U.S. patent application number 14/021766 was filed with the patent office on 2014-01-09 for method and apparatus to optimize electrode placement for neurological stimulation.
This patent application is currently assigned to Medtronic, Inc.. The applicant listed for this patent is Medtronic, Inc.. Invention is credited to Kenneth T. HERUTH, Gabriela C. MOLNAR (FORMERLY MIYAZAWA), Gregory F. MOLNAR, Paul W. WACNIK.
Application Number | 20140012131 14/021766 |
Document ID | / |
Family ID | 38691683 |
Filed Date | 2014-01-09 |
United States Patent
Application |
20140012131 |
Kind Code |
A1 |
HERUTH; Kenneth T. ; et
al. |
January 9, 2014 |
Method And Apparatus To Optimize Electrode Placement For
Neurological Stimulation
Abstract
A method and apparatus can be used to guide or navigate an
instrument relative to a body. Various types of information can be
used to assist in the navigation, such as MRI data, diffusion
tensor image data, and the like. The information can assist in
identifying the portions of the body.
Inventors: |
HERUTH; Kenneth T.; (Edina,
MN) ; MOLNAR (FORMERLY MIYAZAWA); Gabriela C.; (New
Brighton, MN) ; WACNIK; Paul W.; (Minneapolis,
MN) ; MOLNAR; Gregory F.; (New Brighton, MN) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Medtronic, Inc. |
Minneapolis |
MN |
US |
|
|
Assignee: |
Medtronic, Inc.
Minneapolis
MN
|
Family ID: |
38691683 |
Appl. No.: |
14/021766 |
Filed: |
September 9, 2013 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
11683695 |
Mar 8, 2007 |
8532741 |
|
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14021766 |
|
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60843476 |
Sep 8, 2006 |
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Current U.S.
Class: |
600/424 ;
607/62 |
Current CPC
Class: |
A61B 90/36 20160201;
A61B 2034/105 20160201; A61B 2034/2051 20160201; A61N 1/36128
20130101; A61B 2090/376 20160201; A61B 2034/2055 20160201; A61B
2034/107 20160201; A61B 2090/365 20160201; A61B 2034/256 20160201;
A61B 2090/367 20160201; A61B 34/20 20160201; A61B 2034/2074
20160201 |
Class at
Publication: |
600/424 ;
607/62 |
International
Class: |
A61B 19/00 20060101
A61B019/00; A61N 1/36 20060101 A61N001/36 |
Claims
1. A surgical system to navigate a procedure on a patient,
comprising: an imaging device operable to obtain image data of an
anatomy of the patient; a processor operable to identify at least a
portion of a neuron within the image data of the patient; an
instrument; and a tracking system configured to track a tracking
device associated with the instrument to determine a location of
the instrument; wherein the tracking system is operable to track a
position of the instrument relative to the patient in the image
data, wherein the image data includes the identified at least the
portion of the neuron.
2. The system of claim 1, further comprising: a display device
configured to display the image data including a representation of
the identified at least the portion of the neuron and an icon of
the instrument relative to the representation of the identified at
least the portion of the neuron.
3. The system of claim 2, wherein at least the representation of
the identified at least the portion of the neuron includes a neuron
icon based at least in part on a diffusion data.
4. The system of claim 1, wherein the processor is operable with
the tracking system to determine the relative position of the
instrument to the patient in the image data including the
identified at least the portion of the neuron.
5. The system of claim 1, wherein the instrument includes at least
one of a stimulation probe, an ablation device, an electrical lead,
an electrical recorder, or combinations thereof.
6. The system of claim 1, wherein the tracking system includes at
least one of an electromagnetic tracking system, an optical
tracking system, an accelerometer tracking system, a radiation
tracking system, an acoustic tracking system, or combinations
thereof.
7. A method for performing a surgical procedure on an anatomy,
comprising: selecting an identified neuron or portion thereof in
the anatomy based upon an analyzed obtained image data of the
anatomy to apply a selected therapy; executing instructions with a
processor to determine a target location at the selected and
identified neuron or portion thereof to apply the selected therapy
to directly affect the selected and identified neuron or portion
thereof; and displaying an instrument icon representing a navigated
instrument relative to the selected and identified neuron or
portion thereof; wherein the selected therapy is applied with the
navigated instrument, illustrated with the instrument icon, to the
selected identified neuron or portion thereof to provide the
selected therapy to the selected and identified neuron or portion
thereof.
8. The method of claim 7, further comprising: moving an instrument
to the determined target location in the anatomy; wherein the
selecting the identified neuron or portion thereof in the anatomy
and executing instructions with the processor to determine the
target location at the selected and identified neuron or portion
thereof occurs prior to moving the instrument to the determined
target location in the anatomy.
9. The method of claim 8, further comprising: tracking with a
tracking system the location of the instrument relative to the
determined target location at the selected and identified neuron or
portion thereof.
10. The method of claim 9, wherein the selected and identified
neuron or portion thereof in the anatomy includes selecting an axon
of a neuron.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation of U.S. application Ser.
No. 11/683,695 filed on Mar. 8, 2007, which claims the benefit of
U.S. Provisional Application No. 60/843,476 filed on Sep. 8, 2006.
The disclosures of the above applications are incorporated herein
by reference.
FIELD
[0002] The present teachings relate to a surgical procedure, and
particularly to a computer assisted surgical procedure for
determining an anatomical location with various imaging
techniques.
BACKGROUND
[0003] The statements in this section merely provide background
information related to the present disclosure and may not
constitute prior art.
[0004] Surgical procedures are often performed by skilled
individuals, such as surgeons. The surgeons can perform various
surgical procedures based upon their training and past experience,
augmented by study of a particular patient. Nevertheless, various
portions of a particular patient may be difficult to examine or
identify depending upon the area of the anatomy to be examined and
the positioning of the patient.
[0005] Surgical procedures where these difficulties may arise can
include various neurosurgical procedures that affect various
functions of the brain and nervous system. For example, a tumor or
growth may be selected to be removed from a brain or a portion of
the spinal column or the nervous system may be stimulated. Other
procedures, however, may be performed to augment a portion of the
brain without removing a portion of the brain, affecting
surrounding tissue in the brain, or without visual cues of
differences between the area of the brain to be affected and
surrounding areas.
[0006] For example, certain neurological procedures can be
performed that affect "functional targets". The functional targets
can be portions of the brain that naturally affect or control
various portions of the anatomy but are, for various reasons,
damaged. These functional targets in the brain can be stimulated
through procedures such as deep brain stimulation (DBS). Functional
targets, even if malfunctioning in a particular manner, may not
differ anatomically or visually from the surrounding tissues.
Functional targets can also be found in other portions of an
anatomy, such as a spinal cord, peripheral nerves, etc. Therefore,
it is desirable to provide a system that is able to determine the
position of a functional target in the brain.
SUMMARY
[0007] A computer assisted surgical system or navigation system can
be used to determine a portion of anatomy, such as a portion in a
brain or a nervous system that may not be visually distinct from
surrounding tissue portions. It will be understood that although a
system can determine a particular region of a brain, it can also be
used to determine a position of other portions of the anatomy. In
one example, various imaging techniques, such as magnetic resonance
imaging (MRI) can be used to obtain a detailed image of the brain.
Also, additional information or data can be collected such as
diffusion tensor data regarding a selected portion of the anatomy.
A diffusion tensor can be generated from the diffusion data that
describes or identifies the three dimensional shape of diffusion of
a material in the diffusion data.
[0008] A tensor can be created to manipulate the various diffusion
data obtained with the imaging system, such as a magnetic resonance
imaging system. The data can be used to measure the flow of water
or diffusion of water as measured in the image data. The image data
can be analyzed to determine the greatest direction of diffusion of
water as measured in the image data. The tensor of the data can be
used to assist in determining the greatest vector of diffusion.
[0009] Multiple voxels of other image data portions can be analyzed
to measure a direction of diffusion. After multiple voxels have
been analyzed a determination of a direction and connection of a
flow of water can be determined. This connection can be used to
assist in identifying anatomical regions, such as fiber tracts. The
connected regions can be overlaid on other image data, such as MRI
image data for reference.
