DE10242802A1 - Brain surgery navigational assistance device, e.g. for use in tumor removal, wherein both preoperative and intraoperative images are generated with intraoperative imaging using excitation of brain electrical activity - Google Patents

Brain surgery navigational assistance device, e.g. for use in tumor removal, wherein both preoperative and intraoperative images are generated with intraoperative imaging using excitation of brain electrical activity Download PDF

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DE10242802A1
DE10242802A1 DE10242802A DE10242802A DE10242802A1 DE 10242802 A1 DE10242802 A1 DE 10242802A1 DE 10242802 A DE10242802 A DE 10242802A DE 10242802 A DE10242802 A DE 10242802A DE 10242802 A1 DE10242802 A1 DE 10242802A1
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brain
intraoperative
images
preoperative
excitation
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DE10242802B4 (en
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Ulrich Hofmann
Ulrich Knopp
Bernd Fischer
Jan Modersitzki
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UNIVERSITAETSKLINIKUM LUEBECK
Universitatsklinikum Luebeck
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UNIVERSITAETSKLINIKUM LUEBECK
Universitatsklinikum Luebeck
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/52—Devices using data or image processing specially adapted for radiation diagnosis
    • A61B6/5211—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data
    • A61B6/5229—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data combining image data of a patient, e.g. combining a functional image with an anatomical image
    • A61B6/5235—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data combining image data of a patient, e.g. combining a functional image with an anatomical image combining images from the same or different ionising radiation imaging techniques, e.g. PET and CT
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/369—Electroencephalography [EEG]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/52—Devices using data or image processing specially adapted for radiation diagnosis
    • A61B6/5211—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data
    • A61B6/5229—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data combining image data of a patient, e.g. combining a functional image with an anatomical image
    • A61B6/5247—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data combining image data of a patient, e.g. combining a functional image with an anatomical image combining images from an ionising-radiation diagnostic technique and a non-ionising radiation diagnostic technique, e.g. X-ray and ultrasound
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/05—Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves 
    • A61B5/055—Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves  involving electronic [EMR] or nuclear [NMR] magnetic resonance, e.g. magnetic resonance imaging
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment

Abstract

Navigational assistance device for use in brain surgery comprises a first imaging CT or NMR device for generation of images of the operation area and a second imaging device for generation of intraoperative images of the brain area being operated on. The second device includes means for peripheral excitation of the brain using electrical potentials so that brain current flows can be imaged.

Description

Bei der chirurgischen Hirntumorresektion und dgl. finden heute bildgestützte Verfahren Anwendung. Dabei werden in unter Verwendung eines Computertomographens oder Kernspintomographens präoperativ gewonnene Bilder des Operationsfeldes die während der Operation verwendeten Instrumente eingeblendet, so dass der Operateur eine Information über die jeweiligen räumlichen Verhältnisse am Ort des Eingriffs erhält.In surgical brain tumor resection and Like. Find image-based today Procedure application. This is done using a computer tomograph or MRI preoperatively acquired images of the surgical field the instruments used during the operation superimposed so that the surgeon can obtain information about the respective spatial conditions receives at the site of the intervention.

Dabei stellt sich das Problem der intraoperativen Verschiebung von dem Operationsfeld benachbarter Areale des Gehirns nach operativer Tumorteilentlastung, bei Zysteneröffnung oder antikonvulsiver Therapie. Dieser sogenannte Brainshift führt zu einer Abweichung der realen intraoperativen Verhältnisse von den intraoperativ eingespielten, aber präoperativ gewonnenen computertomographischen oder kernspintomographischen Bildern.The problem arises intraoperative displacement from the operating field adjacent Areas of the brain after partial tumor relief, when the cyst opens or anticonvulsant therapy. This so-called brain shift leads to a deviation the real intraoperative conditions of the intraoperatively recorded but acquired preoperatively computed tomography or MRI images.

