Neurosurgical methods and systems for detecting and removing tumor tissue - Patents.com

Abstract

A neurosurgical system for examining a patient's brain tissue for tumor tissue. The system includes an aspiration instrument, an excitation source, an optical instrument, and a controller. The aspiration instrument includes an aspiration cannula defining a lumen, an optical fiber configured to transmit fluorescence emitted by the brain tissue, and an indicator configured to selectively emit visible light. The excitation source is configured to emit excitation light having a wavelength that induces fluorescence in the tumor tissue. The optical instrument is connected to the optical fiber. The optical instrument is configured to transduce the fluorescence emitted by the brain tissue and transmitted by the optical fiber, and is configured to determine that the brain tissue is tumorous based on the electrical signal and activate the indicator based on the determination.

Description

[Technical field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This application claims priority to and all benefits of U.S. Provisional Patent Application No. 63 / 160,099, filed March 12, 2021, the contents of which are incorporated herein by reference. [Background technology]

[0002] Glioma tumors may arise in the glial cells of the brain or spine. Surgery, more specifically tumor resection, is often performed to remove the tumor. The goal of tumor resection surgery is to achieve a gross total resection (GTR). A highly aggressive form of glioma is glioblastoma. In glioblastoma patients, GTR has been shown to increase the patient's life span by approximately 40% (e.g., from 10 to 14 months). In patients with low-grade gliomas, GTR increases the chances of overall survival.

[0003] 5-aminolevulinic acid (5-ALA) is often administered to patients a few hours before surgery. 5-ALA is a naturally occurring compound in the hemoglobin synthesis pathway. In cancer cells, hemoglobin synthesis is interrupted, and the pathway stops at an intermediate compound called protoporphyrin IX (PPIX). During surgery, a medical professional may illuminate an area of ​​brain tissue with excitation light (i.e., blue light) from a surgical microscope. The surgery may be performed in a dark or dimly lit operating room environment. High-grade tumor cells that contain PPIX absorb the excitation light and emit fluorescence with specific optical properties (red fluorescence). The fluorescence may be observed by a medical professional from a surgical microscope.

[0004] Once the target tissue is identified, the medical professional switches the surgical microscope back to standard white light illumination and continues resection of the target tissue. The medical professional alternates between white light and excitation light illumination of the tissue throughout the surgical procedure to ensure that the proper target tissue is resected until tumor resection is complete. Each time the target area is illuminated with excitation light from the surgical microscope, PPIX present at the tumor site may be degraded due to photobleaching from being illuminated by the intense excitation light.

[0005] Fluorescence-guided surgery increases the chances of GTR in high-grade tumors, such as glioblastoma tumors. At present, GTR in low-grade tumors is relatively low. This is because tumor cells only emit low levels of fluorescence, and the human eye is not sensitive enough to detect such low levels of fluorescence, even with an operating microscope, so 5-ALA cannot be used to improve the outcome of low-grade tumor resection. Improved systems for fluorescence-guided surgery that improve the chances of achieving GTR are needed.

[0006] The background information provided herein is intended to generally describe the contents of the present disclosure. To the extent that it is described in this Background section, the work of the currently named inventors, and aspects of the description that may not have been admitted as prior art at the time of filing, are not admitted, expressly or impliedly, as prior art to the present disclosure. Summary of the Invention

[0007] In an aspect, a neurosurgical system for examining a patient's brain tissue for tumor tissue is described. The neurosurgical system includes a suction instrument configured to apply a suction force to the patient's tissue. The suction instrument includes a suction cannula defining a lumen, an optical fiber coupled to the suction cannula, the optical fiber configured to transmit fluorescence emitted by the brain tissue, and an indicator coupled to the suction cannula and configured to selectively emit visible light. The visible light is different from the fluorescence transmitted by the optical fiber. The neurosurgical system also includes an excitation source configured to emit excitation light. The excitation light has a wavelength that induces fluorescence in the tumor tissue. The neurosurgical system also includes an optical instrument coupled to the optical fiber. The optical instrument is configured to convert the fluorescence emitted by the brain tissue and transmitted by the optical fiber into an electrical signal. The neurosurgical system also includes a controller coupled to the indicator and the optical instrument, the controller configured to determine that the brain tissue is tumorous based on the electrical signal and to activate the indicator based on the determination that the brain tissue is tumorous.

[0008] In a feature, a neurosurgical method for detecting whether a patient's brain tissue contains tumor tissue is described. The neurosurgical method is performed using a surgical system, the surgical system including a suction instrument having an optical fiber and an indicator respectively coupled thereto, an excitation source, an optical instrument coupled to the optical fiber, and a controller coupled to the excitation source, the optical instrument, and the indicator. The neurosurgical method includes applying a suction force to the patient's brain tissue using the suction instrument. The neurosurgical method also includes emitting excitation light having a predetermined wavelength from the excitation source to induce fluorescence in the tumor tissue. The neurosurgical method also includes collecting the fluorescence emitted from the brain tissue with the optical fiber. The neurosurgical method also includes converting the fluorescence into an electrical signal using the optical instrument. The neurosurgical method also includes activating the indicator based on the electrical signal using the controller when the controller determines that the electrical signal indicates that the brain tissue is tumorous.

[0009] In a feature, a neurosurgical method is described for detecting whether a target brain tissue is tumorous under ambient light conditions in an operating room using a surgical system. The surgical system includes a working instrument including at least one optical fiber and an indicator, an optical instrument coupled to the at least one optical fiber, an excitation source coupled to the at least one optical fiber, and a controller connected to the optical instrument and the indicator. The neurosurgical method for detecting the target tissue includes detecting fluorescence emitted from the target brain tissue during a surgical procedure. The detecting fluorescence includes emitting blue light from an excitation source to induce fluorescence emission of the target brain tissue. The detecting fluorescence also includes receiving the fluorescence of the target brain tissue from the at least one optical fiber using the optical instrument. The detecting fluorescence also includes converting the fluorescence into an electrical signal using the optical instrument. The neurosurgical method also includes determining, using the controller, that the target brain tissue is tumorous based on the electrical signal. The neurosurgical method also includes activating, using the controller, an indicator of the working instrument in response to determining that the target brain tissue is tumorous.

[0010] Further areas of applicability of the present disclosure will become apparent from the detailed description, claims, and drawings. The detailed description and specific examples are for purposes of illustration only and are not intended to limit the scope of the present disclosure.

[0011] The present disclosure will become more fully understood from the detailed description and the accompanying drawings, wherein: [Brief description of the drawings]

[0012] [Figure 1] 1 shows a chart illustrating the visibility of red fluorescence in tumor tissue when viewed through a surgical microscope according to the teachings of the prior art. [Diagram 2] 1 illustrates a neurosurgical system in accordance with the teachings of the present disclosure. [Diagram 3] 1 shows a functional block diagram of a neurosurgical system according to the teachings of the present disclosure. [Figure 4] 1 illustrates an example of a suction instrument of a neurosurgical system in accordance with the teachings of the present disclosure. [Figure 5A-5B] 1 illustrates an example of a handle for an aspirator of a neurosurgical system in accordance with the teachings of the present disclosure. [Figure 6] 1 illustrates an ultrasonic surgical system of a neurosurgical system in accordance with the teachings of the present disclosure. [Figure 7] 1 illustrates a tissue detection system of a neurosurgical system in accordance with the teachings of the present disclosure. [Figure 8] 1 shows a functional block diagram of a tissue detection system of a neurosurgical system in accordance with the teachings of the present disclosure. [Figure 9A-9B] 1 illustrates an optical system of a tissue detection system in accordance with the teachings of the present disclosure. [Figure 10A-10B] 1 illustrates an exploded view of several components of an optical system of a tissue detection system in accordance with the teachings of the present disclosure. [Figure 11] 1 illustrates an internal view of a control console of a tissue detection system in accordance with the teachings of the present disclosure. [Figure 12A] 1 illustrates sample elements of a tissue detection system according to the teachings of the present disclosure. [Figure 12B] 1 illustrates sample elements of a tissue detection system according to the teachings of the present disclosure. [Figure 12C] 1 illustrates sample elements of a tissue detection system according to the teachings of the present disclosure. [Figure 12D] 1 illustrates sample elements of a tissue detection system according to the teachings of the present disclosure. [Figure 12E] 1 illustrates sample elements of a tissue detection system according to the teachings of the present disclosure. [Figure 13] 4 illustrates an excitation spectrum signal generated by a spectrometer of a tissue detection system in accordance with the teachings of the present disclosure. [Figure 14A-14B] 1 illustrates a first modified spectral signal and a second modified signal generated by a controller of a tissue detection system in accordance with the teachings of the present disclosure. [Figure 15] 13 illustrates a Gaussian curve fitting to a second modified signal generated by a controller of a tissue detection system in accordance with the teachings of the present disclosure. [Figure 16] 1 illustrates PPIX intensity generated by a controller of a tissue detection system according to the teachings of the present disclosure. [Figure 17] 1 illustrates a flow chart of a surgical resection procedure performed using a neurosurgical system in accordance with the teachings of the present disclosure. [Figure 18A-18B] 1 illustrates a sample element of a tissue detection system coupled to an ultrasonic handpiece assembly in accordance with the teachings of the present disclosure. [Figure 19A-19B] 1 illustrates a tissue detection sample element and indicator element coupled to a bipolar forceps of a surgical system in accordance with the teachings of the present disclosure. [Figure 20] 1 illustrates a sample element coupled to an aspiration fixture of an aspiration system with the jacket removed in accordance with the teachings of the present disclosure. [Figure 21] 1 illustrates a sample element coupled to an aspiration apparatus of an aspiration system according to the teachings of the present disclosure. [Figure 22] 1 illustrates a sample element coupled to an aspiration apparatus of an aspiration system according to the teachings of the present disclosure. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0013] In the drawings, reference numbers may be reused to identify similar and / or identical elements.

[0014] The inventors have realized that there is a need for a neurosurgical tumor resection system and / or method that can detect low levels of fluorescence under white light surgical conditions (i.e., without the need for a darkened or dimmed operating room) during the process of resecting a tumor. There is also a need for a system that can reduce the time that the target area is illuminated with excitation light to reduce photobleaching effects. Furthermore, there is a need for a system that can deliver excitation light into deep cavities, as surgical microscopes cannot adequately deliver excitation light into deep cavities. Finally, there is a need for a system that aids in the intraoperative detection of undifferentiated foci of tumors, which is important since the discovery of undifferentiated foci is essential for accurate histopathological diagnosis and optimal patient treatment.