[0010] A system is provided that can determine various anatomical
or functional targets based upon landmarks in the brain or
additional data that can be used to determine certain or selected
anatomical structures. The system can plan a route or trajectory to
reach the selected anatomical targets and determine a point of
entry to reach the anatomical target. The system can be fully
automatic and include a processor to execute instructions to
determine the anatomical targets. The system can also be used to
navigate an instrument to a selected region, which may include the
function targets. The system can also be combined with manual
inputs. The anatomical target can include a functional target which
can be a portion of the brain or nervous system that controls a
certain function of or transmits a signal to the anatomy. Although
it will be understood that a similar system can be used to obtain
access or determine a position of a tumor, a damaged region of the
brain, portions of the brain based upon an anatomical landmarks, or
other portions of the anatomy.
[0011] A system can be used to identify selected regions of the
anatomy, such as portions in the brain or other parts of the
nervous system. For example, diffusion imaging that can include
diffusion tenser imaging data and can be used to assist in
identifying fiber tracts in an anatomical body. For example,
diffusion tenser imaging (DTI) can be used to identify neurons, and
in particular, to identify an axon and dendrites. While the neuron
can include a cell body, a region of the anatomy can include a
plurality of cell bodies with various axons and dendrites relative
thereto. As is understood in the art, stimulation of selection
portions of the anatomy, such as neurons, can provide selected
results. However, providing stimulation of a particular portion of
the neuron, such as the axon, can increase the efficiency and
preciseness of a selected procedure with reduced side effects to
adjoining tissue. Therefore, the DTI data can provide a greater
clarity of a particular axon for stimulation thereof, according to
various embodiments. The DTI data can assist in navigation or
assist in identifying a region of anatomy relative to which an
instrument can be navigated to perform a selected procedure.
[0012] According to various embodiments a surgical navigation
system to navigate a procedure on a patient is disclosed. The
system can include an imaging device operable to obtain diffusion
data within the patient and a tracking system including a localizer
and a tracking device operable to be tracked by the tracking
system. An instrument can be associated with the tracking device. A
processor can be used to determine a selected region of the patient
and a relative position of the instrument to the patient and the
image data including the selected region of the patient.
[0013] According to various embodiments, a method of performing a
procedure on a selected portion of an anatomy is disclosed. The
method can include obtaining image data of the selected portion of
the anatomy and obtaining a second source of data relating to the
selected portion of the anatomy. The method can also include
analyzing the second source of data and identifying a fiber tract
in the obtained image data at least in part with the analyses of
the second source of data. A selected position of treatment in the
anatomy can be determined and a treatment can be applied to the
selected position in of the anatomy.
[0014] According to various embodiments a method for performing a
surgical procedure on an anatomy is disclosed. The method can
include obtaining data regarding the anatomy and analyzing the
obtained data. A fiber tract in the anatomy can be determined based
upon the analyzed obtained data. A region of the anatomy can also
be identified relative to the identified fiber tract. An instrument
can be navigated relative to the anatomy via the identified fiber
tract and a therapy can be applied to the identified fiber tract,
the identified region, or combinations thereof.
[0015] Further areas of applicability will become apparent from the
description provided herein. It should be understood that the
description and specific examples are intended for purposes of
illustration only and are not intended to limit the scope of the
present disclosure.
DRAWINGS
[0016] The drawings described herein are for illustration purposes
only and are not intended to limit the scope of the present
disclosure in any way.
[0017] FIG. 1 illustrates a diagram of a surgical navigation system
according to various embodiments;
[0018] FIG. 2 is diagrammatic image data of a selected region of
the anatomy including a spinal column and neurons relative
thereto;
[0019] FIG. 2A is a diagram of a selected region of the anatomy
including a spinal column and neurons relative thereto;
[0020] FIG. 3 illustrates a display displaying image data of a
selected region of the anatomy according to various
embodiments;
[0021] FIG. 4 illustrates a display displaying image data of a
selected region of the anatomy according to various
embodiments;
[0022] FIG. 5 schematically illustrates portions of a brain and
connections or fiber tracts between the portions; and
[0023] FIG. 6 schematically illustrates peripheral occipital nerve
tracts.
DETAILED DESCRIPTION OF VARIOUS EMBODIMENTS
[0024] The following description is merely exemplary in nature and
is not intended to limit the present disclosure, application, or
uses. Though the following teachings relate to a method and
apparatus for use with a neurosurgical procedure, this is merely
exemplary and not intended to limit the scope of the present
disclosure.
[0025] Identifying various structures of an anatomy, such as
portions of the neuroanatomy, can be useful for performing selected
procedures on a brain, such as deep brain stimulation (DBS),
ablation, tumor removal, drug delivery, gene therapy, cell delivery
therapy, needle delivery, implant delivery, lead or electrode
delivery, and the like. The identification of various brain
structures can be difficult based on the location, size, activity,
and other factors. For example, identifying the location of the
sub-thalamic nucleus (STN) or basal ganglia can be difficult based
upon its location within the brain and its visual similarity to the
area surrounding it. In addition determining the tracts or fiber
connections between different regions, in the brain or otherwise,
can also be difficult.
[0026] It is also useful to identify portions of the anatomy
outside of the brain. Tracts or pathways exist throughout an
anatomy. For example, grey and white matter in a spinal column,
peripheral nerve tracts or bundles, or combinations of these. The
tracts can be identified, as discussed herein, for various
treatment purposes.
[0027] According to the present teachings various imaging
techniques can be used to identify discrete areas of the anatomy,
such as neurons and axons in the brain. Thus, treatments can be
applied to the STN or selected axons of selected neurons to treat a
disease, such as Parkinson's, epilepsy, or psychiatric disorders.
Treatments can include ablation, radio seed placement, short term
or long term electrical or thermal stimulation, etc.
[0028] In addition to providing a therapy (e.g. stimulation) to
selected regions of a brain, such as the fibers or tracts,
therapies can be provided to other portions of the anatomy. For
example, therapies can be provided to selected portions of neurons,
such as an axon, of spinal column neurons. Neurons located in the
dorsal column can be stimulated for various purposes. Briefly,
stimulation of neurons in the dorsal column can be used to
alleviate or reduce pain.
[0029] Stimulation of a selected axon or fiber tract, as discussed
herein, can allow for increased efficiency in using stimulation for
pain relief and can assist in reducing various side effects. For
example, identifying a particular axon to be stimulated can reduce
side effects by eliminating or shielding non-selected axons from
stimulation. Therefore, side effects to a patient can be
substantially eliminated or reduced by providing stimulation to
only a selected axon. It will be understood that the DTI processing
can assist in determining and identifying particular axons.
Further, the DTI processing can be used in conjunction with image
data, including magnetic resonance image data, to assist in
identifying particular axons to be stimulated.
[0030] As discussed further herein, the identification of selected
axons can be used in conjunction with a navigation system 200 to
assist in determining a position of an instrument 252 relative to
the determined and/or selected axon. Therefore, the navigation
system 200 can assist in positioning the instrument 252 relative to
the selected axon according to various imaging and tracking
techniques and systems, discussed herein. Due to the combination of
the determination of a selected axon and navigation of the
instrument 252 relative to the selected axon substantially precise
positioning and treatment can be provided.
[0031] As discussed herein, identifying one or a bundle of tracts
can be used to specifically provide treatment. That is, rather than
navigating an instrument to a general area of interest, the
instrument can be navigated to a specific and localized position.
For example, the instrument can be navigated near a specific tract
or bundle to provide treatment substantially to that tract or
bundle. One skilled in the art, however, will understand that the
instrument 252 can be navigated to any selected location.
[0032] An exemplary system that can be used to perform a guided
procedure can include the navigation system 200, in FIG. 1. The
navigation system can be used for various procedures to stimulate a
selected portion of the anatomy. The navigation system 200 can
include the navigation processor 224 and a planning processor 226
that can execute instructions to perform at least portions of a
guided procedure using selected information. The navigation system
200 can also be used to track the location of the instrument 252,
such as a deep brain stimulator or appropriate stimulator, relative
to a patient 204 to assist in the implementation a guided
procedure. The planning processor 226 can assist in this and can be
used to create or determine a plan for the procedure.