Aus der DE 198 46 687 C2 ist eine Vorrichtung mit den Merkmalen des Oberbegriffs des Anspruchs 1 bekannt, die dem Operateur die präoperativ gewonnenen Bilder anhand von intraoperativ gewonnenen, den Brainshift berücksichtigenden Ultraschallaufnahmen aktualisiert. Dies Vorgehen hat den Nachteil, dass Ultraschallbilder keine ausreichende Genauigkeit erwarten lassen.From the DE 198 46 687 C2 A device with the features of the preamble of claim 1 is known which updates the preoperatively acquired images on the basis of intraoperatively acquired ultrasound recordings which take into account the brain shift. This procedure has the disadvantage that ultrasound images do not allow sufficient accuracy to be expected.

Der Erfindung liegt die Aufgabe zugrunde, eine Vorrichtung zu schaffen, die die Ermittlung des während der Operation auftretenden Brainshifts mit einer höheren Genauigkeit ermöglicht.The invention has for its object a To create device that the determination of during the Operation occurring brain shifts with higher accuracy.

Erfindungsgemäß wird diese Aufgabe gelöst durch eine Navigationshilfsvorrichtung für neurochirurgische Eingriffe am Gehirn, mit einer ersten bildgebenden Einrichtung zur Wiedergabe von präoperativ mittels eines Computertomographens oder eines Kernspintomographens gewonnenen Bildern des Operationsfeldes, und einer zweiten bildgebenden Einrichtung zur Wiedergabe von intraoperativ gewonnenen Bildsignalen in den Bildern der ersten Einrichtung, wobei die Bildsignale die durch den neurochirurgischen Eingriffverursachten Verschiebungen der das Operationsfeld benachbarten Gehirnareale berücksichtigen, bei der die zum Lokalisieren der verschobenen Gehirnareale durch einerseits präoperatives und andererseits intraoperatives Setzen gleicher peripherer Reize und Quellenlokalisation der so evozierten Potentiale durch Hirnstromableitungen und zum Errechnen der durch die intraoperative Verlagerung dieser Gehirnareale erkannten intraoperativer Verschiebungen und deren Darstellung in den Bildern der ersten Einrichtung eingerichtet ist.According to the invention, this object is achieved by a navigation aid for neurosurgery on the brain, with a first imaging device for reproduction from preoperatively by means of a computer tomograph or a magnetic resonance tomograph Images of the operating field, and a second imaging device for reproducing intraoperative image signals in the images the first device, the image signals being transmitted by the neurosurgical Intervention caused displacements of those adjacent to the operating field Take brain areas into account, in which to locate the displaced areas of the brain on the one hand preoperative and on the other hand intraoperative setting of the same peripheral stimuli and source localization of the evoked potentials by brain current leads and for calculating the intraoperative displacement of these Brain areas identified intraoperative shifts and their Representation in the pictures of the first facility is set up.

Vorzugsweise ist die zweite Einrichtung mit einer oberhalb des Operationsfelds auf die Kopfhaut aufgesetzten, zur Ableitung der Hirnströme dienenden Elektrodenmatrix versehen .The second device is preferably with one placed on the scalp above the surgical field, for deriving the brain waves serving electrode matrix.

Die Erfindung gibt also eine chirurgische Hilfsvorrichtung an zur dreidimensionalen Darstellung des Gehirns mit einer CT-iMRl- Bildverarbeitungseinrichtung und einer Recheneinheit, die mit einem EEG-Gerät verbunden ist um die elastischen Verformungen [Brain-Shift] eines Gehirnmodells mittels einer sehr engmaschigen, netzförmigen Elektrodenmatrix [Grid] darzustellen, wobei die Elektroden lokal begrenzt auf dem Kopf fixiert werden und zunächst ein EEG-ähnliches Muster ableiten.The invention thus provides an auxiliary surgical device for three-dimensional imaging of the brain with a CT-iMRI Image processing device and a computing unit with a EEG machine is connected to the elastic deformations [brain shift] of one Brain model using a very close-meshed, mesh-shaped electrode matrix [Grid] with the electrodes localized on the Head fixed and initially an EEG-like Derive patterns.