[0015] Although the present disclosure specifically discusses surgical procedures related to the resection of target tissues of brain tumors by administration of 5-ALA to visualize the fluorescence of PPIX, the teachings of the present disclosure can also be extended to other types of surgical procedures to detect other types of tissues and to detect other types of fluorescent dyes (Hypericin, Hexvix, Idocyanine Green "ICG", etc.). For example, ICG may be administered to help medical professionals visualize blood vessels during surgical procedures. ICG may bind to plasma proteins present in blood. ICG is excited by near-infrared light and emits near-infrared light having a wavelength slightly longer than the near-infrared light that excited the ICG.

[0016] With reference to FIG. 1, chart 10 illustrates the visibility of red fluorescence of PPIX when viewed through a surgical microscope. During brain tumor resection surgery, if the tumor resection surgery is performed according to prior art systems (i.e., using a surgical microscope), target tissue (i.e., tumor tissue) containing high concentrations of PPIX may be inadvertently missed, resulting in a suboptimal GTR. Therefore, a method to more accurately detect elevated concentrations of PPIX would prove highly beneficial in aiding in the achievement of GTR. Open boxes 40 indicate specimens that do not produce visible fluorescence, while solid boxes 44 indicate specimens that do produce visible fluorescence. The y-axis represents the C above a threshold of 0.1 μg / mL. PpIX The x-axis shows the accumulation levels of PPIX for healthy tissue and for target tissue. Region 50 represents a false negative region where PPIX was present in the specimen but did not produce visible light. Notably, sub-region 54 within region 50 contains specimens below level 58, but still produces visible light, when viewed through a surgical microscope. PpIX 62. Thus, if the medical professional misses the PPIX corresponding to the sub-region, GTR will not be achieved.

[0017] With reference to FIG. 2, a neurosurgical system 100 is provided that addresses the shortcomings of the prior art. The neurosurgical system 100 may include a surgical navigation system 104, a surgical microscope 108, a surgical cart 114, and an aspiration system 113. The surgical navigation system 104 includes a cart assembly 106 that houses a navigation computer 110. The navigation computer 110 is also referred to as a navigation controller. A navigation interface is in operative communication with the navigation computer 110. The navigation interface may include one or more input devices, which may be used to input information into the navigation computer 110 or to select / control certain aspects of the navigation computer 110. The navigation interface includes one or more displays 120. Such input devices may include interactive touch screen displays / menus, keyboards, mice, microphones (voice activated), gesture controls, and the like.

[0018] The navigation computer 110 may be configured to store one or more pre-operative or intra-operative images of the brain. Any suitable imaging device may be used to provide pre-operative or intra-operative images of the brain. For example, 2D, 3D, or 4D imaging devices such as isocentric fluoroscopy, biplane fluoroscopy, ultrasound, computed tomography (CT), multislice computed tomography (MSCT), magnetic resonance imaging (MRI), positron emission tomography (PET), optical coherence tomography (OCT), etc. Images may also be acquired and displayed in two, three, or four dimensions. In more advanced forms, a four-dimensional surface rendering region of the body may also be achieved by incorporating patient data or other data from an atlas or anatomical model map, or from pre-operative image data captured by MRI, CT, or echocardiography.

[0019] Navigation computer 110 may generate one or more images of the brain on display 120. Navigation computer 110 may also be connected to a surgical microscope 108. For example, display 120 may display an image corresponding to the field of view of surgical microscope 108. If navigation computer 110 may include two or more displays, one such display may show the field of view of surgical microscope 108 and another such display may show a pre-operative or intra-operative image of the brain.

[0020] The tracking system 124 is coupled to the navigation computer 110 and configured to sense the position of one or more tracking elements attached to the surgical instrument or the patient. The tracking system 124 may be configured to track active or passive infrared tracking elements attached to the surgical instrument or the patient. One example of a surgical navigation system 104 that may be used is Nav3i™, available from Stryker. The surgical navigation system 104 may have various functions and features as described in U.S. Pat. No. 7,725,162 (B2) and U.S. Patent Application Publication No. 2020 / 0100849 (A1), which are incorporated herein by reference in their entireties.

[0021] The surgical microscope 108 includes one or more objective lenses configured to provide a range of magnifications (e.g., from about 2x to about 50x). The surgical microscope 108 can have a field of view having a range of areas. The surgical microscope 108 is configured for fluorescence microscopy, for example, to detect PPIX. The surgical microscope 108 may include one or more excitation sources (e.g., an excitation source configured to emit light in the visible light spectrum or an excitation source configured to emit light in the infrared spectrum) to irradiate the brain tissue 111 with excitation light to cause PPIX to fluoresce. The surgical microscope 108 may also include a camera capable of detecting radiation at the fluorescent wavelengths of PPIX or ICG.

[0022] The surgical cart 114 may include a surgical system 112, a suction system 113, a tissue detection system 116, and an ultrasonic surgical system 118. A display 121 may be coupled to the surgical cart and operatively connected to the surgical system 112, the tissue detection system 116, and / or the ultrasonic surgical system 118 for displaying information associated with each respective system 112, 116, 118. A medical professional may use the ultrasonic surgical system 118 and / or the surgical system 112 to ablate targeted tissue in the patient's brain. The ultrasonic surgical system 118 may include an ultrasonic control console 128 and an ultrasonic handpiece assembly 130.

[0023] The suction system 113 may include a suction instrument 156 and a suction unit 117 for controlling various aspects of the suction instrument 156. A suction tube may connect the suction instrument 156 to the suction system 113. The suction system 113 may receive suction from a vacuum source, such as a vacuum exhaust of a medical facility. The suction system 113 may include one or more regulators or one or more adjustment valves for controlling the suction pressure received from the vacuum source. The suction system 113 may also include one or more containers for storing waste collected by the suction instrument 156. In one example, the suction system 113 may correspond to a wall suction unit. In another example, the suction system 113 may correspond to a portable suction unit. The suction system 113 and the suction instrument 156 may have various features as described in U.S. Pat. No. 9,066,658 and U.S. Patent Application Publication No. 20180344993, the entireties of which are incorporated herein by reference.

[0024] The surgical system 112 may include a surgical instrument, such as a bipolar forceps 160, and a surgical control console 115 for controlling various aspects of the surgical instrument. A medical professional may also use the surgical instrument to perform a surgical operation on tissue, for example, to resect tissue or cauterize tissue. The bipolar forceps may have features as described in U.S. Pat. No. 8,361,070 (B2), which is incorporated herein by reference in its entirety. Although this disclosure discusses and illustrates that the surgical instrument may include a bipolar forceps 160, the surgical system 112 and the surgical instrument may include other instruments, such as a neurostimulator, a dissector, or an ablation device (e.g., an RF ablation device and / or a laser ablation device). For example, the surgical system and / or the surgical instrument may have various features as described in U.S. Pat. No. 8,267,934, which is incorporated herein by reference in its entirety. A medical professional may use any number of surgical systems and any number of surgical instruments in performing a surgical procedure.

[0025] The tissue detection system 116 can include a control console 168 and a sample element 164 (shown coupled to the ultrasound handpiece assembly 130). The control console 168 can provide a real-time indication to the medical professional via the sample element 164 when the brain tissue 111 corresponds to the target tissue. The sample element 164 can also be coupled to a bipolar forceps 160, a suction instrument 156, or other surgical instrument, as described in more detail below. The tissue detection system 116 determines when the brain tissue 111 corresponds to the target tissue based on the fluorescence emitted by the target tissue caused by a fluorescent dye. In one example, the fluorescent dye can correspond to PPIX. In another example, the fluorescent dye can correspond to ICG. Based on the intensity and wavelength of the fluorescence emitted by the PPIX, as described in more detail below, the tissue detection system 116 can determine that the target tissue is present.

[0026] 3, a schematic diagram of a neurosurgery system 100 is shown. The tissue detection system 116 may perform a similar function as the surgical microscope 108 (i.e., allowing a medical professional to detect the presence of PPIX), but may be used in conjunction with the surgical microscope 108 to improve the outcome of the tumor resection procedure and the likelihood of achieving GTR.

[0027] During a surgical procedure, the medical professional can first observe the patient's brain tissue 111 with the surgical microscope 108 under an excitation light (e.g., blue light) and identify which portion of the brain tissue 111 corresponds to the target tissue evidenced by red fluorescence. The medical professional can switch the surgical microscope 108 back to standard white light illumination for better visibility and begin resection of the target tissue. Since the sample element 164 is coupled to the suction instrument 156, the medical professional does not need to consider additional surgical instruments (i.e., optical probes, etc.) in the sterile field. The medical professional can use the bipolar forceps 160 in one hand and the suction instrument 156 in the other hand to perform the resection of the target tissue.

[0028] As the medical professional is resecting the target tissue, the control console 168 can function to provide the medical professional with a real-time indication of the target tissue within the brain tissue 111 by activating an indicator (described in more detail below) of the sample element 164. The tissue detection system 116 according to the teachings of the present disclosure allows the medical professional to avoid switching back and forth between different illumination settings (i.e., illuminating the tissue with an excitation light and a white light) of the surgical microscope 108 as the medical professional is resecting the target tissue. This becomes especially important as the medical professional approaches the edge of the target tissue, as it is desirable for the medical professional to leave as much healthy tissue intact as possible while achieving GTR.

[0029] With reference to FIG. 4, the suction instrument includes a suction cannula 157 and a handle 159. The suction cannula 157 defines a lumen for aspirating fluid, debris, and tissue from the patient. The handle 159 is tubular with a control portion 167, which may be square. The distal end 162 may be tapered and is configured to receive the proximal end 161 of the suction cannula 157. The distal end 165 of the handle 159 includes a vacuum fitting, which may be configured to receive a suction tube 169 that is connected to a vacuum source that generates a suction pressure. The vacuum fitting may be a standard barbed fitting, a quick disconnect, or any other suitable fitting known in the art that allows the suction tube to be fluidly coupled to a vacuum source.

