Surgical navigation system and navigation method

Abstract

The present disclosure relates to a surgical navigation system (1) for intraoperatively guiding a patient (P) using a surgical map (L): a first acquisition modality (2) configured to acquire at least one predefined region of tissue of the patient (P) as a first record (8) recording position data; a second acquisition modality (10) different from the first acquisition modality and configured to acquire the predefined region of tissue of the patient (P) as a second record (16) recording position data; a memory unit (18) in which a two-dimensional or three-dimensional surgical map (L) of the patient (P) is stored, in which for each position of the surgical map (L) both a first numerical pathological value and a second numerical functional value of the tissue are stored; and a control unit (20) configured to: analyze and determine, for a first acquisition modality (2), the first recording (8) such that pathological and / or functional values ​​are assigned to at least portions of the tissue in the first recording (8) and these pathological or functional values ​​are supplemented with associated locations in the surgical map (L); analyze and determine, for a second acquisition modality (10), the second recording, taking into account that in the second recording at least portions of the tissue are assigned pathological and / or functional values ​​and these pathological or functional values ​​are supplemented with associated locations in the surgical map (L), and visually output via a display device (22) a view of the surgical map (L) for navigational aid purposes. The present disclosure also relates to a navigation method according to the alternative independent claims, as well as to a computer-readable storage medium and a computer program.

Description

[Technical Field]

[0001] The present disclosure relates to a surgical navigation system for intraoperative guidance of surgical instruments and the like during a surgical intervention for tumor removal in a patient using a surgical map.

[0002] For this purpose, the navigation system includes a first acquisition modality, in particular a CT imaging device and / or an MRI imaging device. This imaging device is configured to acquire and provide, in a computer-readable manner, a first image of at least one predetermined region of the patient's tissue, together with image position data, based on the first acquisition modality. This means that the position of the image relative to the patient is available as data of the first image. This also allows the image to be spatially assigned relative to the patient. For example, in the case of an MRI image, the position of the tissue is also provided as image position data.

[0003] Furthermore, the present disclosure relates to a navigation method, a computer-readable storage medium and a computer program for intraoperative guidance according to the preambles of the independent claims. [Background technology]

[0004] In neurosurgery, neurosurgeons are often faced with the decision of determining the boundaries of pathological tissue, especially tumor tissue, in order to remove as much of the tumor as possible while preserving as much healthy (functional) tissue as possible and minimizing functional damage.

[0005] For this purpose, various modalities are used intraoperatively to identify pathological tissue and to recognize important structures (functional tissues) that must be protected.

[0006] For example, magnetic resonance imaging and computed tomography images (MRI / CT data) can be used to identify both pathological and critical structures that should be preserved during interventions. The same applies to intraoperative microscopic images / photographs. Recognition can be automatic, for example by trained AI systems, or manual by the physician.

[0007] Fluorescence (images) of 5-ALA and other substances is used to identify tumor tissue, i.e., pathological tissue.

[0008] Meanwhile, intraoperative electrophysiological signals are used to identify important functional tissues, such as vital nerves, that should be preserved.

[0009] Intraoperative histological data collected from the specimens is used to identify both pathological and healthy tissue (selectively or by site), depending on the analysis results.

[0010] Unfortunately, the imaging modalities mentioned above, such as MRI / CT, ​​microscopy, and fluorescence, have limitations in that they are not always accurate in distinguishing between pathological and healthy tissue. Furthermore, these methods generally lack spatial correlation, meaning they are not available as summary maps. Electrophysiological and histological data are more accurate and differentiated, but are only available for individual regions of the anatomy. These limitations mean that surgeons cannot obtain uniform images of the surgical field to reliably distinguish between pathological and healthy tissue.

[0011] Although surgeons use a variety of modalities, it remains unclear where the boundary of pathological tissue should actually be defined. Summary of the Invention

[0012] It is therefore an object and goal of the present disclosure to avoid or at least reduce the drawbacks of the prior art, and in particular to provide a navigation system, navigation method, computer-readable storage medium, and computer program that provides visual assistance in the removal of pathological tissue, and in particular to safely and intuitively indicate to the surgeon the resection area and areas requiring special attention, e.g., areas of functionally important tissue such as nerves, to enable safe navigation and resection, particularly in the resection of tumors. Another partial object is to display the resection border directly on the view to visually indicate possible incision lines and thus assist the surgeon. [Means for solving the problem]

[0013] This object is solved for a universal navigation system according to the invention by the features of claim 1, for a universal navigation method according to the invention by the features of claim 10, for a computer-readable storage medium according to the invention by the features of claim 11 and for a computer program according to the invention by the features of claim 12.