Präoperativ werden dreidimensionale CT-/MRI-Gehirndarstellungen angefertigt. Sie dienen in der chirurgischen Tumorresektion, die bei Gehirntumoren meist die Behandlung der Wahl ist, der Entscheidungsfindung.Three-dimensional CT / MRI brain representations become preoperative prepared. They are used in surgical tumor resection for brain tumors the treatment of choice is mostly decision-making.

Dreidimensionale [3-D-]präoperative Darstellungen in der bildgestützten Chirurgie [Neuronavigation] ermöglichen es dem Chirurgen jeden Schritt des Eingriffs über ein 3-D-Modell am Bildschirm im Voraus zu planen und vor der Operation den idealen Zugang zum Tumor zu berechnen. Der Tumor und seine Umgebung können während der Planungsphase und während der Operation aus verschiedenen Winkeln und im Verhältnis zueinander sowie zu wichtigen Strukturen des Nervensystems betrachtet werden. Neuronavigation ermöglichen dem Chirurgen nur sehr kleine Öffnungen im Schädel anzufertigen – also minimal invasiv mit nur sehr geringer Ausdehnung der Cranotomie, was das Risiko für den Patienten reduziert – und erlauben dennoch eine sehr große Präzision bei der Tumorresektion.Three-dimensional [3-D-] preoperative Representations in the image-based Allow surgery [neuronavigation] the surgeon every step of the procedure via a 3-D model on the screen plan well in advance and have ideal access to the site before the operation Calculate tumor. The tumor and its surroundings can Planning phase and during the operation from different angles and in relation to each other as well as important structures of the nervous system. Enable neuronavigation only very small openings for the surgeon in the skull to make - well minimally invasive with only a very small extension of the cranotomy, what the risk for reduced the patient - and still allow a very large one precision in tumor resection.

Bildgeführte, navigierende chirurgische Eingriffe haben konventionell geführte stereotaktische Operationsverfahren in breiter klinischer Anwendung verdrängt.Image guided, navigating surgical Interventions have conventionally guided stereotactic surgical procedures ousted in wide clinical use.

Probleme treten bei einer Gehirnoperation im Verlaufe der Behandlung dann auf, wenn das Gewebe während der Behandlung Verschiebungen unterliegt, wie das beispielsweise durch einen Flüssigkeitsablauf bei der Schädeldeckeneröffnung oder durch Gewebeentnahmen geschehen kann.Problems occur during brain surgery in the The course of treatment occurs when the tissue during the Treatment is subject to shifts, such as through that a fluid drain at the opening of the skullcap or through Tissue sampling can happen.

Wenn diese Situation eintritt, also eine Verschiebung des Behandlungsortes oder des umliegenden Gewebes zusammen mit dem Behandlungsort erfolgt ist, wird die unterstützende Navigation ungenau, was dazu führt, dass der behandelnde Chirurg wieder mehr auf seine Erfahrungen angewiesen ist oder, falls er die Verschiebung nicht bemerkt, möglicherweise Eingriffe an falscher Stelle durchführt.If this situation occurs, then a shift in the place of treatment or the surrounding tissue together with the place of treatment is done, the supporting navigation inaccurate, which leads to that the treating surgeon is more dependent on his experience or, if he does not notice the shift, intervention on the wrong one Job.

Die erfindungsgemäße chirurgische Hilfsvorrichtung beruht darauf, dass eine engmaschige, netzförmige Elektrodenmatrix auf dem Kopf für die operativ in der Nähe interessierende Stelle fixiert wird und zunächst ein dem herkömmlichen EEG-ähnliches Muster ableitet. Die Quellenlokalisation ausgewählter Gehirnareale vor der Operation erfolgt über fokale Signale. Hierzu werden reizevozierte Potenziale abgeleitet, die sowohl akustisch, visuell oder somatosensorisch ausgelöst werden, so dass entsprechenden Areale im Gehirn bestimmt und festgelegt werden können.The surgical auxiliary device according to the invention is based on the fact that a close-meshed, mesh-shaped electrode matrix is fixed on the head for the area of interest in the operative area and first derives a pattern similar to the conventional EEG. The source localization of selected brain areas before the operation is done via focal signals. For this purpose, stimulated potentials are deducted conducts, which are triggered acoustically, visually or somatosensory, so that corresponding areas in the brain can be determined and fixed.