[0030] 5A and 5B, the control portion 167 may include a teardrop-shaped control 170 for adjusting the suction pressure. For example, when no portion of the teardrop-shaped control 170 is covered by the medical professional, the suction pressure may be minimal, and when the teardrop-shaped control 170 is completely covered, the suction pressure may be maximum. Although the control portion 167 is described as including a teardrop-shaped control, the control portion 167 may include another suitable input, such as a button or a differently shaped control, to allow the medical professional to vary the suction pressure. The control portion includes a through hole 171 for receiving the sample element 164, as described in more detail below. The medical professional holds the suction instrument 156 from the handle 159 and manipulates the suction instrument 156 so that the distal end 163 contacts the patient's tissue during the surgical procedure to provide suction at the desired location. Although the suction instrument 156 is described as having a Fukushima configuration, other configurations, such as a Frazier configuration and a Poole configuration, are also contemplated.

[0031] With reference to FIG. 6, the ultrasonic handpiece assembly 130 may include an ultrasonic handpiece 132 having a proximal end and a distal end. The ultrasonic handpiece assembly 130 may further include a sleeve 136 and an ultrasonic tip 140 that may be coupled to the distal end of the ultrasonic handpiece 132. The sleeve 136 may be configured to provide irrigation to the ultrasonic tip 140 and / or the surgical site. It is further contemplated that the sleeve 136 may be configured to provide suction to the ultrasonic tip 140. The ultrasonic tip 140 may include a cutting mechanism configured to ablate, cut, shape, and / or remove biological tissue. The ultrasonic handpiece assembly 130 may have various features as described in U.S. Pat. Nos. 6,497,715 (B2), 6,955,680 (B2), and 6,984,220 (B2), which are incorporated herein by reference in their entireties, and International Publication WO 2020 / 068756 A1.

[0032] The ultrasonic handpiece assembly 130 may also include a cable 144 or other power cord with a power connector 148 or adapter configured to couple the ultrasonic handpiece assembly 130 to a power source, such as an ultrasonic control console 128 configured to adjust various aspects of the ultrasonic handpiece assembly 130. The ultrasonic control console 128 may also be configured to provide irrigation and / or aspiration via one or more tubes (not shown) connected to the handpiece assembly 130 to adjust the irrigation and / or aspiration functions of the ultrasonic handpiece assembly 130 to optimize ultrasonic handpiece assembly 130 performance. One example of an ultrasonic surgical system that may be used is commercially available from Stryker, including the Sonopet IQ ultrasonic aspirator. The ultrasonic control console 128 may control various operating parameters based on signals received from the tissue detection system 116.

[0033] 7 and 8, the tissue detection system 116 includes a sample element 164 and a control console 168. The sample element 164 is connected to the control console 168 via a connector 172. The sample element 164 may include a detection fiber 264, an indicator element 296, and an electrode 266, which will be described in more detail below. The control console 168 may include a controller 204, a user interface 208, a power supply 212, an optical system 215, a microcontroller 220, and a mapping module 265. The optical system 215 may include an optical block 216, a spectrometer 224, an excitation source 228, and an optical connector 229. The function of each component is described in more detail below.

[0034] The user interface 208 may include a display for displaying output from the controller 204. The user interface 208 may also include one or more inputs (e.g., push buttons, touch buttons, switches, etc.) configured for engagement by a medical professional. A power source 212 may provide power to the various components of the control console 168. The control console 168 may include a probe port 173 to which a connector 172 of the sample element 164 is connected. The detection fiber 264 may then be connected to the optical block 216 via an optical connector 229. The control console 168 may also include an electrical port 174 for establishing a communication link to the surgical system 112 and the ultrasonic surgical system 118. The control console 168 may also include an indicator port 175 for connecting to the indicator element 164, as described in more detail below.

[0035] The mapping module 265 may include a device configured to generate stimulation signals for electrodes 266 configured to deliver the stimulation signals to the brain tissue 111. During surgical resection of the target tissue, a medical professional may need to map the brain tissue 111 to determine which regions of the brain tissue 111 correspond to functionally important regions. For example, functionally important brain regions responsible for language and motor skills may be selected to be avoided if the target tissue cannot be removed without affecting the underlying function of the region, even if it is determined that these regions contain the target tissue. The device may be configured to generate an electrical current, which is then applied by the medical professional to the brain tissue 111 via the electrodes. The electrodes may be stand-alone electrodes disposed on or coupled to an exterior surface of the sample element 164, or the electrodes may be incorporated within the sample element 164, as described in more detail below. The mapping module 265 and / or the electrodes 266 may have various functions and features as described in International Application Publication No. WO2021074265A1 and U.S. Patent No. 7,150,737(B2), which are incorporated by reference herein in their entireties. The controller 204 may be configured to generate an alert based on the result of stimulation of the electrodes 266 on the brain tissue 111. For example, the controller 204 may generate an alert to be displayed on the user interface 208, the display 120, or the display 121. The alert may indicate to a medical professional whether the brain tissue 111 corresponds to a functionally important area, such as an area associated with motor or language function.

[0036] The excitation source 228 can irradiate the target tissue with excitation light via the detection fiber 264. The excitation source 228 can be configured to emit excitation light (e.g., blue light at about 405 nm, or blue light in the range of 400 nm to 500 nm). The excitation source 228 can also be configured to emit excitation light corresponding to other wavelengths, such as wavelengths associated with the remainder of the visible light spectrum other than blue light (e.g., greater than 500 nm but less than 700 nm), wavelengths associated with the ultraviolet light spectrum (less than 400 nm), and / or wavelengths associated with the infrared light spectrum (greater than 700 nm). The excitation source 228 can include any number of light sources, such as light emitting diodes (LEDs), pulsed lasers, continuous wave lasers, modulated lasers, filtered white light sources, etc.

[0037] In certain instances, the excitation source may be further configured to emit excitation light corresponding to a different wavelength than the aforementioned. In this implementation, the excitation sources may be referred to as a first excitation source 228 and a second excitation source, where the first excitation source 228 is configured to emit a first excitation light of a predetermined wavelength in the visible light spectrum, and the second excitation source is configured to emit infrared light in a second wavelength range (e.g., 700 nm to 1 mm) corresponding to the infrared light spectrum. When two excitation sources are present, the first excitation source 228 may be configured to emit light that excites a first fluorescent dye, such as PPIX, while the second excitation source may be configured to emit light that excites a second fluorescent dye, such as ICG.

[0038] The controller 204 can control the operation of the excitation source 228. The controller 204 can control the operation of the excitation source 228 by modifying operating parameters of the excitation source 228. The operating parameters can correspond to time settings, power settings, or other suitable settings. The time settings can include a pulse width. The pulse width can be based on an integration time of the spectrometer 224. The integration time of the spectrometer 224 is described in more detail below.

[0039] The detection fiber 264 may be coupled to an optical connector 229. When the sample element 164 is coupled to a surgical instrument (i.e., the ultrasonic handpiece assembly 130, the suction instrument 156, or the bipolar forceps 160), the distal end 272 of the detection fiber 254 is adjacent to a working portion of the surgical instrument, allowing the excitation light to be delivered to the target tissue.

[0040] 9A and 9B, the optical block 216 is shown. An optical connector 229 may be coupled to the optical block 216. The optical block 216 may include an outer casing 274 made of metal or other suitable material and completely enclose the components 232 of the optical block 216. FIG. 7B shows the optical block 216 with the top end of the casing removed so that the components 232 of the optical block 216 are visible. The optical block 216 may be L-shaped and may include a first portion 280 and a second portion 284. An excitation source 228 may be coupled to the first portion 280 of the optical block 216. A spectrometer 224 may be coupled to the second portion 284 of the optical block 216.

[0041] 10A and 10B, an exploded view of the components 232 of the optical system 215 is shown illustrating an optical path 285 for excitation light and an optical path 287 for light collected from the brain tissue 111. The first portion 280 can include an optical path 285 for excitation light to travel from one or more excitation sources 228 to the brain tissue 111 via the detection fiber 264. The optical path 285 can be defined by the components 232 in the first portion 280 of the optical block. The second portion 284 can include an optical path 287 for collected light to travel from the brain tissue 111 to the spectrometer 224 via the detection fiber 264. The optical path 287 can be defined by the components 232 in the second portion 284 of the optical block. The components 232 of the optical block can be optical components such as one or more laser line filters and one or more long pass filters. The optics block 216 may include other optical components, such as one or more mirrors, lenses, optical connectors, optical fibers, and / or any other suitable optical components.

[0042] In FIG. 10A, the excitation source 228 emits excitation light that passes through one or more components 232, such as a laser line filter and / or a long pass filter. The laser line filter or band pass filter can be configured to remove unwanted noise (e.g., low level transitions, plasma, and glow) generated by the excitation source 228. In other words, the laser line filter can be configured to remove the excitation light or make the excitation light more monochromatic. The long pass filter can be configured to reflect the light down the detection fiber 264 to the brain tissue 111. The excitation source 228 can be configured to deliver unfiltered excitation light (i.e., the filter can be omitted) to the target tissue via the detection fiber 264. The detection fiber 264 can direct the excitation light to the brain tissue 111 via the sample element 164.

[0043] The detection fiber 264 may be configured to collect light (i.e., fluorescence and ambient light) from the brain tissue 111. Coupling of the sample element 164 to a surgical instrument brings the distal end 272 adjacent to a working portion of the surgical instrument to allow collection of light from the target tissue.

[0044] Due to the presence of ambient and / or background light caused by various light sources in the operating room, such as the surgical microscope 108, surgical lamps, or other devices in the operating room, the light collected from the brain tissue 111 may include ambient and / or background light. With reference to FIG. 10B, the light collected by the detection fiber 264 passes through a component 232, such as a long pass filter, in the second portion 284 of the optical block 216. After the light passes through the component 232, the light may enter a spectrometer 224 that is coupled to the optical block 216.

[0045] The detection fiber 264 can be coupled to an optical connector 229. As described in more detail below, the distal end 272 of the detection fiber 264 can include a lens or other transparent material such that when the sample element 164 is positioned on a surgical instrument (i.e., an ultrasonic handpiece, a suction instrument, or a bipolar forceps), the distal end 272 of the detection fiber 264 is adjacent a working portion of the surgical instrument to enable delivery of excitation light to the target tissue by coupling the sample element 164 to the surgical instrument.

[0046] Referring to FIG. 11, a view of the control console 168 with the outer casing removed is shown. The optical block 216 may be directly secured (e.g., via bolts) to the base 217 of the control console 168 to allow for heat dissipation for heat generated by one or more components of the optical system 215. The control console 168 may include sufficient clearance to allow multiple optical blocks 216 to be stacked within the control console 168. For example, a second optical block with various optical components therein may be stacked on top of the optical block 216. A second excitation source may be coupled to the second optical block. The second optical block may include components that define an optical path for light generated by the second excitation source to reach the target tissue.