[0014] Therefore, the basic idea of ​​the present disclosure is to provide a navigation system that utilizes various modalities such as microscopy, MRI images, CT images, electrophysiological testing and / or histological testing (or histological testing) to create an integrated homogenous surgical map that includes the pathological tissue to be removed and the tissue to be preserved (functional tissue, i.e., the anatomical structures to be preserved), defines these together with specially calculated borders, and provides the user with a visual view of this surgical map to assist the user during surgery.

[0015] While each individual modality is already known in its own right, as explained in the introduction, this leads to the corresponding drawback of inaccurate boundary definitions of the regions. Here, a solution is provided: combining all available modalities and integrating them into a single integrated surgical map, which defines the boundaries between pathological tissue to be removed and healthy (functional) tissue to be preserved and visually presents them to the surgeon. Such an integrated map can be created by centrally combining the data and converting the information into a uniform, homogeneous "metric" for the surgical map using numerical values ​​related to the two pathological-functional locations. This integrated map intuitively presents the surgeon with a superimposed view of the pathological and functional tissue regions, for example by overlaying the surgical map with other images, such as MRI images.

[0016] The term "image" should be understood in a very broad sense and can refer to a puncture image or a small area image, e.g. via a biopsy at a location (image location) and a corresponding histological evaluation as to whether pathological or functional tissue is present or not, or also to a larger image, e.g. an MRI image of a patient, where the respective (three-dimensional) image position data is of course also available for the MRI image. In other words, the position of the image (or recorded tissue) relative to the patient is also recorded and provided for each image, so that the various acquisition modalities in a (single) integrated surgical map can also be positionally correctly added together with the corresponding determination of functional and pathological values.

[0017] The analysis and determination of whether functional or pathological tissue is present can be performed in different ways. In particular, such analysis and determination can be performed automatically in a computer-assisted manner. For example, an AI system trained on tumors can be configured to recognize tumors in images, such as CT images, identify this three-dimensional region as pathological tissue, and assign a pathological value to this pathological tissue. For example, the pathological value is defined on a scale from 0 to 10, and the functional value is defined on a scale from -10 to 0. In this way, the intensity of the pathological tissue can also be defined.

[0018] Importantly, the navigation system of the present disclosure converts many different acquisition modalities into a uniform "system" with pathological or functional values ​​at each location (relative to the patient) to generate a homogenous database of pathological and functional tissues that can then be used for further calculations and visualizations, such as the (standardized) calculation of resection lines to support the surgeon during resection.

[0019] In other words, the present disclosure relates to a navigation system that integrates various surgical modalities into a central computerized system. These modalities include, inter alia, MRI / CT (navigation), microscopy, endoscopy, fluorescence, electrophysiological detection, and / or intraoperative histology (e.g., by Raman spectroscopy). The navigation system may also include a tracking system (e.g., an optical tracking system or a (robotic) kinematic tracking system) to determine the exact position (relative to the patient's anatomy) of the corresponding modality data / image. In addition to the image itself, the spatial image position may also be provided. Once the images or data of the used modalities are acquired and integrated into the navigation system, a surgical map can be created. This map includes an intensity map that defines intensities (pathological values ​​as the first numerical value and functional values ​​as the second numerical value) either in a 2D image / 2D view, particularly at a specific pixel (2D), or in 3D space, particularly at a specific voxel (3D). Thus, two opposing / contrasting values ​​or signal types exist: one is pathological intensity and the other is functional intensity. The more pathological a particular pixel or voxel is (especially a tumor), the higher the pathological intensity. The more important tissue to preserve (e.g., a vital nerve), the higher the functional intensity.

[0020] In particular, a (computer-aided) system is provided with a display device and interfaces to the different modalities. Position information for each modality is provided by a tracking system of the navigation system so that the (spatial) image position can be provided in addition to the image. Surgical maps are created in two-dimensional (2D) or three-dimensional (3D) format, and in particular color maps are used to visualize how pathological or functional the tissue is in order to determine the resection borders.