[0033] It should further be noted that the navigation system 200
may be used to navigate or track the instrument 252, which can
include catheters, probes, needles, guidewires, instruments,
implants, deep brain stimulators, electrical leads, etc. Moreover,
the instrument 252 can be used in any region of the body. The
navigation system 200 and various instruments 252 may be used in
any appropriate procedure, such as one that is generally minimally
invasive, arthroscopic, percutaneous, stereotactic, or an open
procedure. An exemplary navigation system 200 can also include an
imaging device 202. One skilled in the art will understand that the
discussion of the imaging device 202 is merely for clarity of the
present discussion and any appropriate imaging system, navigation
system, patient specific data, and non-patient specific data can be
used. For example, the imaging device can be a magnetic resonance
imager that can also be used to collect diffusion data. Also, the
navigation system 200 may not have an imaging system, but may
simply have access to image data or may be an imageless system.
[0034] The navigation system 200 can include the optional imaging
device 202 that is used to acquire pre-, intra-, or post-operative
or real-time image data of a patient 204. Although any appropriate
imaging system can be used to collect or obtain image data at any
appropriate time. The image data acquired with the imaging device
204 can be used to assist in determining the anatomical or
functional targets and the trajectories. The illustrated imaging
device 202 can be, for example, a fluoroscopic x-ray imaging device
that may be configured as a C-arm 206 having an x-ray source 208,
an x-ray receiving section 210. Image data may also be acquired
using other imaging devices, such as those discussed herein. An
example of a fluoroscopic C-arm x-ray device that may be used as
the optional imaging device 202 is the "Series 9600 Mobile Digital
Imaging System," from OEC Medical Systems, Inc., of Salt Lake City,
Utah. Other exemplary fluoroscopes include bi-plane fluoroscopic
systems, ceiling fluoroscopic systems, cath-lab fluoroscopic
systems, fixed C-arm fluoroscopic systems, isocentric C-arm
fluoroscopic systems, 3D fluoroscopic systems, etc.
[0035] The imaging system, however, may also include MRI systems.
MRI systems can be used to collect image data that includes
diffusion of water data between a series of image data. The MRI can
include intraoperative systems such as the POLESTAR.TM. N20 sold by
Medtronic Navigation, Inc., of Colorado, USA. Therefore, the
imaging device 202 can be any appropriate device or system.
[0036] An optional imaging device controller 218 may control the
imaging device 202, such as the C-arm 206, to capture the x-ray
images received at the receiving section 210 and store the images
for later use. The controller 218 may also be separate from the
C-arm 206 and/or control the rotation of the C-arm 206. For
example, the C-arm 206 can move in the direction of arrow 220 or
rotate about a longitudinal axis 204a of the patient 204, allowing
anterior or lateral views of the patient 204 to be imaged. Each of
these movements involves rotation about a mechanical axis 222 of
the C-arm 206.
[0037] Image data of any appropriate type, such as image data
obtained or collected with the C-arm can be forwarded, to a
navigation computer and/or processor 224 having a display 225 and a
user interface 227. The navigation processor 224, display 225, and
user input interface 227 can be part of a work station 229. The
navigation processor 224 can include a planning processor, as
discussed herein, or the separate planning processor system 226 can
be included. The planning processor system 226 can also include a
display 228 and a user input 230. It will also be understood that
the image data can be, but is not necessarily, first retained in
the controller 218, but may be directly transmitted to the
workstation 229 or the planning processor system 226.
[0038] While the optional imaging device 202 is shown in FIG. 1,
any other alternative 2D, 3D or 4D imaging modality may also be
used. For example, any 2D, 3D or 4D imaging device, such as
isocentric fluoroscopy, bi-plane fluoroscopy, ultrasound, computed
tomography (CT), multi-slice computed tomography (MSCT), T1
weighted magnetic resonance imaging (MRI), T2 weighted MRI, high
frequency ultrasound (HIFU), positron emission tomography (PET),
optical coherence tomography (OCT), intra-vascular ultrasound
(IVUS), ultrasound, intra-operative CT, single photo emission
computed tomography (SPECT), or planar gamma scintigraphy (PGS) may
also be used to acquire 2D, 3D or 4D pre- or post-operative and/or
real-time images or image data of the patient 204. The images may
also be obtained and displayed in two, three or four dimensions. In
more advanced forms, four-dimensional surface rendering regions 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
modalities. A more detailed discussion on optical coherence
tomography (OCT), is set forth in U.S. Pat. No. 5,740,808, issued
Apr. 21, 1998, entitled "Systems And Methods For Guiding Diagnostic
Or Therapeutic Devices In Interior Tissue Regions," which is hereby
incorporated by reference.
[0039] Image datasets from hybrid modalities, such as positron
emission tomography (PET) combined with CT, or single photon
emission computer tomography (SPECT) combined with CT, can also
provide functional image data superimposed onto anatomical data to
be used to confidently reach target sites or functional targets
within the patient 204. It should further be noted that the
optional imaging device 202, as shown in FIG. 1, provides a virtual
bi-plane image using a single-head C-arm fluoroscope as the
optional imaging device 202 by simply rotating the C-arm 206 about
at least two planes, which could be orthogonal planes to generate
two-dimensional images that can be converted to three-dimensional
volumetric images. By acquiring images in more than one plane, an
icon representing the location of an impacter, stylet, reamer
driver, taps, drill, deep brain stimulation leads, electrical
leads, needles, implants, probes, or other instrument, introduced
and advanced in the patient 204, may be superimposed in more than
one view on display 225 or 228 allowing simulated bi-plane or even
multi-plane views, including two and three-dimensional views.
[0040] These types of imaging modalities may provide certain
distinct benefits for their use. For example, magnetic resonance
imaging (MRI) is generally performed pre-operatively using a
non-ionizing field. This type of imaging provides very good tissue
visualization in three-dimensional form and also provides
anatomical and functional information from the image data. MRI
image data can be registered and compensated for motion correction,
using dynamic reference frames (DRF) discussed further herein.
Also, different types of MRI techniques can be used to more clearly
illustrate different portions of the anatomy. As discussed above,
T1 weighted MRI images may be used to display selected anatomical
regions in the brain. Further, MRI systems can be used to obtain
diffusion image data, of a selected region of the patient 204, and
tensor and tensor analysis can be performed to obtain diffusion
tensor image (DTI) data.
[0041] With continuing reference to FIG. 1, the navigation system
200 can further include an electromagnetic navigation or tracking
system 244 that includes a localizer, such as a transmitter coil
array 246, a coil array controller 248, a navigation probe
interface 272, the instrument 252 (e.g. catheter, needle, or
instruments, as discussed herein) and a dynamic reference frame
254. The dynamic reference frame 254 can include a dynamic
reference frame member or holder 256 and a removable tracking
device 258. Alternatively, the dynamic reference frame 254 can
include a tracking device that is formed integrally with the
dynamic reference frame member 256. One skilled in the art will
understand that the tracking device 258 can be any appropriate
device that can be an emitter, a receiver, a reflector, a sensor to
sense a field, or any other appropriate device that can be tracked
by a tracking system including a localizer.
[0042] The instrument 252 can be any appropriate instrument, for
example and referred to herein as a catheter, electric lead, or
stimulator. Other appropriate instruments can be used to deliver a
therapy to a region of the anatomy or to record information from a
region of the anatomy. For example, a recording device can be
placed in a cranium 288 of the patient 204 to record electrical
activity of a selected region of the brain for analysis and
treatment options. Thus, it will be understood that the instrument
252 can be selected to be any appropriate device, and a stimulator,
catheter, probe, etc. are merely exemplary.
[0043] The transmitter coil array 246 may also be supplemented or
replaced with a mobile localizer 267. The mobile localizer 267 may
be one such as that described in U.S. patent application Ser. No.
10/941,782, filed Sep. 15, 2004, now U.S. Pat. App. Pub. No.
2005/0085720, and entitled "METHOD AND APPARATUS FOR SURGICAL
NAVIGATION", herein incorporated by reference. As is understood the
localizer array can transmit signals that are received by the
dynamic reference frame 254, and a tracking device 260. The dynamic
reference frame 254 and the tracking device 260 can then transmit
signals based upon the received signals from the array. One skilled
in the art will also understand that the reverse can be true where
the tracking device 206 will transmit a signal received by the
array.
[0044] It will be understood that the tracking system may be any
appropriate tracking system and can include an optical tracking
system with an optical localizer 264, illustrated in phantom.
Optical tracking systems can include the STEALTHSTATION.RTM.