[0047] 12A, the sample element 164 is shown. The sample element 164 may also include an indicator element 296. The indicator element 296 may include a transmission member 297 connected to an indicator 298. The indicator 298 may include one or more light emitting diodes or another suitable light source. The indicator 298 is configured to emit light in response to detection of tumor tissue or target tissue by the controller 204. The indicator 298 may be spherical, dome-shaped, cylindrical, or another suitable shape. A jacket 292 may surround a portion of the detection fiber 264 and a portion of the indicator element 296, specifically the transmission member 297. In other words, the jacket 292 may terminate well before the distal end 272 of the detection fiber 264 leaves the transmission element 297, the indicator 298, and the detection fiber 264 at least partially exposed. The jacket 292 may be formed from any one of polyvinyl chloride, polyethylene, chlorinated polyethylene, and chlorosulfonated polyethylene / neoprene or another suitable material. 12A, the electrode 266 may be integral with the sample element 164. For example, the distal end of the electrode may be positioned adjacent to the distal end of the detection fiber 264 such that the distal end of the electrode 266 can contact the brain tissue 111.

[0048] As described above, the detection fiber 264 can carry excitation light from the optical system 215 to the brain tissue 111, and the detection fiber 264 can collect light from the brain tissue 111 and deliver it to the optical system 215, which provides a filtered optical signal to the spectrometer 224.

[0049] The sample element 164 may be coupled to any surgical instrument (i.e., ultrasonic handpiece assembly 130, suction instrument 156, or bipolar forceps 160) such that a distal end 272 of the detection fiber 264 is proximal to the working portion of the surgical instrument. The distal end 272 of the detection fiber 264 may include a lens, collimator, or another suitable optical component that enables the detection fiber 264 to deliver excitation light to the brain tissue 111 and to collect light from the brain tissue 111.

[0050] In this example, the detection fiber 264 functions to deliver excitation light to the tissue and collect light from the tissue, although the system may instead include two separate fibers, such as a collection fiber and an excitation fiber. The collection fiber may collect light from the tissue, and the excitation fiber may deliver excitation light to the tissue. The detection fiber 264 and any other fibers described herein are considered as single fibers for simplicity, but it is understood that each of the fibers may include two or more fibers. For example, the detection fiber 264 may include a bundle of detection fibers all connected in a manner similar to the single fiber connection described above. In another example, the detection fiber 264 may include any number of fibers connected in series.

[0051] Referring to Figure 12B, there is shown a second alternative configuration of the sample element 164. The illustrated sample element 164' is functionally equivalent to the sample element 164 shown in Figure 12A, and therefore a detailed description of the functionally equivalent parts will be omitted. The illustrated indicator 298' is cylindrical in shape, as opposed to the spherical indicator 298 shown in Figure 12A.

[0052] 12D, a third configuration of the sample element 164 is shown. The illustrated sample element 164'' is functionally equivalent to the sample elements 164 and 164' shown in FIGS. 12A and 12B, and therefore a detailed description of the functionally equivalent parts will be omitted here. In this configuration, the indicator element 296' is provided separately from the sample element 164' (i.e., the indicator element 296 is not integrated with the sample element 164'). The indicator element 296''' may include a transmission member 297', such as a jacketed wire and / or cable, an indicator 298, and a connector 299 for connecting the transmission member 297 to the indicator port 175 of the control console 168. The indicator element 296 may include a connector 299 for connecting the indicator element 296 to the indicator port 175 of the control console 168.

[0053] 12E, a fourth configuration of the sample element 164 is shown. The illustrated sample element 164''' is functionally equivalent to the sample elements 164, 164', and 164'' shown in FIGS. 12A, 12B, and 12D, and therefore a detailed description of the functionally equivalent parts is omitted here. Here, the transmission member 297''' and the indicator 298 of the indicator element 296''' can be replaced with an optical fiber, hereinafter referred to as an indicator fiber. The indicator fiber functions to emit light in response to detection of the target tissue by the controller 204. The sample element 164''' can also include an indicator portion 291 illuminated by the indicator fiber as light travels down the sample element 264'''. The indicator portion 291 can be located proximal to the distal portion of the sample element 164 to allow the medical professional to see the indicator portion 291 as the tissue is being excised. The indicator portion 291 can be transparent or can correspond to a removed portion of the jacket 292 of the sample element 164. The indicator fiber can be coupled to the optical block 216 via an optical connector and can receive light of a different wavelength than the excitation light from the excitation source 228 or another excitation source. For example, the excitation source can generate green light (e.g., a wavelength of about 520-564 nm) when commanded by the controller 204 to indicate detection of target tissue.

[0054] The sample element 164''' may include a coaxial fiber having a central core and an outer channel covered by a jacket 292. The detection fiber 264''' may be disposed in the central core, while the indicator fiber is disposed in the outer channel. A portion of the jacket 292 of the sample element 164''' may be removed to allow the indicator fiber to shine light through a sidewall of the outer channel to illuminate the indicator portion 291.

[0055] The controller 204 can transmit an activation signal to the indicator 298 in response to detecting the target tissue. The indicator 298 can emit light in response to receiving the activation signal. The controller 204 can control the LED to emit different colors of light depending on whether the controller 204 detects PPIX or ICG (i.e., whether the brain tissue 111 corresponds to the target tissue or to a blood vessel). For example, the controller 204 can control the LED to emit green light (e.g., wavelength of about 520-564 nm) if PPIX above a threshold is detected, or yellow light (e.g., wavelength of about 565-590 nm) if ICG is detected.

[0056] The spectrometer 224 is configured to convert the filtered optical signal (i.e., the filtered light) into a spectral signal in the form of an electrical signal. The microcontroller 220 is configured to control the operation of the spectrometer 224. Examples of spectrometer systems that may be used are commercially available from Hamamatsu, including the Mini-Spectrometer Micro Series C12880MA. Although the spectrometer 224 is contemplated throughout this disclosure, other optical instruments may be used in place of the spectrometer 224. The spectrometer 224 may include an entrance slit, a collimating lens / mirror, a transmissive grating element, a focusing mirror, and an image sensor. The entrance slit receives the collected light from the optical block 216, after which the light passes through the collimating lens / mirror. The collimating lens / mirror collimates the collected light that passes through the entrance slit and directs it to the grating element. The grating element separates the incident light from the collimating lens into different wavelengths and passes or reflects the light of each wavelength at a different diffraction angle. A focusing lens or mirror images the light dispersed into wavelengths by the diffraction grating element onto linearly arranged pixels of the image sensor according to wavelength.

[0057] Each wavelength is photoelectrically converted into an electrical signal (spectral signal). The image sensor outputs the signal of the light incident on each pixel at a regular time interval (i.e., the image sensor converts the optical signal into an electrical signal and outputs it). This time interval is sometimes called integration timing. The microcontroller 220 may be configured to control the operation of the spectrometer 224, for example, the integration timing based on an instruction from the controller 204. The microcontroller 220 transfers the spectral signal to the controller 204 via a communication interface (e.g., a serial peripheral interface (SPI)).

[0058] The controller 204 is configured to convert the spectral signals provided by the microcontroller 220 into simple / usable output variables in real time to provide the medical professional with an indication of the presence of target tissue within the sterile field. The controller 204 may illuminate an indicator 298 of the sample element 164 in response to detection of target tissue.

[0059] Because ambient light may be present in the optical signal collected at the target tissue, and therefore in the spectral signal provided by the spectrometer 224, the controller 204 is configured to perform one or more control functions or methods to remove the ambient light from the spectral signal (i.e., wavelengths associated with ambient light) to accurately detect when brain tissue 111 corresponds to the target tissue as evidenced by PPIX being present in the target tissue.

[0060] The controller 204 may be configured to remove ambient light from the spectral signal in any suitable manner using any suitable method, function, or algorithm. In one example, the controller 204 may pulse one or more excitation sources 228. The controller 204 may be configured to pulse the excitation source 228 such that an alternating spectral signal is collected. During a first period, the controller 204 may operate the excitation source 228 in a first illumination state (IS1) in which the excitation source 228 is on and irradiating the target tissue via the detection fiber 264. During a second period, the controller 204 may be configured to operate the excitation source 228 in a second illumination state (IS2) in which the excitation source 228 is off and not irradiating the target tissue via the detection fiber 264.

[0061] The resulting spectral signal of the optical signal provided by the spectrometer 224 and collected from the target tissue while the excitation source 228 is in the first illumination state (IS1) during the first time period should include red fluorescence when the brain tissue 111 corresponds to the target tissue. The spectral signal received by the controller 204 during the first time period while the excitation source 228 is in the first illumination state (IS1) may hereafter be referred to as the excitation spectral signal. With reference to FIG. 13, an excitation spectral signal 356 corresponding to the red fluorescence collected during the first time period is shown. Due to the presence of ambient and / or background light caused by various light sources in the operating room, such as the surgical microscope 108, the surgical lamp, or any other device in the operating room, the excitation spectral signal 356 shows a wide range of wavelengths present in addition to the wavelengths associated with red fluorescence. With reference to FIG. 10B, the light collected by the detection fiber 264 passes through a component 232, such as a long pass filter, of the second portion 284 of the optical block 216. After the light passes through component 232 , the light may enter a spectrometer 224 that is coupled to the optical block 216 .

[0062] The spectral signal generated as a result of the optical signals provided by the spectrometer 224 and collected from the target tissue while the excitation source 228 is in the second illumination state (IS2) may include ambient light and should not include red fluorescence generated by the target tissue, even though the excitation light must be absorbed by the target to cause the tissue to fluoresce. The spectral signal received by the controller 204 during the second time period while the excitation source 228 is in the second illumination state (IS2) may be referred to as an ambient spectral signal.

[0063] 14A and 14B, a first modified spectral signal 360 and a second modified spectral signal 368 of a target tissue are shown. Fluorescence intensity is shown on one axis and emission wavelength is shown on the other axis. The controller 204 may be configured to generate the first modified spectral signal 360 in any suitable manner to exclude ambient light (i.e., ambient spectral signal) from consideration. For example, the controller 204 may be configured to subtract the ambient spectral signal from the excitation spectral signal (i.e., subtract the spectral signal provided over the second illumination condition (IS2) from the spectral signal provided over the first illumination condition (IS1)). After the first modified spectral signal 360 is generated, the controller 204 may be configured to further subtract any background signal still present from the first modified spectral signal 360.