[0021] In yet another aspect, a surgical navigation system is provided for intraoperatively guiding a surgical instrument in a surgical intervention for tumor removal in a patient using a surgical map. The surgical navigation system comprises: a first acquisition modality, in particular a CT imaging device or an MRI imaging device, configured to acquire, preoperatively and / or intraoperatively, a first image having image position data based on the first (acquisition) modality of at least one predefined region of the patient's tissue and provide the same in a computer-readable manner; and a second acquisition modality different from the first modality, in particular a fluorescence imaging device or an electrophysiological imaging device, configured to acquire, preoperatively and / or intraoperatively, a second image having image position data based on the second (acquisition) modality of the predefined region of the patient's tissue and provide the same in a computer-readable manner. The storage unit stores a two-dimensional or three-dimensional surgical map of the patient, where for each (2D or 3D) location (pixel or voxel) of the surgical map in at least a predefined region of tissue, a pathology value as a first numerical value of the tissue and a functional value as a second numerical value of the tissue are stored. Further, the control unit is configured to process the provided first image together with the image location data and process the provided second image together with the image location data, and for the first acquisition modality, analyze the first image to determine a pathology value assigned to at least some regions of tissue in the first image and / or a functional value assigned to at least some regions of tissue in the first image, and add these pathology values ​​and functional values, respectively, to corresponding locations of the surgical map. Then, for the second acquisition modality, the second image is analyzed to determine whether pathological values ​​are assigned to at least some regions of tissue in the second image and / or whether functional values ​​are assigned to at least some regions of tissue in the second image, and these pathological values ​​or, respectively, functional values ​​are added to the associated locations of the surgical map, and a view of the surgical map is visually output via a display device, in particular a monitor in an operating room, for navigational assistance.

[0022] Advantageous embodiments are set forth in the dependent claims and are particularly described below.

[0023] In particular, the navigation system may be configured to register a first image (of a first acquisition modality) in the form of a CT image and / or an MRI image and / or DTI data by tracking it with the patient via a tracking system of the navigation system.

[0024] The navigation system can be configured to spatially track the position of a surgical microscope (as a visualization system with corresponding second (microscopic) images and a further acquisition modality) and / or an endoscope (as a visualization system with corresponding second (endoscopic) images and a further acquisition modality).

[0025] The navigation system can be configured to detect and localize electrophysiological images or signals with the tracked probe.

[0026] The navigation system can be configured to detect and spatially localize histological images or data with a tracked (biopsy) probe.

[0027] This allows the different images to be provided with corresponding image position data, which can be transferred to the surgical map.

[0028] In particular, the navigation system may include a robot or a robotic system (combined with a robotic system), and the visualization system (in particular a surgical microscope and / or endoscope) and / or the probe are moved and positioned by a robotic arm of the robotic system.

[0029] In particular, the robot kinematics can be used as a tracking system to determine the position of the visualization system and / or probe.

[0030] According to one embodiment, the control unit can be configured to assign a first color to a first numerical pathological value and a second, different, particularly complementary, color to a second numerical functional value of the tissue, with the color intensity proportional to the numerical value. When the view is output via the display device, a surgical map with a colored background is output. Thus, colors can be used to distinguish between pathological and functional intensities. Specifically, pathological intensity can be displayed in red and functional intensity in blue. In particular, the color of pathological intensity is complementary to functional intensity. As a result, a color map is created as a surgical map, where higher red intensity indicates more resection is recommended and blue indicates less resection is recommended. Because non-image-based modalities do not provide data for each pixel or voxel (e.g., electrophysiological or histological data), color mapping allows for extrapolation of pathological and functional region labeling based on 3D point / location signals. This visualization allows surgeons to better select tissue resection locations during surgery. Individualized views can also be adjusted based on the data from the integrated surgical map. In particular, such views can be created based on temporal (position-related) values, with extrapolation between individual values ​​to display a continuously differentiable surface.

[0031] According to further embodiments, the control unit can be configured to determine a gradient between the pathological and functional values ​​and display a boundary line within the view based on the gradient to indicate to the user the boundary for resection. In particular, the navigation system can be configured to utilize the image gradient to generate a specific boundary line (in 2D cases) or boundary (surface) area (in 3D cases). For example, the location with the highest gradient between a red pathological area of ​​tissue and a blue functional area of ​​tissue is used to define the boundary. As a result, a boundary for resection may be defined and displayed, as well as a color map showing the pathological and functional tissues. Thus, the navigation system can also use the image gradient to calculate and visualize a clear boundary.