TRIA.TM. and STIMPILOT.TM., and electromagnetic systems can include
the AXIEM.TM., all sold by Medtronic Navigation, Inc. of
Louisville, Colo. Other tracking systems include acoustic,
radiation, radar, infrared, laser, accelerometer, etc. The optical
localizer 264 can transmit and receive, or combinations thereof. An
optical tracking device 266 can be interconnected with the
instrument 252, or other portions such as the dynamic reference
frame 254. As is generally known the tracking device 266 can
reflect or transmit an optical signal to the optical localizer 264
that can be used in the navigation system 200 to navigate or track
various elements.
[0045] Further included in the navigation system 200 may be an
isolator circuit or assembly 270. The isolator assembly 270 may be
included in a transmission line to interrupt a line carrying a
signal or a voltage to a navigation device interface 272.
Alternatively, the isolator circuit included in the isolator
assembly 270 may be included in the navigation device interface
272, the instrument 252, the dynamic reference frame 254, the
transmission lines coupling the devices, or any other appropriate
location. The isolator assembly 270 can isolate the patient from
any of the instruments or portions that are in contact with the
patient 204 should an undesirable electrical surge or voltage take
place.
[0046] It should further be noted that the entire tracking system
244 or parts of the tracking system 244 may be incorporated into
the imaging device 202, including the work station 229.
Incorporating the tracking system 244 may provide an integrated
imaging and tracking system. Any combination of these components
may also be incorporated into the imaging system 202, which can
include an appropriate imaging device.
[0047] The transmitter coil array 266 is shown attached to the
receiving section 210 of the C-arm 206. It should be noted,
however, that the transmitter coil array 266 may also be positioned
at any other location as well. For example, the transmitter coil
array 266 may be positioned at the X-ray source 208, within or atop
an operating room (OR) table 276 positioned below the patient 204,
on siderails associated with the OR table 276, or positioned on the
patient 204 in proximity to the region being navigated, such as on
the patient's chest. The coil array is used in an electromagnet
tracking system as the localizer therefore. It will be understood
by one skilled in the art that any appropriate localizer may be
used.
[0048] The transmitter coil array 266 may also be positioned in the
items being navigated, further discussed herein. The transmitter
coil array 266 can include a plurality of coils that are each
operable to generate distinct electromagnetic fields into the
navigation region of the patient 204, which is sometimes referred
to as patient space. Representative electromagnetic systems are set
forth in U.S. Pat. No. 5,913,820, entitled "Position Location
System," issued Jun. 22, 1999 and U.S. Pat. No. 5,592,939, entitled
"Method and System for Navigating a Catheter Probe," issued Jan.
14, 1997, each of which are hereby incorporated by reference.
[0049] The transmitter coil array 266 is controlled or driven by
the coil array controller 232. The coil array controller 232 drives
each coil in the transmitter coil array 266 in a time division
multiplex or a frequency division multiplex manner. In this regard,
each coil may be driven separately at a distinct time or all of the
coils may be driven simultaneously with each being driven by a
different frequency. Upon driving the coils in the transmitter coil
array 266, with the coil array controller 232, electromagnetic
fields are generated within the patient 204 in the area where the
medical procedure is being performed. The volume of the field
relative to the patient or the patient in general can also be
referred to as patient space. The electromagnetic fields generated
in the patient space induce currents in a sensor 258 positioned on
or in the device 252. These induced signals from the device 252 are
delivered to the navigation device interface 272 through the
isolation assembly 270 and subsequently forwarded to the coil array
controller 232. The navigation device interface 272 may provide all
the necessary electrical isolation for the navigation system 200.
Alternatively, the electrical isolation may also be provided in the
isolator assembly 270. Nevertheless, the isolator assembly 270 may
be included in the navigation device interface 272 or may be
integrated into the device 252, and any other appropriate location.
The navigation device interface 272 can also include amplifiers,
filters and buffers to directly interface with the tracking device
258 in the instrument 252. Alternatively, the instrument 252, or
any other appropriate portion, may employ a wireless communications
channel, such as that disclosed in U.S. Pat. No. 6,474,341,
entitled "Surgical Communication Power System," issued Nov. 5,
2002, herein incorporated by reference, as opposed to being coupled
directly to the navigation device interface 272.
[0050] When the navigation system 200 uses an EM based tracking
system, various portions of the navigation system 200, such as the
instrument 252, the dynamic reference frame (DRF) 254, the
instrument 252, are equipped with at least one, and generally
multiple, EM tracking devices 260, that may also be referred to as
localization sensors. The EM tracking devices 260 can include one
or more coils that are operable with the EM localizer array 266 or
267. An alternative device may include an optical device, such as
the optical tracking device 258a, and may be used in addition to or
in place of the electromagnetic tracking device 258. The optical
tracking device may work with the optional optical localizer 264.
One skilled in the art will understand, however, that any
appropriate tracking device can be used in the navigation system
200. An additional representative alternative localization and
tracking system is set forth in U.S. Pat. No. 5,983,126, entitled
"Catheter Location System and Method," issued Nov. 9, 1999, which
is hereby incorporated by reference. Alternatively, the
localization system may be a hybrid system that includes components
from various systems.
[0051] The EM tracking device 258 on the instrument 252 can be in a
handle or inserter that interconnects with an attachment and may
assist in placing an implant or in driving a portion. The
instrument 252 can include a graspable or manipulable portion at a
proximal end and the tracking device 258 may be fixed near the
manipulable portion of the instrument 252 or at a distal working
end, as discussed herein. The tracking device can also be
positioned near a distal or working end of the instrument 252. In
addition, the tracking device can be incorporated into the
instrument 252, such as that disclosed in U.S. patent application
Ser. No. 11/241,837 (now U.S. Patent Application Publication No.
2006/0084867) entitled, "Method and Apparatus for Surgical
Navigation", filed Sep. 30, 2005, incorporated herein by reference.
The tracking device 258 can include an electromagnetic device to
sense the electromagnetic field generated by the transmitter coil
array 266 that can induce a current in the electromagnetic device
258. Alternatively, it will be understood that the tracking device
can transmit a signal to be received by the coil array.
[0052] The dynamic reference frame 254 of the tracking system 244
is also coupled to the navigation device interface 272 to forward
the information to the coil array controller 232. The dynamic
reference frame 254, according to various embodiments, may include
a small magnetic field detector. The dynamic reference frame 254
may be fixed to the patient 204 adjacent to the region being
navigated so that any movement of the patient 204 is detected as
relative motion between the transmitter coil array 266 and the
dynamic reference frame 254. The dynamic reference frame 254 can be
interconnected with the patient in any appropriate manner,
including those discussed herein. This relative motion is forwarded
to the coil array controller 232, which updates registration
correlation and maintains accurate navigation, further discussed
herein. The dynamic reference frame 254 may be any appropriate
tracking device used as the dynamic reference frame 254 in the
navigation system 200. Therefore the dynamic reference frame 254
may also be optical, acoustic, etc. If the dynamic reference frame
254 is electromagnetic it can be configured as a pair, trio, etc.
of orthogonally oriented coils, each having the same center or may
be configured in any other non-coaxial or co-axial coil
configurations.
[0053] The dynamic reference frame 254 may be affixed externally to
the patient 204, adjacent to the region of navigation, such as on
the patient's cranium 288, etc., as shown in FIG. 1. The dynamic
reference frame 254 can be affixed to the patient's skin, by way of
a selected adhesive patch and/or a tensioning system. The dynamic
reference frame 254 may also be removably attachable to a fiducial
marker 280. The fiducial markers can be anatomical landmarks or
members attached or positioned on the patient's 204 body. The
dynamic reference frame 254 can also be connected to a bone portion
of the anatomy. The bone portion can be adjacent, the area of the
procedure, the bone of the procedure, or any appropriate bone
portion.
[0054] Briefly, the navigation system 200 operates as follows. The
navigation system 200 creates a translation map between all points
in the image data or image space and the corresponding points in
the patient's anatomy in patient space. After this map is
established, the image space and patient space are registered. In
other words, registration is the process of determining how to
correlate a position in image space with a corresponding point in
real or patient space. This can also be used to illustrate a
position of the device relative to the proposed trajectory and/or
the determined anatomical target. The work station 229 in
combination with the coil array controller 232 and the C-arm
controller 218 can identify the corresponding point on the
pre-acquired image or atlas model relative to the tracked device
252 and display the position on display 225. This identification is
known as navigation or localization. An icon representing the
localized point or instruments is shown on the display 225 within
several two-dimensional image planes, as well as on three and four
dimensional images and models.