[0064] The controller 204 may be configured to subtract background signals still present in the first modified spectral signal to generate a second modified spectral signal. For example, the controller 204 may be configured to use a polynomial-based algorithm, such as an automatic polynomial fitting routine based on a modified version of a least squares polynomial, to obtain a baseline curve 364 that represents any background signals still present. The controller 204 using the algorithm may then subtract the baseline curve 364 from the first modified spectral signal 360 to obtain a second modified spectral signal 368 that represents red fluorescence emanating from the target tissue with ambient and background light removed.

[0065] The controller 204 may be configured to fit at least one Gaussian distribution / curve to the spectral signal. The controller 204 may fit at least one Gaussian distribution to the raw spectral signal (i.e., the excitation spectral signal and / or the ambient spectral signal), the first modified spectral signal, or the second modified spectral signal. This may allow a confidence level to be determined based on the fitting results. In FIG. 15, three Gaussian curves (372, 376, 380) were fitted to the remaining three spectral bands of the second modified spectral signal 368 (i.e., the spectral signal remaining after the ambient light and background light are removed).

[0066] 16, the controller 204 can be configured to select a Gaussian band fitted to the emission band of PPIX (i.e., the band that includes 635 nm) and generate the selected band 372 for display in real time to allow a medical professional to view the PPIX intensity in real time as the sample element 164 collects the sample. The controller 204 can store a predetermined intensity threshold associated with the target tissue.

[0067] The controller 204 can be configured to generate an activation signal based on a comparison of the PPIX intensity in the Gaussian-band-fitted PPIX emission band to a predetermined intensity threshold. In response to the PPIX intensity exceeding the threshold, the controller 204 can generate the activation signal. Based on the activation signal, the indicator 298 of the sample element 164 can emit light, thereby providing a medical professional with a real-time indication of the presence of target tissue.

[0068] The controller 204 may be configured to perform an error correction process before generating the actuation signal. During the error correction process, the controller 204 may be configured to determine a ratio of any of the spectral signals (raw spectral signal, excitation spectral signal, ambient spectral signal, first modified spectral signal, or second modified spectral signal) to a Gaussian band, such as a Gaussian band fitted to the PPIX emission band. The controller 204 may be configured to calculate at least two full width at half maximum (FWHM) points in the Gaussian band. The controller 204 may be configured to calculate how far the at least two FWHM points are from any of the spectral signals (as a percentage of their intensity). If the ratio exceeds a threshold value (e.g., 2 percent), the controller 204 may be configured to return that the PPIX intensity has fallen below the threshold value, and thus the controller 204 does not generate an actuation signal, even if the actuation signal was generated before the error correction process was performed.

[0069] The controller 204 can communicate with the ultrasonic surgical console via a communication link established through the electrical port 174. For example, a cord can be plugged into the electrical port and also into the ultrasonic control console 128 to establish a communication link. The communication link can also be established wirelessly. The controller 204 can notify the ultrasonic control console 128 based on the type of tissue detected. The controller 204 can notify the ultrasonic control console 128 when target tissue is present or not present. Based on the information provided by the controller 204, the ultrasonic control console 128 can adjust one or more operating parameters. For example, if target tissue is present, the ablation rate may not be limited, but if target tissue is not present, the ablation rate may be limited such that the ultrasonic surgical handpiece is prevented from cutting healthy tissue. In such an example, the ultrasonic console can control a drive signal, such as a voltage, current, or both, supplied to the ultrasonic handpiece based on whether target tissue is detected. In this example, the controller 204 can communicate with the ultrasound control console 128, but the controller 204 may alternatively communicate with the surgical control console 115 to control various surgical instruments (e.g., bipolar forceps 160, neurostimulators, dissectors, ablation devices, etc.) based on the presence or absence of target tissue.

[0070] The controller 204 may be configured to execute one or more standardization and / or calibration routines. The controller 204, via the user interface 208, prompts the medical professional to execute a calibration routine at the beginning of the ablation procedure to account for variations in autofluorescence of the brain tissue 111 from person to person. The controller 204 may instruct the medical professional to collect light from known healthy brain tissue 111 using the detection fiber 264 of the sample element 164 to use as a standard baseline. Based on characteristics of the collected light, the controller 204 may adjust one or more parameters of an algorithm for determining whether the brain tissue is tumorous, such as a predetermined intensity threshold in PPIX.

[0071] In the standardization routine, during a first time period, the controller 204 may instruct the medical professional to collect light from a light source (e.g., a nearby light) that outputs light from a consistent spectral band using the detection fiber 264 of the sample element 164. After the optical system 215 converts the collected light into an electrical signal (hereinafter referred to as the first standardized electrical signal), the controller 204 may store the first standardized electrical signal that represents a characteristic of the collected light. During a second time period that occurs after the first time period, the controller 204 may instruct the medical professional to collect light from the same light source. After the optical system 215 converts the collected light into a second standardized signal, the controller 204 may compare the first standardized signal obtained during the first time period with the second standardized signal obtained during the second time period and use the results to account for any variations in the optical readings over time. For example, the controller 204 may adjust one or more parameters of an algorithm used to determine whether brain tissue is tumorous or not, or one or more settings of the spectrometer 224, to account for any variations in the optical readings over time.

[0072] 17 includes a flowchart 400 illustrating a surgical resection procedure in accordance with the teachings of the present disclosure. As will be appreciated from the ensuing description, this flowchart represents merely an exemplary, non-limiting sequence of blocks for describing a typical resection procedure performed to resect targeted tissue, and is in no way intended to serve as a complete functional block diagram of all steps of the resection procedure.

[0073] The ablation procedure 400 begins at 404, where a medical professional may identify target tissue using the surgical microscope 108 under excitation light. After the target tissue is identified at 408, the medical professional may perform ablation of the target tissue using one of the surgical instruments described above. After ablation of the target tissue identified via the surgical microscope at 412, the medical professional determines whether there is any suspect brain tissue that may correspond to the target tissue (e.g., tissue that does not emit visible light when viewed through the surgical microscope 108 under excitation, but has properties associated with the target tissue). If no suspicious brain tissue is present, the ablation procedure may end, otherwise the ablation procedure proceeds to 416.

[0074] At 416, the medical professional engages the sample element 164 with the suspected brain tissue (e.g., to excite the brain tissue and collect light from the brain tissue). At 420, the medical professional determines whether the tissue contains PPIX, as evidenced by the indicator 298 of the sample element 164. If so, the ablation procedure proceeds to 424; if not, the ablation procedure continues back to 412. At 424, the medical professional applies an electrical stimulus to the target tissue. At 428, the medical professional determines whether the electrical stimulus affected the patient. If so, the medical professional can choose not to ablate the target tissue; if not, the ablation procedure continues back to 408.

[0075] 18-21, the sample element 164 may be coupled to any surgical instrument. The sample element 164 may be coupled to an ultrasonic handpiece assembly 130 as shown in FIGS. 18A and 18B, coupled to a bipolar forceps 160 (or any surgical instrument associated with the surgical system 112, such as a dissector), as shown in FIGS. 19A and 19B, or coupled to a suction fitting 156, as shown in FIGS. 20-22. The sample elements 164 and 164′ and / or indicator element 296 may be coupled to the surgical instrument in any suitable manner. For example, the sample element 164 (or sample element 164″ and indicator element 296″) may be coupled to the surgical instrument via an adhesive. The adhesive may be in the form of a sticker or a substance such as glue. Additionally or alternatively, the sample element 164 (or the sample element 164'' and the indicator element 296'') may also be coupled to the surgical instrument via a fixation element, which is described in more detail with respect to FIG. 22, or may be coupled to the surgical instrument via a jacket, which is described in more detail with respect to FIGS. 21 and 22.

[0076] 18B, the sample element 164''' may be coupled to the ultrasonic handpiece assembly 130 in any manner, so long as there is no direct contact between the tip 140 and a distal portion of the sample element 164'''. For example, the sample element 164''' may terminate in a portion of the sleeve 136 proximal to the tip 140. In another example, the sample element 164''' may extend beyond the sleeve 136, but may be positioned such that there is sufficient empty space between the tip 140 and the sample element 164''' to prevent contact between the tip 140 and the sample element 164'''.

[0077] 19A and 19B, the sample element 164'' is shown coupled to an outer portion of the first pincer 302 of the bipolar forceps 160, and the indicator element 296'' is shown coupled to an inner portion of the second pincer 304 of the bipolar forceps 160. As shown, the indicator is positioned near the tip of the second pincer, allowing the medical professional to see the indicator 298'' without looking at another screen or portion of the instrument when performing the excision of the targeted tissue.

[0078] 20 and 21, the sample element 164 is shown coupled to the suction instrument 156. The detection fiber 264 and a portion of the indicator element 296 (i.e., the transmission element 297 and the indicator 298) may be guided through the through hole 171 of the handle 159. The distal end 272 of the detection fiber 264 may be located proximal to the distal end of the aspiration cannula 257. The indicator 298 may be located near the distal end of the detection fiber 264, but proximal to the distal end 162 of the control portion 167 of the handle 159 relative to the distal end 162 of the control portion 167 of the handle 159. In other words, the distal end 162 of the detection fiber 264 may be disposed proximal to the distal end of the aspiration cannula 157 relative to the indicator 298. 21 , after the detection fiber 264 and a portion of the indicator element 296 are fed through the through hole 171, a jacket 306 can be attached over the aspiration cannula 157, the detection fiber 264, and the transmission element 297. The jacket 306 can be fitted to the distal end 162 of the handle 159 such that the distal end 162 and the through hole 171 are covered. The jacket 306 can terminate just before the indicator 298 is coupled to the aspiration cannula 157. The detection fiber 264 can protrude from under the jacket 306 so that the jacket 306 does not interfere with the delivery of excitation light or the collection of fluorescence from the tissue. Also, as shown, the indicator 298 may be fully exposed but partially covered by the jacket 306. In some configurations, the jacket 306 may be omitted.

[0079] 22, a different configuration of the suction tube 156' is shown. Specifically, the suction tube 156' does not include a through hole in the handle 159' of the suction tube 156'. Instead, the sample element 164''' is coupled to the suction instrument 156' via a fastening element 308. Specifically, the sample element 164''' is shown coupled to the suction cannula 157' by two fastening elements. Although only two fastening elements 308 are shown, three or more fastening elements 308 can be used to couple the sample element 164 to the suction cannula 157' or to the handle 159'. The fastening elements 308 can include clips, bands, or anything capable of fastening the sample element 164 to the suction instrument 156'.