[0032] Preferably, the navigation system may include an input device. In particular, the display device may be configured as a touch display to detect user input, and the control unit is configured to adjust the gradient setting based on the input to change the boundary of the resection in the view of the surgical map. In particular, a control (e.g., a slider) for the gradient setting is displayed on the touch display, and the user can change the setting by touching the control. Depending on the aggressiveness of the pathology (e.g., glioblastoma, for which aggressive resection is recommended), the gradient can be adjusted to suit the surgeon's preferences and the patient's needs. An adjustable gradient allows for more or less aggressive resection depending on the type of pathology. In particular, the navigation system may also use an adjustable gradient to define the aggressiveness of the resection region. In particular, the user may use the input to move or adjust the boundary in a "positive direction" (i.e., toward a more pathological direction) from the gradient or gradient maximum value to protect more functional tissue, or to move or adjust the boundary in a "negative direction" (i.e., toward a more functional direction) from the gradient maximum value to more aggressively remove pathological tissue. In particular, it is therefore possible to adjust the aggressiveness of tissue removal by "moving" the boundary line "positively" (i.e., making the boundary line further / larger in relation to the surroundings or functional tissue) or "negatively" (i.e., making the boundary line smaller in relation to the surroundings or functional tissue) from the maximum value of the gradient. The gradient exhibits a maximum where the difference between pathological and functional tissue is greatest. For example, if an initial boundary is drawn at the maximum value of the gradient, this boundary can be adjusted toward the functional tissue for more aggressive removal or toward the pathological tissue for less aggressive removal.

[0033] Preferably, the navigation system includes an input unit for detecting input by a user, in particular the display device may be configured as a touch display, and the control unit is configured to manually define a region of tissue based on the input, the region being assigned a first numerical pathology value and / or a second numerical function value of the tissue, and via the input for manually identifying the region, the region being assigned the first numerical pathology value and / or the second numerical function value of the tissue. In addition to the at least two different acquisition modalities, the surgeon can also manually define regions with significant functions or pathologies that can be added to the surgical map, or can add additional regions using image segmentation.

[0034] In particular, at least as the first or second acquisition modality -MRI and / or CT and / or DTI images -Surgical microscope -Endoscopy -Electrophysiological equipment -Histological equipment At least one fluorescence imaging device may be used.

[0035] Thus, modalities may include, among others, CT / MRI / DTI (with navigation), microscopy, endoscopy, electrophysiology, histology, and fluorescence imaging. Each of these different acquisition modalities has the advantage of accurate determination of pathological or functional tissue and can be used in a targeted manner to combine and integrate all advantages.

[0036] In particular, the first and / or second acquisition modalities may be connected to the robot as end effectors, and in particular, a surgical microscope and / or an endoscope and / or a fluorescence imager may be attached to a robot arm as an end effector, in other words, the microscope, endoscope and / or fluorescence imager may be attached to the robot arm and may be actuated, moved or positioned by the robot arm.

[0037] Preferably, a probe for measuring data, such as a biopsy probe, may be attached to the robotic arm.

[0038] According to one embodiment, the navigation system may have a navigation camera as an optical camera and be configured to track a fiducial tracker (reference tracker), or the navigation system may have a navigation camera as an optical camera and use a machine learning image processing system to spatially track objects. In particular, the navigation system may use an optical (navigation) camera with a fiducial tracker, or a (machine) image processing system.

[0039] The object is to provide a navigation method for intraoperative guidance of a surgical instrument in a surgical intervention for tumor removal in a patient using a surgical map, the navigation method comprising the steps of: - pre- and / or intra-operatively acquiring a first image having image position data of at least one predetermined area of ​​the patient's tissue via a first acquisition modality, in particular a CT or MRI imaging device, and - pre- and / or intra-operatively acquiring a second image having image position data of the predetermined area of ​​the patient's tissue via a second acquisition modality different from the first acquisition modality, in particular a fluorescence or electrophysiological image, and - analyzing and determining the first acquisition modality of the first image such that at least some areas of the tissue in the first image are assigned a pathological value and / or a functional value is assigned to at least some areas of the tissue in the first image. the step of adding these pathological or functional values ​​to the relevant locations of a surgical map in which a pathological value as a first numerical value of the tissue and a functional value as a second numerical value of the tissue are stored for each (2D or 3D) location (pixel or voxel) within at least a predetermined region of the tissue; - the step of analyzing and determining for a second acquisition modality of the second image that at least some regions of the tissue in the second image have been assigned a pathological value and / or that at least some regions of the tissue in the second image have been assigned a functional value, and adding the pathological or functional values ​​to the relevant locations of the surgical map; - the step of outputting a view of the surgical map for navigation assistance via a display device, in particular a surgical monitor.