[0055] To register the patient 204, a physician or user 282 may use
point registration by selecting and storing particular points from
the pre-acquired images and then touching the corresponding points
on the patient's anatomy with a pointer probe or any appropriate
tracked device, such as the instrument 252. The navigation system
200 analyzes the relationship between the two sets of points that
are selected and computes a match, which allows for a determination
of a correlation of every point in the image data or image space
with its corresponding point on the patient's anatomy or the
patient space.
[0056] The points that are selected to perform registration or form
a translation map are the fiducial markers 280, such as anatomical
or artificial landmarks. Again, the fiducial markers 280 are
identifiable on the images and identifiable and accessible on the
patient 204. The fiducial markers 280 can be artificial landmarks
that are positioned on the patient 204 or anatomical landmarks that
can be easily identified in the image data. The artificial fiducial
markers 280, can also form part of the dynamic reference frame 254,
such as those disclosed in U.S. Pat. No. 6,381,485, entitled
"Registration of Human Anatomy Integrated for Electromagnetic
Localization," issued Apr. 30, 2002, herein incorporated by
reference. It will be understood that the "X" illustrated in FIG. 1
can merely indicate a position of a fiducial marker 280 rather than
being the fiducial marker 280.
[0057] The system 200 may also perform registration using anatomic
surface information or path information as is known in the art (and
may be referred to as auto-registration). The system 200 may also
perform 2D to 3D registration by utilizing the acquired 2D images
to register 3D volume images by use of contour algorithms, point
algorithms or density comparison algorithms, as is known in the
art. An exemplary 2D to 3D registration procedure is set forth in
U.S. Ser. No. 10/644,680, filed on Aug. 20, 2003, now U.S. Pat.
App. Pub. No. 2004-0215071, entitled "Method and Apparatus for
Performing 2D to 3D Registration", hereby incorporated by
reference.
[0058] In order to maintain registration accuracy, the navigation
system 200 continuously can track the position of the patient 204
during registration and navigation with the dynamic reference frame
254. This is because the patient 204, dynamic reference frame 254,
and transmitter coil array 266 may all move during the procedure,
even when this movement is not desired. Alternatively, the patient
204 may be held immobile once the registration has occurred, such
as with a head frame. If the navigation system 200 did not track
the position of the patient 204 or area of the anatomy, any patient
movement after image acquisition would result in inaccurate
navigation within that image. The dynamic reference frame 254
allows the tracking system 244 to track the anatomy and can assist
in registration. Because the dynamic reference frame 254 is rigidly
fixed to the patient 204, any movement of the anatomy or the
transmitter coil array 266 is detected as the relative motion
between the transmitter coil array 266 and the dynamic reference
frame 254. This relative motion is communicated to the coil array
controller 232, via the navigation probe interface 272, which
updates the registration correlation to thereby maintain accurate
navigation.
[0059] The dynamic reference frame 254 can be affixed to any
appropriate portion of the patient 204, and can be used to register
the patient to the image data, as discussed above. For example,
when a procedure is being performed relative to the cranium 288,
the dynamic reference frame 254 can be interconnected with the
cranium 288. The dynamic reference frame 254 can be interconnected
with the cranium 288 in any appropriate manner, such as those
discussed herein according to various embodiments.
[0060] To enable navigation relative to image data, registration
should occur and the navigation system 200 must be able to
determine both the position of the patient's anatomy and the
position of the instrument 252 or attachment member (e.g. tracking
device 258) attached to the instrument 252. Knowing the location of
these two items allows the navigation system 200 to compute and
display the position of the instrument 252 or any portion thereof
in relation to the patient 204 on the display device 225. The
tracking system 244 is employed to track the instrument 252 and the
anatomy simultaneously.
[0061] The tracking system 244, if it is using an electromagnetic
tracking assembly, essentially works by positioning the transmitter
coil array 266 adjacent to the patient space to generate a
low-energy magnetic field generally referred to as a navigation
field. Because every point in the navigation field or patient space
is associated with a unique field strength, the electromagnetic
tracking system 244 can determine the position of the instrument
252 by measuring the field strength at the tracking device 258
location. The dynamic reference frame 254 is fixed to the patient
204 to identify the location of the patient in the navigation
field. The electromagnetic tracking system 244 continuously
recomputes the relative position of the dynamic reference frame 254
and the instrument 252 during localization and relates this spatial
information to patient registration data to enable image guidance
of the instrument 252 within and/or relative to the patient
204.
[0062] To obtain a maximum reference it can be selected to fix the
dynamic reference frame 254 in each of at least 6 degrees of
freedom. Thus, the dynamic reference frame 254 or any of the
tracking device 258 can be fixed relative to axial motion X,
translational motion Y, rotational motion Z, yaw, pitch, and roll
relative to the portion of the patient 204 to which it is attached.
Any appropriate coordinate system can be used to describe the
various degrees of freedom. Fixing the dynamic reference frame
relative to the patient 204 in this manner can assist in
maintaining maximum accuracy of the navigation system 200.
[0063] In addition the dynamic reference frame 254 can be affixed
to the patient in such a manner that the tracking sensor portion
thereof is immovable relative to the area of interest, such as the
cranium 288. A head band may form a part of the dynamic reference
frame 254. Further, a stereotactic frame, as generally known in the
art, can be attached to the head band. Such systems for tracking
and performing procedures are disclosed in U.S. patent application
Ser. No. 10/651,267, filed on Aug. 28, 2003, now U.S. Pat. App.
Pub. 2005/0049486, and incorporated herein by reference.
[0064] Although the navigation system 244, discussed above, can be
provided in a plurality of ways and with a plurality of mechanisms
it can be used to track the instrument 252. As discussed above the
instrument 252 can be a catheter and can be any appropriate
catheter and can include a tracking sensor such as the tracking
device 258. Briefly, it will be understood that the catheter can
represent any appropriate instrument such as a deep brain
stimulator (DBS) lead, a needle, a probe, a guidewire, etc. The
tracking device 258 included in the instrument 252 can be any
appropriate tracking sensor and can be formed in any appropriate
manner such as the catheters described in pending U.S. patent
application Ser. No. 11/241,837, filed on Sep. 30, 2005, now U.S.
Pat. App. Pub. No. 2006/0084867, incorporated herein by
reference.
[0065] The instrument 252 can include the tracking device 258 at
any appropriate position, such as near a distal end of the
instrument 252. By positioning the tracking device 258 near the
distal end of the instrument 252 knowing or determining a precise
location of the distal end can be efficiently done. Determining a
position of the distal end of the instrument 252 can be used to
achieve various results, such as determining a precise position of
the distal end of the instrument 252, a precise movement of the
distal end of the instrument 252, or other appropriate purposes. It
will be understood that knowing a position and moving the
instrument 252 in a precise manner can be useful for various
purposes, including those discussed further herein. Likewise, the
instrument 252 can be directable or steerable according to various
mechanisms and such as directing or pulling wires, directing or
pulling signals, or any appropriate mechanism generally known in
the art.
[0066] The instrument 252 can be used for various mechanisms and
methods, such as delivering a material or therapy to a selected
portion of the patient 204, such as within the cranium 288,
peripheral muscles or nerves, the spinal cord, dorsal nerves, etc.
The material or therapy can be a bioactive material, a
pharmacological material, a contrast agent, an electrical current,
or any appropriate material. The instrument 252 can also be
provided to diagnose or assist in diagnosis. For example, the
instrument can include a micro-electrode recorder that can record
or sense an electrical current in the patient 204. As discussed
further herein, the instrument 252 can be precisely positioned via
the navigation system 200 and otherwise used to achieve a protocol
for positioning the material relative to the patient 204 in any
appropriate manner, such as within the cranium 288. The instrument
252 may also include a brain probe to perform deep brain
stimulation. The instrument 252 can be tracked to navigate it along
the determined trajectory to stimulate an anatomical target, such
as a fiber tract, axon, etc. in the patient 204.
[0067] As discussed above, the image data for the patient 204 can
include any appropriate image data. For example, MRI image data can
be obtained for selected portions of the anatomy. Further, the
image data can be obtained at any appropriate time, such as prior
to the performance of a procedure on the patient 204. Also,
diffusion data regarding the patient can be obtained. Further, it
will be understood that although a procedure on the cranium 288 and
the brain is illustrated in FIG. 1, that any appropriate procedure
can be performed.
