a pathological value and / or a functional value, and to supplement this pathological or functional value in the associated position of the surgical map (L); - for the second acquisition modality (10), to analyze the second image and to determine that at least a partial area of ​​the tissue of the second image is assigned a pathological value and / or a functional value, and to supplement these pathological or functional values ​​in the corresponding position of the surgical map (L); and - to visually output a view of the surgical map (L) for navigation assistance via a display device (22), in particular an operating room monitor, in order to be able to reliably distinguish between pathological tissue and functional tissue.

2. Surgical navigation system (1) according to claim 1, characterized in that the control unit (20) is adapted to assign a first color to the first numerical pathological value and to assign a second, different color to the second numerical functional value of the tissue, wherein an intensity of the color is proportional to the respective numerical value, so that when the view is output via the display device, a color-highlighted surgical map is output.

3. Surgical navigation system (1) according to one of the preceding claims, characterized in that the control unit (20) is adapted to determine a gradient between the pathological values ​​and the functional values ​​of the surgical map (L) and, on the basis of the gradient, to display a boundary line (24) in the view in order to show the user a boundary for a resection.

4. Surgical navigation system (1) according to claim 3, characterized in that the navigation system (1) has an input unit (26), in particular the display device (22) is designed as a touch display in order to detect an input by the user, wherein the control unit (20) is adapted to adapt a gradient setting on the basis of the input in order to change a boundary line (24) of the resection in the view of the surgical map.

5. Surgical navigation system (1) according to one of the preceding claims, characterized in that the navigation system (1) has an input unit (26), in particular the display device (22) is designed as a touch display in order to detect an input by the user, wherein the control unit (20) is adapted to manually define regions of a tissue on the basis of the input, to which a first numerical pathological value and / or a second numerical functional value of the tissue is assigned by means of the input in order to also manually mark regions.

6. Surgical navigation system (1) according to one of the preceding claims, characterized in that the at least first or second detection modality is used: - an MRI scanner and / or a CT scanner and / or a DTI scanner; - a surgical microscope; - an endoscope; - an electrophysiology; - a histology; and / or - a fluorescence imaging device.

7. Surgical navigation system (1) according to one of the preceding claims, characterized in that the first detection modality (2) and / or second detection modality (10) is connected to a robot (100) as an end effector, in particular a surgical microscope and / or an endoscope and / or a fluorescence recording device is mounted as an end effector on a robot arm.

8. Surgical navigation system (1) according to one of the preceding claims, characterized in that probes which measure data are attached to a robot arm of a robot (100).

9. Surgical navigation system (1) according to one of the preceding claims, characterized in that the navigation system (1) has a navigation camera as an optical camera and is adapted to track fiducial trackers, or the navigation system (1) has a navigation camera as an optical camera and uses a machine vision system to spatially track objects.

10. Navigation method for intraoperative guidance of a surgical instrument during a surgical procedure for tumor removal in a patient using a surgical map, in particular for a navigation system (1) of the preceding claims, characterized by the steps: - capturing (S1) at least one predefined region of a tissue of the patient (P) preoperatively and / or intraoperatively as a first image (8) with image position data by means of a first acquisition modality (2), in particular a CT imager or an MRI imager; - capturing (S2) the predefined region of the patient's (P) tissue preoperatively and / or intraoperatively as a second image (16) with image position data using a second acquisition modality (10) different from the first acquisition modality (2), in particular fluorescence imaging or an electrophysiological recording; - analyzing and determining (S3) for the first acquisition modality (2) of the first image (8) in such a way that a pathological value and / or a functional value is assigned to at least a partial area of ​​the tissue of the first image (8), and supplementing this pathological or functional value in the associated position of a surgical map (L), in which, for each position at least in the predefined area of ​​the tissue, a first numerical pathological value and a second numerical functional value of the tissue are stored or can be stored; - analyzing and determining (S4) for the second acquisition modality (10) of the second image (16) that at least a partial area of ​​the tissue of the second image (16) is assigned a pathological value and / or a functional value, and supplementing these pathological or functional values ​​in the associated position of the surgical map (L); and - Outputting (S5) via a display device (22), in particular an operating room monitor, a view of the surgical map for navigation assistance in order to be able to reliably distinguish between pathological tissue and functional tissue.

11. A computer-readable storage medium comprising instructions which, when executed by a computer, cause the computer to carry out the method steps of the navigation method according to claim 10.

12. A computer program comprising instructions which, when executed by a computer, cause the computer to carry out the method steps of the navigation method according to claim 10.

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