[0040] With regard to the computer-readable storage medium and the computer program, the object is solved by including instructions which, when executed by a computer, cause the computer to perform the method steps of the navigation method according to the present disclosure. The application to brain surgery described here can of course also be used in other indications where different modalities are used intraoperatively to distinguish the border between pathological and functional tissue.

[0041] The present disclosure will be described in more detail below with reference to preferred embodiments and with reference to the accompanying drawings. [Brief explanation of the drawings]

[0042] [Figure 1] FIG. 1 shows a schematic diagram of a navigation system of a first embodiment of the present disclosure having different acquisition modalities.

[0043] [Figure 2] Figure 2 shows a schematic diagram of the combination of pathology and functional values ​​to define the color map and calculate the resection boundary.

[0044] [Figure 3] FIG. 3 shows an exemplary surgical map with adjustable boundaries or borders.

[0045] [Figure 4] Figure 4 shows an exemplary surgical map with adjustable boundaries or borders. 4 shows an exemplary surgical map as a color map with red and blue intensity maps, with red used for pathological tissue and blue for critical functional tissue.

[0046] [Figure 5] 6 shows a two-dimensional plan view of the surgical map of FIG. 5.

[0047] [Figure 6] FIG. 6 shows a schematic flow diagram of a navigation method according to a preferred embodiment.

[0048] The figures are schematic in nature and are intended only to aid in the understanding of the present disclosure. Identical elements are provided with identical reference numerals. Features of the various implementations are interchangeable. DETAILED DESCRIPTION OF THE INVENTION

[0049] FIG. 1 is a schematic diagram of a surgical navigation system 1 (hereinafter referred to as the system) for intraoperatively guiding a surgical cutting instrument during a surgical intervention to remove a tumor from a patient P using a surgical map L.

[0050] The system 1 has a first acquisition modality 2 in the form of a CT imaging device 4 and an MRI imaging device 6 and is configured to preoperatively acquire at least one predetermined region of tissue of a patient P as a first image 8 having associated image position data, i.e. information regarding the spatial position of the image relative to the patient P, and provide it in a computer-readable manner based on this first acquisition modality.

[0051] Furthermore, the system 1 also comprises a further second acquisition modality 10 in the form of a surgical microscope 11, different from the first acquisition modality 2, configured to acquire pre- and / or intra-operatively a pre-defined region of tissue of the patient P as a second image 16 with image position data and provided in a computer readable manner based on the second (acquisition) modality. The system 1 also comprises a further third acquisition modality in the form of a fluorescence image 12, in which the image is also acquired in the same manner as in the first and second acquisition modalities 2, 10.

[0052] Furthermore, the system also has a fourth acquisition modality in the form of an electrophysiological imaging system 14 and a fifth acquisition modality in the form of intraoperative histology, ie intraoperative sampling with a probe.

[0053] All five different acquisition modalities are centrally integrated and processed. For this purpose, the system has a storage device 18 in which a two-dimensional or three-dimensional surgical map L of the patient P is stored, and for each (two-dimensional or three-dimensional) position (pixel or voxel) of the surgical map L, a pathological value as a first numerical value of the tissue and a functional value as a second numerical value are stored, at least in a predefined region of the tissue. In this embodiment, the three-dimensional surgical map L is stored, and for each position (X, Y, Z) (here, set to 0 before imaging), a pathological value (P value) and a functional value (F value) are stored. This allows the system 1 to read out the intensities of pathological and functional tissues after imaging and corresponding addition of the respective pathological or functional values ​​for a specific position (x1, y1, z1).

[0054] Furthermore, the system 1 comprises a central control unit 20 configured to process the provided first image 8 with image position data and to process the provided second image 16 with image position data. Similarly, the control unit 20 is also configured to process a third image of a third acquisition modality, a fourth image of a fourth acquisition modality, and a fifth image of a fifth acquisition modality with corresponding image position data. A tracking system 23 may also be used to determine (e.g. via transformation) the positions of the acquisition modalities and thus the positions of the images themselves.