[0080] Terms

[0081] Clause 1 - An ultrasonic surgical system comprising: an ultrasonic handpiece assembly configured to remove brain tissue; a sample element including at least one fiber coupled to the ultrasonic handpiece assembly and configured to collect fluorescence emitted from the brain tissue; an indicator coupled to the ultrasonic handpiece assembly and configured to selectively emit light; and a controller configured to detect a type of brain tissue based on the fluorescence, activate the indicator based on the detected type of brain tissue, and control the ultrasonic handpiece assembly based on the detected type of brain tissue.

[0082] Clause 2 - An ultrasonic surgical system of clause 1, wherein at least one fiber is coupled to an excitation source, and the at least one fiber is configured to irradiate excitation light from the excitation source to induce fluorescence emitted from brain tissue and collect the fluorescence.

[0083] Clause 3 - The ultrasonic surgical system of clause 2, further comprising an optical system coupled to the controller and the sample element, the optical system including an excitation source and an optical detection system configured to convert the fluorescence into an electrical signal, and the controller detects the type of brain tissue from the electrical signal.

[0084] Clause 4 - The ultrasonic surgical system of clause 3, wherein the excitation source is further defined as a first excitation source, the fluorescence is further defined as a first fluorescence, and the electrical signal is further defined as a first electrical signal, the optical system further includes a second excitation source, the at least one fiber is configured to irradiate second excitation light from the second excitation source to induce second fluorescence emitted from the brain tissue and collect the second fluorescence, the optical detection system is configured to convert the second fluorescence into a second electrical signal, and the controller is configured to determine a second type of brain tissue from the second electrical signal.

[0085] Clause 5 - The ultrasound surgical system of clause 3, wherein the controller is configured to detect a type of brain tissue based on an algorithm.

[0086] Clause 6 - The ultrasound surgical system of clause 5, wherein the algorithm includes a calibration routine to be performed with respect to healthy tissue or baseline parameters.

[0087] Clause 7 - The ultrasonic surgical system of clause 5, wherein the algorithm is configured to calculate a modified electrical signal by fitting a baseline polynomial curve to the electrical signal and to subtract the baseline polynomial curve from the electrical signal to remove ambient light.

[0088] Clause 8 - The ultrasonic surgical system of clause 7, wherein the algorithm includes fitting at least one Gaussian distribution to the modified electrical signal.

[0089] Clause 9 - An ultrasonic surgical system as in clause 5, wherein the controller is configured to cycle the excitation source on and off, the sample element is configured to collect ambient light when the excitation source is off and not illuminating the brain tissue with fluorescence, and the sample element is configured to collect ambient light and fluorescence when the excitation source is on and the sample element is illuminating the brain tissue with fluorescence, and the algorithm includes subtracting the ambient light from the fluorescence.

[0090] Clause 10 - The ultrasonic surgical system of clause 1, wherein the ultrasonic handpiece assembly includes an ultrasonic handpiece and a sleeve, and the indicator is coupled to the sleeve.

[0091] Clause 11 - The ultrasonic surgical system of clause 1, further comprising an electrode configured to apply electrical stimulation to brain tissue, the controller generating an alarm when the electrical stimulation results in a predetermined response from the patient.

[0092] Clause 12 - A surgical system comprising: a surgical instrument configured to remove brain tissue; a sample element coupled to the surgical instrument and including at least one fiber configured to (i) collect fluorescence emitted from the brain tissue; an indicator coupled to the surgical instrument and configured to selectively emit light; and a controller configured to detect a type of brain tissue based on the fluorescence, activate the indicator based on the type of brain tissue detected, and control the surgical instrument based on the type of brain tissue detected.

[0093] Clause 13 - The surgical system of clause 12, further comprising an optical system coupled to the controller and the sample element, the optical system including an excitation source coupled to at least one fiber, the at least one fiber configured to irradiate the brain tissue with excitation light from the excitation source to induce fluorescence emitted from the brain tissue and collect the fluorescence, and an optical detection system configured to convert the fluorescence into an electrical signal, and the controller detects the type of brain tissue from the electrical signal.

[0094] Clause 14 - The surgical system of clause 13, wherein the excitation source is further defined as a first excitation source, the fluorescence is further defined as a first fluorescence, and the electrical signal is further defined as a first electrical signal, the optical system further includes a second excitation source, the at least one fiber is configured to irradiate second excitation light from the second excitation source to induce second fluorescence emitted from the brain tissue and collect the second fluorescence, the optical detection system is configured to convert the second fluorescence into a second electrical signal, and the controller is configured to determine a second type of brain tissue from the second electrical signal.

[0095] Clause 15 - The surgical system of clause 13, wherein the controller is configured to detect the type of brain tissue based on an algorithm.

[0096] Clause 16 - The surgical system of clause 15, wherein the algorithm includes a calibration routine to be performed with respect to healthy tissue or baseline parameters.

[0097] Clause 17 - The surgical system of clause 15, wherein the algorithm is configured to calculate a modified electrical signal by fitting a baseline polynomial curve to the electrical signal and to subtract the baseline polynomial curve from the electrical signal to remove ambient light.

[0098] Clause 18 - The surgical system of clause 17, wherein the algorithm includes fitting at least one Gaussian distribution to the modified electrical signal.

[0099] Clause 19 - The surgical system of clause 15, wherein the controller is configured to cycle the excitation source on and off, the sample element is configured to collect ambient light when the excitation source is off and not illuminating the brain tissue with fluorescence, and the sample element is configured to collect ambient light and fluorescence when the excitation source is on and the sample element is illuminating the brain tissue with fluorescence, and the algorithm includes subtracting the ambient light from the fluorescence.

[0100] Clause 20 - The surgical system of clause 12, wherein the surgical instrument comprises a bipolar forceps.

[0101] Clause 21 - The surgical system of clause 12, wherein the surgical instrument comprises a neurostimulator.

[0102] Clause 22 - The surgical system of clause 12, wherein the surgical instrument comprises a nerve dissector.

[0103] Clause 23 - The surgical system of clause 12, wherein the surgical instrument comprises an ablation device.

[0104] Clause 24 - The surgical system of clause 12, wherein the controller is configured to control the surgical instrument by adjusting an operating parameter of the surgical instrument based on the detection of the type of brain tissue.

[0105] Clause 25 - The surgical system of clause 12, further comprising an electrode configured to apply electrical stimulation to brain tissue.

[0106] Clause 26 - The surgical system of clause 25, wherein the controller generates an alarm when the electrical stimulation results in a predetermined response from the patient.

[0107] Clause 27 - A surgical aspiration system comprising a suction instrument configured to apply a suction force to brain tissue, a sample element including at least one optical fiber coupled to the suction instrument and configured to collect fluorescence emitted from the brain tissue, an indicator coupled to the suction instrument and configured to selectively emit light, and a controller configured to detect a type of brain tissue based on the fluorescence and to activate the indicator in response to the type of brain tissue detected.

[0108] Clause 28 - The surgical aspiration system of clause 27, wherein at least one optical fiber is coupled to an excitation source, and the at least one fiber is configured to irradiate excitation light from the excitation source to induce fluorescence emitted from the brain tissue and collect the fluorescence.

[0109] Clause 29 - The surgical aspiration system of clause 28, further comprising an optical system coupled to the controller and the sample element, the optical system including an excitation source and an optical detection system configured to convert the fluorescence into an electrical signal, and the controller detects the type of brain tissue from the electrical signal.

[0110] Clause 30 - The surgical aspiration system of clause 29, wherein the excitation source is further defined as a first excitation source, the fluorescence is further defined as a first fluorescence, and the electrical signal is further defined as a first electrical signal, the optical system further includes a second excitation source, the at least one fiber is configured to irradiate second excitation light from the second excitation source to induce second fluorescence emitted from the brain tissue and collect the second fluorescence, the optical detection system is configured to convert the second fluorescence into a second electrical signal, and the controller is configured to determine a second type of brain tissue from the second electrical signal.

[0111] Clause 31 - The surgical aspiration system of clause 29, wherein the controller is configured to detect the type of brain tissue based on an algorithm.

[0112] Clause 32 - The surgical aspiration system of clause 31, wherein the algorithm includes a calibration routine to be performed with respect to healthy tissue or baseline parameters.

[0113] Clause 33 - The surgical aspiration system of clause 31, wherein the algorithm is configured to calculate a modified electrical signal by fitting a baseline polynomial curve to the electrical signal and to subtract the baseline polynomial curve from the electrical signal to remove ambient light.

[0114] Clause 34 - The surgical aspiration system of clause 33, wherein the algorithm includes fitting at least one Gaussian distribution to the modified electrical signal.

[0115] Clause 35 - The surgical aspiration system of clause 31, wherein the controller is configured to cycle the excitation source on and off, the sample element is configured to collect ambient light when the excitation source is off and not illuminating the brain tissue with fluorescence, and the sample element is configured to collect ambient light and fluorescence when the excitation source is on and the sample element is illuminating the brain tissue with fluorescence, and the algorithm includes subtracting the ambient light from the fluorescence.

[0116] Clause 36 - The surgical aspiration system of clause 27, further comprising an electrode configured to apply electrical stimulation to brain tissue, the controller generating an alarm when the electrical stimulation results in a predetermined response from the patient.

[0117] Clause 37 - The surgical aspiration system of clause 27, wherein the aspiration instrument includes a handle portion and an elongate portion, and the sample element is coupled to the elongate portion.

[0118] Clause 38 - A method for detecting target tissue under ambient light conditions in an operating room, comprising the steps of positioning an optical fiber in a sterile field containing brain tissue illuminated by ambient light, collecting fluorescence emitted from the brain tissue with the optical fiber, detecting target tissue in the brain tissue based on the fluorescence emitted from the brain tissue using a controller coupled to the optical fiber, and activating an indicator positioned in the sterile field to provide a visual alert in response to detection of the target tissue.

[0119] Clause 39 - The method of clause 38, wherein fluorescence is emitted from the brain tissue in response to irradiating the brain tissue with excitation light from an excitation source coupled to the optical fiber.

[0120] Clause 40 - The method of clause 39, wherein detecting fluorescence emitted from the target tissue during the surgical procedure is based on an algorithm.

[0121] Clause 41 - The method of clause 40, wherein the algorithm includes a calibration routine to be performed on healthy tissue or baseline parameters.

[0122] Clause 42 - The method of clause 40, further comprising an optical system coupled to the optical fiber and the controller, the optical system configured to convert the fluorescence collected from the target tissue into an electrical fluorescence signal.