[0068] Various types of image data can be obtained for different
portions of the anatomy. As will be discussed further herein,
anatomical data and functional data can be obtained for a selected
region of the anatomy. Various types of data or information can
include Diffusion Tensor Image (DTI) data, functional MRI data,
etc. A hybrid image or an overlay image can be produced that
displays both the anatomical data and the functional data at the
same time. Alternatively, the functional data and the anatomical
data can be displayed separately for viewing by the user 282.
[0069] The image data can be obtained at any appropriate time, such
as preoperatively or intraoperatively. For example, the anatomical
image data and the DTI can be obtained preoperatively. The image
data, as discussed above, can then be registered to the patient 204
during the procedure according to various techniques. Therefore,
the image data can be obtained at any appropriate time and can be
used to both plan a procedure and to assist in the navigation of a
surgical procedure.
[0070] Further, the image data can be used to assist in determining
various functional and anatomical portions of the anatomy. For
example, the DTI image data can be used to assist a user or a
system to determine various selected regions of the anatomy. For
example, the DTI analysis or development can be used to assist a
user in determining the location, size, orientation, path, and the
like of various axons or fiber tracts. The information can then be
used to assist in determining an appropriate target for a therapy.
Determination of an appropriate tract or distinguishing a first
fiber tract from a second fiber tract can be used to assist in both
the navigation and planning of a procedure.
[0071] For example, with reference to FIGS. 2 and 2A, image data of
a lower torso portion of the patient 204 can be imaged. For
example, image data of a region of a spinal column 300 and in
particular a spinal cord 301 can be imaged with the appropriate
imaging system, such as a MRI. It will be understood that the
representation in FIG. 2 is merely exemplary of information that
can be obtained with an MRI. Nevertheless, MRI data can be used to
display an appropriately dimensioned image, such as a
two-dimensional, three-dimensional, or even four-dimensional image
data of a selected portion of the anatomy, including the spinal
column 300.
[0072] The image data can also include an image of one or more
neurons 302. The neurons can be individual neurons or bundles of
neurons. For example, various dorsal roots can be imaged and
identified in the image data. DTI can be used to assist in
identifying the various portions, such as the fiber tracts, in the
image data.
[0073] The neurons 302, as understood in the art, can include
various portions such as a cell body 304, an axon 306, and
dendrites 308. It will be understood by one skilled in the art that
various portions of the neuron 302 can also include other
anatomical portions, such as myelin, other sheath portions, and the
like. One skilled in the art will also understand that a signal can
be transferred along the axon 306, past or across a synapse 310,
and through the dendrite 308 to transfer information, such as a
movement signal, a pain signal, or any other appropriate signal.
For example, the signal can be transferred to a muscle fiber or
bundle 312 or to an organ 314. The signal transfer can provide
information to contract, expand, perform a function, transfer a
pain signal, or the like.
[0074] As discussed above, in various conditions, an anomaly can
occur, where selected signals are transferred without an anatomical
purpose. For example, nerve damage or other damage can cause pain
signals to be transferred for no apparent reason. Also, excessive
activity can occur in a region of the anatomy that can be a source
of issues in the anatomy. The signal can be transferred through the
spinal column 300, including the dorsal column, to be interpreted
by the brain in the cranium 288. Because of these anomalies, it may
be selected to provide a treatment to the region to assist in
reducing or eliminating the pain.
[0075] Treatments that can be applied can include stimulation of
the neurons to assist in reducing the pain transferred to the brain
to be interpreted or felt by the patient. The treatment can include
treatment or stimulation of a single cell or fiber. The treatment
can include providing an electrical signal or electrical current to
assist in reducing a felt pain signal.
[0076] Magnetic resonance imaging can be used to impose a change on
atoms that is interpreted by the magnetic resonance imager.
Obtaining magnetic resonance image data is well understood in the
art and will not be explained in detail here. Also, the magnetic
resonance image data can generally be used to identify various
anatomical portions, such as the cell body 304. In addition, the
MRI data can include diffusion image data. The diffusion data can
be used to determine a tensor to determine or illustrate a flow or
movement of water. The flow of water can be generally understood to
include diffusion of water.
[0077] Water can diffuse in various ways, such as isotropic or
anisotropic. An anisotropic diffusion generally describes the
movement of the water in a specific or selected direction or
through a corridor or path. With the diffusion tensor data the,
direction of the water can be determined and can be illustrated
either separately or with the MRI image data. A processor, such as
the planning processor 228 or the navigation processor 224, can be
used to illustrate the diffusion tensor image data either alone or
relative to an MRI data. The diffusion tensor data can include any
appropriate illustration, such as a line 320.
[0078] The DTI data can be used for calculating, with the tensor,
the main direction of diffusion of water in a region. Diffusion
data can be analyzed for a particular portion of the image data,
such as a voxel of image data, to determine the strongest direction
of diffusion. When using 3-D data, such as MRI data, the diffusion
direction can be determined in 3-D. To determine a path multiple
voxels that touch one another are analyzed to determine a flow of
water in a path from one point to another.
[0079] The line 320, either alone or with any appropriate image
data, can be illustrated on the display 225. The image data can be
used by a user to assist in determining a tract, such as an axon
tract 306 or fiber tract in the imaged area of the patient 204. The
axon tract 306 can constrict the movement of water. Therefore, the
diffusion of water can be assumed or determined to be along the
axon 306.
[0080] The determination of the axon 306 can be performed with any
appropriate tractography method. It will be understood that an
individual axon may not be determined or imaged, but rather a group
of similarly oriented and positioned axons may be determined or
imaged. The group of axons can be referred to as a fiber or neural
tract. Therefore, a fiber tract can represent one or more axons
that interconnect a group of cell bodies.
[0081] Generally, if diffusion occurs in an anisotropic manner then
a tract is determined to be present. The tracts can be determined
with various methods. For example, a fast marching or moving front
method can be used to determine the diffusion of the water along
the axon 306 to determine a tract. Once the entire diffusion tract
has been determined, it can be used to assist in determining the
location of a particular axon, such as an axon 306a to distinguish
it from a second axon, such as the axon 306b. Therefore, the
particular, or a particular, axon can be determined based on the
collected image data.
[0082] The axon 306 of the neuron 302 is representative of a single
neuron or a bundle of neurons in the patient 204. The neuron or
bundle can also be physically dissected, if selected. The DTI,
however, allows a graphical or visual or virtual dissection for
analysis and treatment. The DTI analysis of the image data allows
the determination of different neurons or bundles for
treatment.
[0083] Treatment applied to the neurons can at any appropriate
region, such as along the axon 306a. The axon 306a is more easily
stimulated with electrical stimulation than other parts of the
neuron, such as the cell body 304. Because the axon 306a is more
excitable and a signal is generally transferred along the axon
306a, stimulating the axon 306a can increase efficiency of the
stimulation and reduce the amount of current or voltage needed to
achieve a selected stimulation to therapy result. Further,
stimulating a particular axon, such as the axon 306a, can assist in
reducing possible side affects that may occur when stimulating a
general region of the neuron or stimulating an incorrect or
additional axon (e.g. axon 306b) that is not part of the disease
area. Also, stimulation of the axons or fiber tracts may produce a
more robust therapeutic effect due to the convergence and/or
density of information within the fiber tracts. This is opposed to
stimulating a larger volume of cell bodies that send signals via
the fiber tracts.
[0084] One skilled in the art will understand that stimulation of
the selected neuron or bundle 302 can be applied to any appropriate
location. Although stimulation of the axon 306a can provide a
selected result, stimulation of the cell body 304, a combination of
the cell body 304 and the axon 306a, stimulation within the grey
matter, (i.e. near the synapse), stimulation of both the grey
matter and the white matter, or any appropriate location can be
applied. The image data of the anatomy that is obtained and the
diffusion tensor analysis applied to the data can be used to
identify the various portions of the neuron 302 or bundle of
neurons. Therefore, an application of a treatment to a selected
portion can be, enhanced or selected, based upon the determined
portion of the neuron 302. Thus, the determination of the
appropriate portions of the neuron or neuron bundle can be used to
provide a selected treatment to the selected region. Thus, the
stimulation can be applied anywhere along the neuron, such as near
the affected region of the anatomy, such as an organ or a muscle,
or substantially in or near the spinal cord 301.