[0055] The control unit 20 is further configured to analyze and determine the first image 8 for the first acquisition modality 2 such that pathological values ​​are assigned to at least some areas of the tissue in the first image 8 and / or functional values ​​are assigned to at least some areas of the tissue in the first image and add these pathological values ​​or respective functional values ​​to associated positions on the surgical map L.

[0056] In this embodiment, the detected pathological value (here positive) is added to the pathological value of the surgical map according to the position, and the detected, here negative, functional value of the surgical map is also added. In particular, the MRI image can be analyzed by an artificial intelligence system (AI system) trained by tumors to determine the areas of pathological tissue in the MRI image and evaluate them according to the pathological value. In particular, the control unit 20 performs the analysis and determination and is configured accordingly.

[0057] Similarly, for the second acquisition modality 10, the second image is analyzed and determined such that pathological values ​​are assigned to at least some regions of the tissue in the second image and / or functional values ​​are assigned to at least some regions of the tissue in the second image, and these pathological or functional values ​​are added to the relevant locations of the surgical map L.

[0058] Similarly, for the third, fourth and fifth acquisition modalities, pathological and / or functional values ​​are assigned (analyzed and determined) to the various respective spatial locations and added to the integrated (single) surgical map L in each case.

[0059] This results in a combination and integration of various modalities into a uniform, homogeneous integrated surgical map L (see, e.g., FIG. 2), which may be integrated into different output modes, showing regions and boundaries and which can be overlaid onto, for example, a three-dimensional MRI image for visual display to the surgeon.

[0060] The control unit 20 of this embodiment is configured to visually output, via a display device 22 in the form of a surgical monitor, a view of the surgical map L for navigational assistance, e.g., a virtual perspective view at a position with a predetermined viewing direction of the tissue with marked areas of pathological and functional tissue and displayed borders 24 (see also Figure 2).

[0061] In contrast to conventional techniques, each acquisition modality is not considered separately and in isolation, but rather many different acquisition modalities are all used and centrally integrated, standardized and stored in a unified surgical map L.

[0062] In particular, extrapolation can also be performed to estimate the surrounding area from temporal values ​​such as pathological values ​​determined with the aid of a biopsy.

[0063] FIG. 2 is a schematic diagram for understanding the present disclosure showing the combination of pathology and functional values ​​in a standardized map L of both values ​​to aid navigation.

[0064] In the upper left of Figure 2, so-called antagonists in the cold zone are shown as an example, which represent structures at risk and therefore have a high functional value. This structure at risk can be determined via a first acquisition modality 2, in particular using DTI / fiber segmentation, e.g., MRI or CT images, and neuromonitoring. This allows the system 1 to obtain a functional map of the structure at risk (i.e., the anatomical structure to be preserved).

[0065] Meanwhile, the main character of the so-called hot zone, representing the target structure for ablation, is shown by way of example in the lower left of Figure 2. This data can be obtained by a further second acquisition modality 10, such as, for example, an MRI image with tumor visualization, a biopsy / histological result, or a fluorescence image for visualizing and detecting the tumor structure, thereby allowing the system 1 to obtain a pathological map of the structure to be ablated.

[0066] Both maps, the functional map and the pathological map, are merged and combined into an integrated surgical map L. That is, both functional and pathological structures are integrated and centrally available. If further acquisition modalities are added, these new acquisition modalities can simply supplement the integrated surgical map with information about functional or pathological tissues that are positionally correct with respect to the patient (after all, images have image position data). Thus, all information can be centrally and homogeneously compiled to create a combined, dynamically growing surgical map L.

[0067] Finally, to support the surgeon in the intervention, so-called gradient volumes can be output, as shown in the right part of Figure 2. The boundary 24 represents the standard calculated resection boundary and is already shown here.

[0068] For example, a slider displayed on a touch display and used as an operable input unit 26 can be used to change the gradient setting to adjust the aggressiveness of the ablation by changing the ablation boundary or border 24.

[0069] Therefore, a threshold can be set on the gradient-defined contour (level set), which is particularly useful as a guide for surgeons. For example, steep or high gradients can be difficult to distinguish due to the proximity of pathological and functional areas.

[0070] For illustrative purposes, Figure 3 shows an example of such a gradient setting. The gradient between the functional and pathological regions is shown schematically in region A of Figure 3, where two distinct boundaries are visible: a first boundary or border 24 indicating a less aggressive ablation of tumor tissue (pathological tissue), and a second boundary for aggressive ablation to detect and remove the surrounding area of ​​pathological tissue. Thus, a gradient can be set between these two boundaries 24 with different aggressiveness. Region B of Figure 3 shows a highly defensive ablation border as an example.