[0123] Clause 43 - The method of clause 42, wherein the optical system includes a spectrometer.

[0124] Clause 44 - The method of clause 42, wherein the algorithm includes fitting a baseline polynomial curve to the electrofluorescence signal and calculating a corrected electrofluorescence signal by subtracting the baseline polynomial curve from the electrofluorescence signal to remove ambient light.

[0125] Clause 45 - The method of clause 44, wherein the algorithm includes fitting at least one Gaussian distribution to the corrected electrofluorescence signal.

[0126] Clause 46 - The method of clause 40, further comprising the steps of periodically turning on and off an excitation light from an excitation source and collecting ambient light using an optical fiber when the excitation light is off and the brain tissue is not illuminated by the excitation light, wherein the algorithm includes subtracting the ambient light from the fluorescence.

[0127] Clause 47 - The method of clause 38, wherein the optical fiber is incorporated into at least one of a surgical instrument and a stand-alone device.

[0128] Clause 48 - The method of clause 38, wherein the indicator comprises a light emitting device coupled to the surgical instrument.

[0129] Clause 49 - A method for detecting target tissue under ambient light conditions in an operating room using a surgical system, the surgical system comprising a working instrument including at least one optical fiber, an indicator, an optical system coupled to the working instrument, and an excitation source coupled to the at least one optical fiber, the method for detecting target tissue comprising the steps of: positioning the working instrument in a sterile field containing brain tissue illuminated by ambient light; and detecting, using the optical system, fluorescence emitted from the target tissue during a surgical procedure using at least one optical fiber of the working instrument, wherein the step of detecting fluorescence comprises the steps of illuminating the tissue with blue light from the excitation source using the at least one optical fiber; collecting the ambient light and the fluorescence using the at least one optical fiber; generating a fluorescence signal based on the fluorescence emitted from the target tissue when the ambient light is removed; determining the presence of target tissue based on the detected fluorescence; and activating an indicator of the working instrument in response to detection of the target tissue.

[0130] Clause 50 - The method for detecting target tissue of Clause 49, wherein the step of illuminating the tissue with blue light from an excitation source using at least one optical fiber is performed for a first time period, the step of illuminating the tissue with blue light is not performed for a second time period, the step of collecting ambient light and fluorescence is performed for a first time period, and the step of detecting fluorescence further includes the steps of collecting ambient light for a second time period using at least one optical fiber, (i) generating a first signal based on the ambient light and fluorescence collected during the first time period, and (ii) generating a second signal based on the ambient light collected during the second time period, wherein the ambient light is removed from the fluorescence signal using an algorithm based on the first signal and the second signal.

[0131] Clause 51 - The method for detecting a target tissue of clause 50, wherein the algorithm includes calculating a baseline curve using a least squares polynomial based on a difference between the first signal and the second signal.

[0132] Clause 52 - The method for detecting a target tissue of clause 51, wherein the algorithm comprises subtracting a baseline curve from the difference between the first signal and the second signal to obtain a fluorescent signal.

[0133] Clause 53 - The method for detecting a target tissue of clause 52, wherein the algorithm comprises calculating at least one Gaussian curve for at least one spectral band of the fluorescent signal.

[0134] Clause 54 - The method for detecting target tissue according to clause 49, wherein the working tool is a suction handle.

[0135] Clause 55 - A method for detecting target tissue according to clause 49, wherein the working instrument is an ablation device.

[0136] Clause 56 - The method for detecting target tissue of clause 55, further comprising the step of removing the target tissue based on the indicator using a working tool.

[0137] Clause 57 - The method for detecting target tissue of clause 49, wherein the ambient light includes light generated by a surgical microscope and light generated by one or more surgical lamps.

[0138] Clause 58 - The method for detecting target tissue of clause 49, wherein the surgical system includes a display, and the method further includes the step of displaying the fluorescent signal on the display.

[0139] Clause 59 - The method for detecting a target tissue of clause 49, wherein the working instrument includes at least one electrode configured to apply a stimulation current to the target tissue, and the method for detecting the target tissue includes the steps of applying an electrical stimulation to the target tissue and determining whether the electrical stimulation of the target tissue has an effect on the patient.

[0140] Clause 60 - A method for detecting target tissue according to clause 59, comprising controlling operation of the working instrument to prevent the working instrument from acting on the target tissue in response to a determination that the electrical stimulation will affect the patient.

[0141] Clause 61 - The method for detecting target tissue of clause 60, wherein controlling the operation of the work implement comprises modifying an operating parameter of the work implement.

[0142] Clause 62 - The method for detecting target tissue of clause 61, wherein the operating parameters include at least one of an applied voltage, a current drawn, and a power consumption.

[0143] Clause 63 - The method for detecting target tissue of clause 59, wherein the indicator is further defined as a first indicator and the working instrument includes a second indicator, and the method for detecting target tissue further comprises the step of activating the second indicator in response to determining that the electrical stimulation affects the patient.

[0144] Clause 64 - A method for detecting a target tissue of Clause 49, wherein the target tissue is further defined as a first target tissue, and the method further comprises a step of detecting a second target tissue using an optical system based on a second fluorescence emitted from the second target tissue.

[0145] Clause 65 - The method for detecting target tissue of clause 64, further comprising the step of controlling operation of the working instrument in response to detection of the second target tissue to prevent the working instrument from acting on the second target tissue.

[0146] Clause 66 - A method for detecting a target tissue according to clause 64, wherein the second target tissue corresponds to a blood vessel.

[0147] Clause 67 - A method for detecting a target tissue according to clause 49, wherein the detection of fluorescence is performed in less than one second.

[0148] Clause 68 - A method for detecting and removing target tissue under ambient light conditions in an operating room using a surgical system, the surgical system comprising a first working instrument, a second working instrument, an attachment including at least one optical fiber, an indicator, an optical system, and an excitation source coupled to the at least one optical fiber, the method for detecting the target tissue comprising coupling the attachment to at least one of the first working instrument and the second working instrument, detecting the target tissue during a surgical procedure based on fluorescence emitted from the target tissue using the optical system, and coupling the attachment to at least one of the first working instrument and the second working instrument, the optical system and the excitation source coupled to the at least one optical fiber. and a second working instrument are in a sterile field; viewing the indicator on the attachment while at least one of the first working instrument and the second working instrument are in the sterile field; performing a first surgical procedure at the surgical site while the first working instrument is in a first hand of the surgeon; and performing a second surgical procedure at the surgical site while the second working instrument is in a second hand of the surgeon in response to the indicator while holding the first working instrument in the first hand.

[0149] Clause 69 - The method for detecting and removing target tissue of clause 68, wherein the first working instrument corresponds to a suction cannula and the first surgical procedure includes aspirating fluid from the surgical site.

[0150] Clause 70 - The method for detecting and removing target tissue of clause 68, wherein the second working instrument corresponds to a bipolar forceps.

[0151] Article 71 - A method for detecting and removing target tissue under ambient or microscopic light conditions in an operating room using a surgical system comprising an aspiration cannula including at least one optical fiber, an indicator, a working instrument, an optical system, and an excitation source coupled to the at least one optical fiber, the method comprising the steps of: positioning the working instrument and the aspiration cannula in a sterile field including brain tissue illuminated by ambient light; detecting the target tissue during a surgical procedure based on fluorescence emitted from the target tissue using the optical system; activating an indicator of the aspiration cannula in response to detection of the target tissue while the aspiration cannula is in the sterile field; viewing the indicator of the aspiration cannula while the aspiration cannula is in the sterile field; aspirating fluid from the surgical site using the aspiration cannula while the aspiration cannula is in a first hand of a surgeon; and operating on the target tissue using a working instrument in a second hand of the surgeon in response to the indicator while holding the aspiration cannula in the first hand of the surgeon.

[0152] Clause 72 - A method for detecting target tissue under ambient light conditions in an operating room using a surgical system, the surgical system comprising a working instrument including at least one optical fiber, an indicator, an optical system coupled to the working instrument, and an excitation source coupled to the at least one optical fiber, the method for detecting the target tissue comprising the steps of detecting fluorescence emitted from the target tissue during a surgical procedure by at least one optical fiber of the working instrument using the optical system, the step of detecting fluorescence comprising the steps of illuminating the tissue with blue light from the excitation source using the at least one optical fiber, collecting ambient light and the fluorescence using the at least one optical fiber, generating a fluorescence signal based on the fluorescence emitted from the target tissue in a state where the ambient light is removed, determining that the target tissue is present based on the detected fluorescence, and activating an indicator of the working instrument in response to detection of the target tissue.

[0153] Article 73 - An optical probe system for determining whether brain tissue of a patient is tumorous. The optical probe system includes a sample element including an optical fiber configured to transmit fluorescence emitted by the brain tissue, and an indicator configured to selectively emit visible light different from the fluorescence transmitted by the optical fiber. The optical probe system includes an excitation source configured to emit excitation light having a wavelength for inducing fluorescence in the tumor tissue. The optical probe system includes an optical instrument coupled to the optical fiber, the optical instrument configured to convert the fluorescence emitted by the brain tissue and transmitted by the optical fiber into an electrical signal, and a controller coupled to the indicator and the optical instrument, the controller configured to determine that the brain tissue is tumorous based on the electrical signal and to activate the indicator based on the determination that the brain tissue is tumorous.

[0154] The foregoing description is merely exemplary in nature and is not intended to limit the disclosure, its application, or uses in any way. The broad teachings of the disclosure can be embodied in various forms. Thus, while the disclosure includes specific examples, the true scope of the disclosure should not be so limited, since other modifications will become apparent upon review of the drawings, specification, and claims that follow. It should be understood that one or more steps in a method can be performed in a different order (or simultaneously) without altering the principles of the disclosure. Furthermore, although each example is described above as having specific features, any one or more of these features described with respect to any example of the disclosure may be implemented in and / or combined with any feature of any of the other examples, even if the combination is not explicitly described. In other words, the described examples are not mutually exclusive, and substitution of one or more examples for one another is also included within the scope of the disclosure.

[0155] Spatial and functional relationships between elements (e.g., between controllers, between circuit elements, between semiconductor layers, etc.) are described using a variety of terms including "connected," "engaged," "coupled," "adjacent," "next to," "on," "above," "below," and "disposed," unless expressly described as "direct," and where a relationship between a first element and a second element is described in the above disclosure, the relationship can be a direct relationship where there are no other intervening elements between the first element and the second element, but it may also be an indirect relationship where there are one or more intervening elements (spatial or functional) between the first element and the second element.