[0085] The determination of the axon 306a, as distinguished from
other axons or portions of the anatomy, such as the cell body 304
or muscle fiber 312, etc., can assist in providing a treatment to a
particular area without affecting other areas of the anatomy. Also,
if the treatment to be provided is stimulation stimulating the axon
can affect a pathway or communication network within the patient
204. This can also increase the efficacy of a treatment, in
addition to stimulating a more sensitive portion of the neuron.
Further, as discussed above, the reduction of side affects may be
obtained by eliminating or reducing the area to be stimulated with
the instrument 252.
[0086] It will be understood that the instrument 252 can include a
stimulator that can be used to stimulate the axon 306a and any
appropriate portion of the anatomy, such as near the spinal column
300. It will also be understood that the instrument can include an
implanted instrument, such as an implant and electrode, which is
maintained near the axon 306a for continuous or extended
stimulation thereof. The navigated instrument 252 can be any
appropriate instrument or can be positioned at any appropriate
location, and being positioned near the cranium 288 is merely
exemplary.
[0087] As illustrated in FIG. 3, the display 225 can illustrate any
appropriate image data, such as MRI image data to illustrate the
anatomy, including the spinal column 300 and the neuron 302. In the
alternative, or in addition to the MRI or other anatomical image
data, the DTI image data can also be displayed or superimposed over
the MRI data on the display 225. As discussed above, the DTI image
data can include the line 320 that illustrates the diffusion path
and direction of water or fluid through a selected portion of the
anatomy. One skilled in the art will understand, the diffusion of
the water along the path can illustrate or be used to determine the
axon or location of the axon 306a. It will also be understood that
the axon 306a, as determined by any appropriate means, including
the DTI image data 320, can be determined or selected to be the
axon to be stimulated.
[0088] The instrument 252 can be displayed on the display 225 in
any appropriate manner, such as superimposing an icon 340
representing the instrument 252 or the MRI/DTI image data using the
navigation processor 224 or any appropriate system, including the
tracking system 244. As discussed above, the instrument 252 can be
tracked in any appropriate manner and with the appropriate tracking
system. Nevertheless, on the display 225, the various icons can be
used to illustrate the position, planned position, or the like of
the instrument 252.
[0089] On the display 225, the icon 340 can illustrate a current
location of the instrument 252 relative to the image data, if an
image guided system is selected. In addition to the current
location icon 340, a planned or projected location icon 342 can
also be displayed. The projected location icon 342 can include a
planned trajectory of the instrument 252 to reach a target location
344. The target location 344 can be determined at any appropriate
time such as during pre-operative planning or intra-operative
planning. The target location 344, which can include an anatomical
target, can be determined or selected based upon the various
information including the DTI information 320. The projected icon
342 can act as a guide for the user 282 to move the instrument 252
relative to the selected axon 306a.
[0090] As discussed above, the instrument 252 can be any
appropriate instrument such as a stimulator to stimulate the axon
306a. The navigation of the instrument 252 can assist in
positioning the instrument at a selected location, such as the
target location 344 illustrated on the display 225. The target
location 344 can be determined in any appropriate manner, such as
automatically based upon the DTI information 320, manually by the
user, or any combination thereof.
[0091] The target location 344 can be displayed with the icon 340
on the display 225. Additional information can also be provided to
the user 282 to let the user know when the target location has been
reached, assist the user in reaching the target location with the
instrument 252, or any appropriate information. Further, the target
location 344, as discussed above, can be based upon selected
information and the information can also be displayed on the
display 225 with the progress information. Therefore, the use of
selected information, such as the DTI information 320, can be used
to assist in navigating the instrument 252 relative to the patient
204.
[0092] As discussed above, an appropriate therapy can be applied to
a selected region, such as the axon 306a. Any selected area or
combination of areas can be treated. Further, the target icon 344
can be used to indicate a selected location for the application of
a therapy. In addition to the target icon 344, additional
information can also be displayed on the display 225, which can
include an "affected area". An affected area can include a first
affected area 351a and a second affected area 351b.
[0093] The affected area icons 351a, 351b can illustrate the areas
that would be affected by a particular treatment and/or an amount
of the treatment or therapy. For example, if the instrument 252 is
a stimulation probe, the affected area icons 351a, 351b can be used
to illustrate the area that would be stimulated by a selected
electrical current over a period of time. The affected area icons
351a, 351b can also illustrate the area that a particular therapy
would spread over a selected period of time. Therefore, the
affected area icons 351a, 351b can assist a user 282 in determining
an appropriate amount of a therapy to be applied and where the
therapy might be effective. Also, the type or amount of treatment
can be selected intraoperatively, thus the icons can change
intraoperatively.
[0094] The affected area icons 351a, 351b can also assist a user in
reducing selected side effects. As discussed above, the
identification of the particular axon or fiber tract 306a, as
distinguished from the second fiber tract 306b can be useful in
limiting side effects to un-diseased areas. Therefore, the affected
area icons 351a, 351b can also assist a user in determining the
amount of a therapy that should be applied to maximize the therapy
applied to the selected axon 306a, while minimizing the effects of
the therapy on an unselected axon, such as the axon 306b. Thus, the
display 225, or any appropriate information output, can be used
with the user to determine an appropriate affected area of a
therapy.
[0095] One skilled in the art will understand that any appropriate
target location can be determined or selected, and the selection of
the axon 306a is merely exemplary. Nevertheless, locating the axon
306a can be assisted or enhanced with the DTI icon 320. As
discussed above, the DTI data can assist in determining the
location of the axon 306a, which can be determined or selected for
a treatment or therapy. Further, the combination of the DTI icon
320 with other appropriate information, such as anatomical MRI
information, can further assist in the determination of the
location of a selected region to be treated. The treatment of the
axon 306a can be any appropriate treatment such as stimulation with
a DBS probe, ablation, cutting, or the like.
[0096] With reference to FIG. 4, the procedure also can be provided
or applied to the brain. The patient 204 can be imaged in any
appropriate manner, such as those discussed above. For example, MRI
image data can be obtained of the brain and the images or the image
data of the brain can be displayed as an image 360 on the display
225. The MRI image data can generally display or show the anatomy
of the brain. In addition, DTI data can also be obtained for the
brain region. The DTI data can be obtained in substantially similar
ways as that discussed above, and can also be displayed on the
display 225. The DTI data or information can include tensor
analysis of diffusion data.
[0097] The DTI data can be displayed in any appropriate manner,
such as a line or a series of lines 362. The line 362 can show the
diffusion direction and the diffusion amount within the data, as
obtained and generally understood in the art. Therefore, the DTI
data can be interpreted to display or show a tract between various
regions in the brain. For example, the tract or fiber connection or
axon connection can be amongst the basal ganglia, such as between
the lenticular nucleus 364 and the caudate nucleus 366. Therefore,
the DTI data can be used to determine a connection or communication
region, such as along an axon, between various portions of the
brain. It will be understood that within the brain connection paths
or tracts are formed of axons and synapses between axons. The
connection paths or tracts can be between different neuron cell
bodies and neuron concentrations in the brain.
[0098] The DTI data can be obtained at any time, such as
substantially with the MRI data. Therefore, the DTI data can be
displayed substantially simultaneously or can be analyzed and
overlaid on the MRI image data for display on the display 225. It
will also be understood that these various types of data can be
displayed separately and displaying them together or overlaying one
on top of another is merely exemplary.
[0099] Further, on the display, an icon 368 representing a current
location of the instrument 225 can be illustrated. A proposed or
projected icon 370 can also be illustrated on display to show a
proposed or projected movement or position of the instrument 252.
As discussed above, the projected icon 370 can include either a
proposed or planned path of the instrument 252 or a projected
position of the instrument 252, if it continues along its current
path. As discussed above, the determination of a position of the
instrument is performed by the tracking system 244, which can be
any appropriate tracking system. The display 225 can also display a
target icon 372.
[0100] The target icon 372 can be generally near an axon or one of
the determined tracks within the brain. The tract and target can be
determined based upon the DTI data and other image data obtained of
the patient 240. As discussed above the tract icon 362 can be a
display of the DTI data for the region of the brain and the target
icon 372 can be selected in any appropriate manner. Further, the
tract icon 362 can be augmented or enhanced in any appropriate
manner such as with color, arrows, moving icons, or the like.
[0101] With continuing reference to FIG. 4, affected area icons
373a, 373b can also be illustrated on the display 225. The affected
area icons 373a, 373b can illustrate an area that would be affected
by a selected treatment if applied at certain parameters. This can
assist in ensuring that a therapy is applied only to a selected
region or a selected axon, such as the fiber tract, illustrated by
icon 362. The various side effects can also be reduced by ensuring
that the therapy would only affect the selected region.