[0071] Figure 4 shows an exemplary representation of the surgical map L as a color map with red and blue intensity maps, where red is used for pathological tissue and blue for important functional tissue (shown here in shades of color). The amplitudes represent the areas accordingly. Positive amplitudes represent pathological areas with pathological values, while negative amplitudes represent functional areas that should be preserved. A continuous surface is shown as an example between these areas. A gradient may be used to set the boundaries.

[0072] FIG. 5 is an exemplary top view of FIG. 4, showing the area to be removed (in red) in two dimensions.

[0073] 6 illustrates a navigation method according to a preferred embodiment, which is used in particular in the navigation system 1 of the present disclosure for intraoperative guidance of surgical instruments during a surgical intervention for tumor removal in a patient using a surgical map.

[0074] In step S1, at least one predefined region of tissue of patient P is detected preoperatively and / or intraoperatively as a first image having image position data via a first acquisition modality, in particular a CT imaging device or an MRI imaging device.

[0075] In step S2, a predefined region of the patient's tissue is then detected preoperatively and / or intraoperatively as a second image having image position data using a second acquisition modality different from the first acquisition modality, in particular a fluorescence image or an electrophysiological image.

[0076] In step S3, analysis and determination is performed on a first acquisition modality of the first image such that at least some regions of tissue in the first image are assigned pathological values ​​and / or functional values ​​are assigned to at least some regions of tissue in the first image, and these pathological values ​​or respective functional values ​​are added to associated positions of a surgical map in which a first numerical pathological value and a second numerical functional value of the tissue are stored for each position within at least a predefined region of the tissue.

[0077] In step S4, analysis and determination is performed on the second acquisition modality such that a pathological value is assigned to at least some regions of tissue in the second image and / or a functional value is assigned to at least some regions of tissue in the second image, and this pathological value or functional value is added to the associated location on the surgical map.

[0078] Finally, in step S5, a view of the surgical map for navigational assistance is output via a display device, in particular a surgical monitor.

[0079] 1. Surgical navigation system 2. First Acquisition Modality 4 CT imaging device 6. MRI imaging device 8. First Image 10 Secondary Acquisition Modality 11 Surgical microscope 12 Fluorescence Images 14 Electrophysiological Imaging 16 Second Image 18 Storage device 20 Control Unit 22 Display device 23 Tracking System 24 Borderline 26 Input Devices 100 robots P patient L Surgery Map

[0080] S1 Step of taking an image using a first acquisition modality S2 Step of taking an image with a second acquisition modality S3 Analyzing and determining the pathological and / or functional value of the first image S4 Analyzing and determining the pathological and / or functional value of the second image S5. Outputting a view of the surgical map via a display device

Claims

1. A surgical navigation system (1) for intraoperative guidance of surgical instruments in a surgical intervention for tumor removal in a patient (P) using a surgical map (L), comprising: a first acquisition modality (2), a second acquisition modality (10), a storage device (18), a control unit (20), and a display device (22); The first acquisition modality (2) comprises: In particular a CT imaging device (4) or an MRI imaging device (6), Pre-operatively and / or intra-operatively, at least one predetermined area of ​​tissue of a patient (P) is Acquire as a first image (8) having image position data to be detected; configured to provide the information in a computer-readable manner, The second acquisition modality (10) comprises: is different from the first acquisition modality (2), In particular, a fluorescence image (12) or an electrophysiological image (14), Preoperatively and / or intraoperatively, a predetermined area of ​​tissue of a patient (P) is a second image (16) having said image position data; configured to provide the information in a computer-readable manner, The storage device (18) storing an integrated two-dimensional or three-dimensional surgical map (L) of a patient (P); For each location of said surgical map (L), at least in a predetermined area of ​​tissue, a pathology value as a first numerical value and a function value as a second numerical value of the tissue are stored or can be stored; The control unit (20) is configured as follows: processing the provided first image (8) together with the image position data; processing the provided second image (16) together with the image position data; For the first acquisition modality (2), so that the pathology value and / or the functional value is assigned to at least some regions of tissue in the first image (8), analyzing the first image (8) to determine; adding said pathological values ​​or said functional values ​​to the relevant locations of said surgical map (L); For said second acquisition modality (10), such that the pathology value and / or the functional value is assigned to at least some regions of tissue in the second image (16); analyzing the second image (16) to determine; adding said pathological values ​​or respectively said functional values ​​to the relevant positions of said surgical map (L), To ensure that pathological tissue can be distinguished from functional tissue, via said display device (22), in particular a monitor in an operating room, The system visually outputs a view of said surgical map (L) as a navigation aid.