Mittels Beam-Forming, einem Signalverarbeitungsalgorithmus zur Störgeräuschunterdrückung [Verbesserung des Signal to Noise Ratio] und Nutzsignalbündelung kann die Quellenlokalisation fokaler Signale in 3-D-Darstellung sehr präzise erfolgen.Using beam forming, a signal processing algorithm for noise suppression [improvement of the signal to noise ratio] and useful signal bundling can source localization focal signals in 3-D representation are very precise.

Während der Operation werden die peripheren Reize fortgesetzt, die Signalableitung vom Grid erfolgt fortlaufend und wird online verrechnet, so dass eine eventuelle Verschiebung der Gehirnareale in einer 3-D-Darstellung in Echtzeit abgebildet werden kann.While The peripheral stimuli, the signal derivation, are continued during the operation from the grid is ongoing and is charged online so that a possible shift of the brain areas in a 3-D representation can be mapped in real time.

Die gewonnenen Daten werden im Verlaufe der Operation mit den zuvor gewonnenen Daten verglichen, zu einem neuen 3-D-Bild verrechnet und als Dynamic-mapping auf die präoperativen Aufnahmen zur Quellenlokalisation aufgespielt und während der Operation ständig aktualisiert. Die für die Operation wichtigen Areale können in ihrer Verschiebung in Echtzeit beobachtet und berücksichtigt werden; der Brain-Shift kann erfindungsgemäß qualifiziert und lokalisiert werden.The data obtained are used in the course of Operation compared with the previously obtained data, to a new one 3-D image calculated and as dynamic mapping on the preoperative Recordings for source localization uploaded and during the operation constantly updated. The for important areas of surgery observed and taken into account in their shift in real time become; According to the invention, the brain shift can be qualified and localized become.

Mit dieser physiologischen Quellenlokalisations kann die lokale Verschiebung einzelner Punkte im Gehirn auf ca. 2 mm detektiert werden, was gegenüber den auf Ultraschall basierenden Bilddarstellungsvorrichtungen eine Verbesserung bis um den Faktor 5 bedeutet.With this physiological source localization the local shift of individual points in the brain to approx. 2 mm can be detected, which is compared to those based on ultrasound Image display devices an improvement by a factor 5 means.

Eine besonders genaue Quellenlokalisation ist zu erwarten, wenn die präoperativ und die intraoperativ evozierten Potentiale bei schon geöffneten Kortex direkt aus dem Gehirn abgeleitet werden.A particularly accurate source location is to be expected if the preoperative and the intraoperatively evoked potentials with the cortex already open derived directly from the brain.

Claims (2)