[0102] The DTI data can be used to identify and determine the
tracts near which the instrument 252 can be positioned. The
instrument 252 can be any appropriate instrument such as an
ablation device, a stimulator, an electrode, a probe, or the like.
The instrument 252 can also include a permanent or long-term
implant or a single use or short-term implant. Nevertheless,
positioning of the instrument 252 near the axon, which can be
determined by the DTI data 362, can assist in ensuring an
appropriate or selected positioning of the instrument 252.
[0103] One skilled in the art will understand that the image data
and the DTI data illustrated in FIG. 4 are merely exemplary.
Various different and numerous tracts can be determined and
identified with the DTI data. The tracts can be displayed with or
without other image data and be used by a user in a selected
manner.
[0104] In addition to the tracts discussed above, other tracts can
be determined. As schematically illustrated in FIG. 5 various
portions of the brain can be identified in MRI image data. For
example the thalamus 400, the globus pallidus interna 402,
sub-thalamic nucleus 404, the zona incerta (ZI) 406, and the
pedunculopontine nucleus (PPN) 408 can be identified in selected
MRI image data. These portions of the brain can be identified in
any appropriate manner and selected procedures can be carried out
on them or near them. It can be selected however, to identify the
axons or tracts that interconnect them. These tracts, which allow
for communication between these regions, can then have a therapy
applied to them.
[0105] The tracts between the various regions can include an ansa
lenticularis 412, an internal capsule 414, a lenticular fasciculus
416, and Fields of Forel 418, 420. The tracts can allow for
communication and stimulus transport between the different regions
of the brain. These tracts can also be stimulated with stimulators
and probes. The tracts can be identified with the DTI data similar
to the DTI data 362. Though various tracts can be identified for
different procedures or treatments the use of the DTI data can
assist in the appropriate identification.
[0106] As briefly discussed above, image data, such as MRI
diffusion image data can be used to perform a tensor analysis to
provide for a virtual or in vivo dissection of the anatomy. The
virtual dissection can identify various fiber tracts and axon
tracts within the anatomy, such as the brain. For example, the
brain can include long and short fibers that interconnect various
regions of the brain, as discussed above. Further exemplary regions
can include the interior limb of the internal capsule. Various mood
disorders, such as depression, manic, and the like can be treated
by a stimulating the anterior limb of the internal capsule. Further
fiber tracts, in the brain, include the mammillothalamic tract. The
mammillothalamic tract can be targeted for epilepsy. Stimulation
can include electrical stimulation, such as providing a current
through a probe or electrode to the selected region of the anatomy.
The fiber tracts can be identified with the DTI data and
stimulating the fiber tracts can be performed.
[0107] It will be understood that a combination of any appropriate
anatomical features can be stimulated, however. For example, the
white matter and grey matter can be stimulated together,
separately, in sequence or one or the other can be stimulated.
Nevertheless, the DTI data can be used in combination with other
image data to assist in identifying the particular fiber tracts to
allow for stimulation thereof or in areas relative thereto.
[0108] With reference to FIG. 6, additional peripheral nerves can
be identified. A display can be used to display image data of a
selected portion of the patient 204. On the display, image data can
be displayed as can DTI data 370. As illustrated above, the DTI
data 370 can be used to identify tracts of the various nerves or
nerve tracts. The nerves can include the peripheral nerves that
extend from the spinal cord into various regions of the anatomy,
such as over the cranium. Stimulation of the nerves of the nerve
tracts can be used to treat various issues such as head pain or
headaches. Specific nerve tracts can include those of the occipital
nerves.
[0109] Therefore, one skilled in the art will understand that the
provision of stimulation to nerve tracts or fiber tracts need not
be deep within an anatomical structure, such as the brain, and can
be near the surface. In addition to the peripheral nerves, which
can surround the cranium, peripheral nerves that extend from the
spinal cord can also be stimulated, to treat pain in the anatomy or
treat various ailments of selected organs.
[0110] Stimulation of the selected portions of the anatomy can be
provided for various purposes. The identification and isolation of
the axon fiber tracts, such as within the image data, can be used
to assist in identifying regions for stimulation or treatment. It
will be understood that various techniques can be used to identify
the axons and DTI image data is merely exemplary. The DTI image
data can assist in resolving or identifying specific tracts, but
analysis of the image data can use other techniques to identify
axon tracts. For example, a user can review the image data
displayed and identify specific or selected axon fiber tracts for
positioning a treatment device.
[0111] Further, identifying the fiber tracts or axons of neurons
can assist in positioning treatment or a treatment device, such as
the instrument 252, relative thereto. Positioning the instrument
directly on or only near the axons, however, is not required. A
selected position to provide a treatment can overlap both the axon
and a cell body, and other portions of the anatomy. For example,
such as within the brain, stimulation of both the fiber tract
(white matter) and cell bodies or other portions of the brain (grey
matter) can be selected to provide a treatment. Therefore,
providing a treatment only to the axon is not required.
[0112] One skilled in the art will understand that the image data,
including the MRI and the DTI, can be obtained at any time. Thus,
the data can be obtained prior to a procedure to assist in planning
a procedure. The target can be identified, which can include the
tract that is determined with the DTI data. Further, a projected or
planned trajectory can be determined while planning the
procedure.
[0113] The data can also be used for display during a procedure to
assist in navigation of the instrument 252 to the selected target.
The target can be selected intra-operatively or pre-operatively. In
any case, the target can be identified as an axon with the DTI
data. The instrument, which can include a stimulator, can then be
navigated to the target for performing the procedure.
[0114] Various issues can be treated with a stimulator. For example
various psychiatric issues can be treated with stimulation, such as
Obsessive Compulsive Disorder and depression. Stimulation of the
tracts can provide additional stimulation in the selected portion
of the brain to treat these issues. Also, epilepsy and Parkinson's
disease can be treated by stimulating selected regions in the
brain.
[0115] Stimulating the tracts directly can also assist in reducing
power or current usage and increase efficiency and reduce side
effects of a stimulation procedure. Thus, the determination of the
tracts can assist in directing a stimulation directly to the tract.
The DTI data can assist in determining the tract by identifying the
regions in which anisotropic diffusion is occurring.
[0116] As discussed above the tracts can be more sensitive to
stimulation, thus a lower current can be used when treating the
tract. Also, the area being stimulated can be more definitely or
narrowly determined, which can also allow for reduction of current
during stimulation. Side effects can also be reduced by limiting
the current and the areas to be stimulated. Thus, stimulating the
tracts determined with the DTI data can assist in increasing the
efficiency and efficacy of the procedure.
[0117] One skilled in the art will also understand that any
appropriate tracts throughout the body can be determined and
stimulated. Tracts in the brain and spinal column are merely
exemplary of tracts to be stimulated. Other tracts, as discussed
above can include peripheral nerve tracts. Also, any appropriate
instrument can be navigated relative to the selected or determined
areas to provide any appropriate treatment to the selected area or
target.
[0118] As discussed above, the application of a therapy to a
particular region can be enhanced by determining a fiber tract or
axon that transmits signals between selected anatomical regions.
The axon can be treated with any appropriate treatment, such as an
electrical stimulation to achieve a selected result. The axons or
fiber tracts can be determined with various techniques, such as DTI
image data that can be used with or without anatomical image data.
Thus, the use of the DTI image data can assist a user in
determining a particular fiber tract. It also can assist a user in
determining a first particular fiber tract from a second particular
fiber tract for application of therapy to the particular fiber
tract. In addition, the fiber tract can be mapped appropriately
with the DTI data and image data for application of therapy to a
selected location on the fiber tract or to multiple locations on
the fiber tract.
[0119] The identification of a fiber tract for application of a
therapy can assist in reducing an amount of current applied during
stimulation and enhance accuracy of the application of the therapy.
As opposed to applying a therapy to a general area, such as to the
sub-thalamic nucleus or the basal ganglia, the DTI image data can
assist in determining a particular fiber tract to which a therapy
can be applied.
[0120] The teachings herein are merely exemplary in nature and,
thus, variations that do not depart from the gist of the teachings
are intended to be within the scope of the teachings. Such
variations are not to be regarded as a departure from the spirit
and scope of the teachings.
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