2. A surgical navigation system (1) according to claim 1, The control unit (20) assigning a first color to the pathology value, the first numerical value of the tissue; configured to assign a second different color to the second numeric value of the feature value; The intensity of each color is proportional to its respective numerical value, The system causes the surgical map (L) to be output with the color background when a view is output via the display device (22).

3. A surgical navigation system (1) according to claim 1 or 2, The control unit (20) determining a gradient between the pathology value and the functional value in the surgical map (L); To present the user with the boundaries for resection, The system is configured to display a boundary line (24) in a view of the surgical map (L) based on the gradient.

4. A surgical navigation system (1) according to claim 3, The navigation system (1) comprises an input device (26), The display device (22) is configured as a touch display capable of detecting input by a user; The control unit (20) The system is configured to adjust gradient settings based on the input to change the boundary (24) of the resection in a view of the surgical map.

5. A surgical navigation system (1) according to any one of claims 1 to 4, The navigation system (1) comprises an input device (26), The display device (22) is configured as a touch display capable of detecting input by a user, The control unit (20) configured to manually define an area of ​​tissue based on the input; The system is configured to manually identify the region by assigning via the input the pathology value, which is the first numerical value, and / or the functional value, which is the second numerical value, of tissue.

6. A surgical navigation system (1) according to any one of claims 1 to 5, The system, wherein at least one of an MRI imaging device, a CT imaging device, a DTI imaging device, a surgical microscope, an endoscope, an electrophysiological device, a histological device, or a fluorescence imaging device is used as the first acquisition modality or the second acquisition modality.

7. A surgical navigation system (1) according to any one of claims 1 to 6, the first acquisition modality (2) and / or the second acquisition modality (10) are connected to a robot (100) as end effectors; In particular, a system in which a surgical microscope, endoscope, or fluorescence imaging device is attached to a robotic arm as the end effector.

8. A surgical navigation system (1) according to any one of claims 1 to 7, A system in which a probe for measuring data is attached to a robotic arm of a robot (100).

9. A surgical navigation system (1) according to any one of claims 1 to 8, The navigation system (1) has a navigation camera as an optical camera and is configured to track a reference tracker, or A navigation system (1) has the navigation camera as the optical camera and uses a machine image processing system to spatially track objects.

10. 10. A navigation method for intraoperative guidance of the surgical instruments in the surgical intervention for tumor removal in a patient (P) using the surgical map of the surgical navigation system (1) according to any one of claims 1 to 9, comprising: It includes the following steps: In step S1, the first image (8) comprising the image position data is acquired preoperatively and / or intraoperatively via the first acquisition modality (2), in particular a CT or MRI imaging device, of at least one predetermined region of the tissue of the patient (P), In step S2, a second image (16) having the image position data is acquired preoperatively and / or intraoperatively of the predetermined region of the tissue of the patient (P) using a second acquisition modality (10) different from the first acquisition modality (2), in particular a fluorescence imager or an electrophysiological image; In step S3, the first image (8) acquired with the first acquisition modality (2) is analyzed to determine whether the pathological values ​​and / or functional values ​​are assigned to at least a portion of the tissue, and the pathological values ​​or functional values ​​are added to the corresponding positions of the surgical map (L), wherein the surgical map (L) stores or is capable of storing the pathological values ​​as the first numerical values ​​of the tissue and the functional values ​​as the second numerical values ​​of the tissue at each position of at least a predetermined region of the tissue; In step S4, the second image (16) acquired with the second acquisition modality (10) is analyzed and determined so that the pathological value and / or the functional value is assigned to at least the part of the tissue area, and the pathological value or the functional value is added to the corresponding position of the surgical map (L); In step S5, a view of the surgical map is output as a navigation aid via the display device (22), in particular a surgical monitor, in order to ensure that the pathological tissue can be distinguished from the functional tissue.

11. A computer-readable storage medium containing instructions for causing a computer to perform the steps of the navigation method of claim 10.

12. A computer program comprising instructions for causing a computer to carry out the steps of the navigation method according to claim 10.

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