[0156] As used herein, the phrase "at least one of A, B, and C" should be construed to mean a logical non-exclusive OR (A OR B OR C), and not to mean "at least one of A, at least one of B, and at least one of C." The term subset does not necessarily require a proper subset. In other words, a first subset of a first set may be coextensive (equal) with the first set.

[0157] In a diagram, the direction of an arrow, as indicated by the arrowhead, generally indicates the flow of information (such as data or instructions) that is important to the diagram. For example, an arrow may point from element A to element B if elements A and B exchange various information, but the information conveyed from element A to element B is relevant to the diagram. This unidirectional arrow does not imply that other information cannot be conveyed from element B to element A. Additionally, for information sent from element A to element B, element B may send a request for the information or an acknowledgment of receipt to element A.

[0158] In this application, including the definitions below, the term "controller" or "module" may be substituted with the term "circuitry." The term "controller" may refer to, be a part of, or include an application specific integrated circuit (ASIC), a programmable system on a chip (PSoC), digital, analog, or mixed analog / digital discrete circuitry, a digital, analog, or mixed analog / digital integrated circuit, a combinatorial logic circuit, a field programmable gate array (FPGA), a processor circuit (shared, dedicated, or group) that executes code, a memory circuit (shared, dedicated, or group) that stores code executed by the processor circuitry, other suitable hardware components that provide the described functionality, or a system on a chip, or any combination of any or all of the above.

[0159] The controller may include one or more interface circuits with one or more transceivers. In some examples, the interface circuit may implement a wired or wireless interface to connect to a local area network (LAN) or a wireless personal area network (WPAN). Examples of LANs include the Institute of Electrical and Electronics Engineers (IEEE) standard 802.11-2016 (also called the WIFI wireless networking standard) and IEEE standard 802.3-2015 (also called the ETHERNET wired networking standard). Examples of WPANs include the Bluetooth wireless networking standard from the Bluetooth Special Interest Group and IEEE standard 802.15.4.

[0160] Controllers can communicate with other controllers using interface circuits. Although in this disclosure the controllers are shown as logically communicating directly with controllers, in various implementations the controllers can actually communicate through a communication system. The communication system may include physical and / or virtual networking equipment such as hubs, switches, routers, gateways, transceivers, etc. In some implementations the communication system connects to or traverses a wide area network (WAN) such as the Internet. For example, the communication system may include multiple LANs interconnected via the Internet or point-to-point leased lines using technologies such as Multiprotocol Label Switching (MPLS) and Virtual Private Networks (VPNs).

[0161] In various implementations, the functionality of a controller may be distributed among multiple controllers connected via a communication system. For example, multiple controllers may implement the same functionality distributed by a load balancing system. In a further example, the functionality of a controller may be split between a server (also known as a remote or cloud) controller and a client (or user) controller.

[0162] Some or all of the hardware characteristics of the controller may be defined using a hardware description language, such as IEEE Standard 1364-2005 (commonly referred to as "Verilog") or IEEE Standard 1076-2008 (commonly referred to as "VHDL"). The hardware description language may be used to manufacture and / or program the hardware circuitry. In some implementations, some or all of the functionality of the controller may be defined by a language such as IEEE 1666-2005 (commonly referred to as "SystemC"), which encompasses both code and hardware descriptions, as described below.

[0163] The term code as used above includes software, firmware, and / or microcode and may refer to programs, routines, functions, classes, data structures, and / or objects. The term shared processor circuit includes a single processor circuit that executes some or all code from multiple controllers. The term group processor circuit includes a processor circuit that executes some or all code from one or more controllers in combination with additional processor circuits. References to multiple processor circuits include multiple processor circuits on separate dies, multiple processor circuits on a single die, multiple cores of a single processor circuit, multiple threads of a single processor circuit, or combinations of the above. The term shared memory circuit includes a single memory circuit that stores some or all code from multiple controllers. The term group memory circuit encompasses a memory circuit that stores some or all code from one or more controllers in combination with additional memory.

[0164] The term memory circuit is a subset of the term computer-readable medium. The term computer-readable medium as used herein does not encompass a transitory electrical or electromagnetic signal propagating in a medium (such as a carrier wave). Thus, the term computer-readable medium may be considered tangible and non-transitory. Non-limiting examples of non-transitory computer-readable media are non-volatile memory circuits (such as flash memory circuits, erasable programmable read-only memory circuits, or masked read-only memory circuits), volatile memory circuits (e.g., static random access memory circuits or dynamic random access memory circuits), magnetic storage media (such as analog or digital magnetic tape, hard disk drives, etc.), and optical storage media (such as CDs, DVDs, or Blue-ray discs).

[0165] The apparatus and methods described in this application may be implemented in part or in full by a special-purpose computer created by configuring a general-purpose computer to perform one or more specific functions embodied in a computer program. The functional blocks and flow chart elements described above may function as software specifications that may be converted into a computer program by the routine work of a skilled technician or programmer.

[0166] A computer program includes processor-executable instructions stored on at least one non-transitory computer-readable medium. A computer program may also include or depend on stored data. A computer program may include a basic input / output system (BIOS) that interacts with the hardware of a special-purpose computer, device drivers that interact with specific devices of a special-purpose computer, one or more operating systems, user applications, background services, and background applications.

[0167] A computer program may include (i) explanatory text to be parsed, such as HTML (Hypertext Markup Language), XML (Extensible Markup Language), or JSON (JavaScript Object Notation); (ii) assembly code; (iii) object code generated from source code by a compiler; (iv) source code executed by an interpreter; (v) source code compiled and executed by a just-in-time compiler; etc. By way of example only, the source code may be written using syntax from languages ​​including C, C++, C#, Objective-C, Swift, Haskell, Go, SQL, R, Lisp, Java®, Fortran, Perl, Pascal, Curl, OCaml, JavaScript®, HTML5 (Hypertext Markup Language Fifth Edition), Ada, ASP (Active Server Pages), PHP (PHP: Hypertext Preprocessor), Scala, Eiffel, Smalltalk, Erlang, Ruby, Flash®, Visual Basic®, Lua, MATLAB®, SIMULINK®, and Python®.

Claims

1. A surgical suction system comprising a suction instrument configured to apply a suction force to brain tissue, a sample element including at least one optical fiber coupled to the suction instrument and configured to collect fluorescence emitted from the brain tissue, an indicator coupled to the suction instrument and configured to selectively emit light, and a controller configured to detect a type of brain tissue based on the fluorescence and activate the indicator in response to the type of brain tissue detected.

2. The surgical suction system of claim 1, wherein the at least one optical fiber is coupled to an excitation source, and the at least one fiber is configured to irradiate excitation light from the excitation source to induce fluorescence emitted from brain tissue and collect the fluorescence.

3. The surgical suction system of claim 2, further comprising an optical system coupled to the controller and the sample element, the optical system including the excitation source and an optical detection system configured to convert the fluorescence into an electrical signal, and the controller detecting a type of brain tissue from the electrical signal.

4. The surgical aspiration system of claim 3, wherein the excitation source is further defined as a first excitation source, the fluorescence is further defined as a first fluorescence, the electrical signal is further defined as a first electrical signal, the optical system further includes a second excitation source, the at least one fiber is configured to irradiate second excitation light from the second excitation source to induce second fluorescence emitted from brain tissue and collect the second fluorescence, the optical detection system is configured to convert the second fluorescence into a second electrical signal, and the controller is configured to determine a second type of brain tissue from the second electrical signal.

5. The surgical aspiration system of claim 3, wherein the controller is configured to detect a type of brain tissue based on an algorithm.

6. The surgical aspiration system of claim 5, wherein the algorithm includes a calibration routine to be performed with respect to healthy tissue or baseline parameters.

7. The surgical aspiration system of claim 5, wherein the algorithm is configured to calculate a modified electrical signal by fitting a baseline polynomial curve to the electrical signal and subtract the baseline polynomial curve from the electrical signal to remove ambient light.

8. The surgical suction system of claim 7, wherein the algorithm includes fitting at least one Gaussian distribution to the modified electrical signal.

9. The surgical aspiration system of claim 5, wherein the controller is configured to periodically turn the excitation source on and off, the sample element is configured to collect ambient light when the excitation source is off and not illuminating brain tissue with fluorescent light, and the sample element is configured to collect ambient light and the fluorescent light when the excitation source is on and the sample element is illuminating brain tissue with the fluorescent light, and the algorithm includes subtracting the ambient light from the fluorescent light.

10. A surgical suction system as described in any one of claims 1 to 9, further comprising electrodes configured to apply electrical stimulation to brain tissue, wherein the controller generates an alarm when the electrical stimulation results in a predetermined response from the patient.

11. A surgical suction system as described in any one of claims 1 to 10, wherein the suction instrument includes a handle portion and an elongated portion, and the sample element is coupled to the elongated portion.

12. The surgical system of claim 1, wherein the suction instrument comprises a handle including a control portion having a distal end, and the indicator is located near the distal end of the optical fiber but closer to the distal end of the control portion of the handle than the distal end of the optical fiber.

13. The surgical system of claim 12, wherein the indicator is an indicator fiber.

14. The surgical system of claim 13, wherein the indicator fiber is coupled to a second light source, the second light source generating light of a different wavelength than the excitation light.

15. The surgical system of claim 6, wherein the controller 204 is configured to generate an actuation signal based on a comparison of PPIX intensity in a PPIX emission band adapted to the Gaussian band with a predetermined intensity threshold.

16. A neurosurgery system for examining brain tissue of a patient for tumor tissue, comprising:

1. A suction instrument configured to apply suction to tissue of a patient, comprising: an aspiration cannula defining a lumen; an optical fiber coupled to the suction cannula, the optical fiber configured to transmit fluorescence emitted by brain tissue; and an indicator coupled to the aspiration cannula and configured to selectively emit visible light distinct from the fluorescent light transmitted by the optical fiber; A suction device comprising: an excitation source configured to emit excitation light, the excitation light having a wavelength that induces fluorescence in the tumor tissue; an optical instrument coupled to the optical fiber and configured to convert fluorescence emitted by brain tissue and transmitted by the optical fiber into an electrical signal; and a controller coupled to the optical instrument, determining that the brain tissue is tumorous based on the electrical signals; and activating the indicator based on said determination that the brain tissue is tumorous. A controller configured to: A neurosurgery system comprising:

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