Navigationshilfsvorrichtung für neurochirurgische Eingriffe am Gehirn mit einer ersten bildgebenden Einrichtung zur Wiedergabe von präoperativ mittels eines Computertomographens oder eines Kernspintomographens gewonnenen Bildern des Operationsfeldes und einer zweiten bildsignalgebenden Einrichtung zur Wiedergabe von intraoperativ gewonnenen Bildsignalen in den Bildern der ersten Einrichtung, wobei die Bildsignale die die durch den neurochirurgischen Eingriffverursachten Verschiebungen der das Operationsfeld benachbarten Gehirnareale berücksichtigen, dadurch gekennzeichnet dass die zweite Einrichtung zum Lokalisieren der verschobenen Gehirnareale durch einerseits präoperatives und andererseits intraoperatives Setzen gleicher peripherer Reize und Quellenlokaliation der so evozierten Potential durch Hirnstrormableitungen ausgebildet ist..Auxiliary navigation device for neurosurgical interventions on the brain with a first imaging device for reproducing images of the operating field obtained preoperatively by means of a computer tomograph or a magnetic resonance tomograph and a second image-signaling device for reproducing intraoperatively obtained image signals in the images of the first device, the image signals being those obtained by the neurosurgical intervention caused shifts in the areas of the brain adjacent to the operating field take into account, characterized in that the second device for localizing the displaced areas of the brain is formed on the one hand by preoperative and on the other hand intraoperative setting of the same peripheral stimuli and source localization of the evoked potential by brain current leads. Vorrichtung nach Anspruch 1, dadurch gekennzeichnet, dass die zweite Einrichtung eine oberhalb des Operationsfelds auf die Kopfhaut aufgesetzten, zur Ableitung der Hirnströme dienenden Elektrodenmatrix aufweist.Device according to claim 1, characterized in that the second facility is located above the surgical field put on the scalp to drain the brainwaves Has electrode matrix.
DE10242802A 2002-09-14 2002-09-14 Navigation aid for neurosurgery on the human brain Expired - Fee Related DE10242802B4 (en)

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Citations (8)

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WO1999048422A1 (en) * 1998-03-24 1999-09-30 Siemens Aktiengesellschaft Method for localising and identifying signal activities of at least one delimited area in a section of biological tissue
DE19915171A1 (en) * 1999-04-27 2000-11-02 Olaf Suess Stimulation tool for use in stimulation of cerebral cortex and for imaging during computer assisted neuro-surgery using stylus or navigation pointer
DE19938549A1 (en) * 1999-08-18 2001-02-22 Uwe Thomas Microprobe system used in neurophysiology and neurosurgery comprises a self-bearing device, a microfiber electrode and a macro-therapy electrode
DE10044115A1 (en) * 1999-09-13 2001-04-12 Medtronic Inc Combined micro-macro-brain stimulation lead and method of use
DE19846687C2 (en) * 1998-10-09 2001-07-26 Auer Dorothee Auxiliary surgical device for use in performing medical procedures and methods for generating an image in the context of medical procedures
EP0477434B2 (en) * 1990-09-24 2001-11-14 Biomagnetic Technologies, Inc. Analysis of biological signals using data from arrays of sensors
US6330466B1 (en) * 1998-02-23 2001-12-11 California Institute Of Technology Using a multi-electrode probe in creating an electrophysiological profile during stereotactic neurosurgery

Patent Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE3741874C2 (en) * 1986-12-16 1998-10-22 Sam Tech Inc Method and system for displaying the position of neuronal activity and the temporal interrelations between brain areas
EP0477434B2 (en) * 1990-09-24 2001-11-14 Biomagnetic Technologies, Inc. Analysis of biological signals using data from arrays of sensors
US6330466B1 (en) * 1998-02-23 2001-12-11 California Institute Of Technology Using a multi-electrode probe in creating an electrophysiological profile during stereotactic neurosurgery
WO1999048422A1 (en) * 1998-03-24 1999-09-30 Siemens Aktiengesellschaft Method for localising and identifying signal activities of at least one delimited area in a section of biological tissue
DE19846687C2 (en) * 1998-10-09 2001-07-26 Auer Dorothee Auxiliary surgical device for use in performing medical procedures and methods for generating an image in the context of medical procedures
DE19915171A1 (en) * 1999-04-27 2000-11-02 Olaf Suess Stimulation tool for use in stimulation of cerebral cortex and for imaging during computer assisted neuro-surgery using stylus or navigation pointer
DE19938549A1 (en) * 1999-08-18 2001-02-22 Uwe Thomas Microprobe system used in neurophysiology and neurosurgery comprises a self-bearing device, a microfiber electrode and a macro-therapy electrode
DE10044115A1 (en) * 1999-09-13 2001-04-12 Medtronic Inc Combined micro-macro-brain stimulation lead and method of use

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