Demonstrator an sonodynamic ablative procedures

在项目的初始阶段（FOR 1585，多端口骨手术作为耳基MUKNO的例子），通过优化耳基内不同感兴趣区域的成像、配准和风险评估，开发了基于软件的多端口入路规划和模拟。这些结果可以在人体颞骨尸体模型的仿真传输中得到验证。然而，在石质骨的较深部分的通路的干扰，以及操作空间的设计，例如在微创切除肿瘤的情况下仍然存在问题。通过非线性路径，可以绕过关键区域，以最短的路径到达感兴趣的区域，有望向前迈出重要的一步。尽管MUKNO手术的可行性，但可能钻孔轨迹的直径以及手术操作的靶区空间与患者解剖结构的关系仍然有限。因此，在岩质骨中实施微创手术的另一个条件是，尽管目的地的操作空间有限，但灵活的器械也可以使非线性通道安全操作。为此目的还需要其他特别是灵活的微型仪器。此外，必须使用其他组织调制的物理方法，因为在电缆引导应用的基础上，通路的线性缺失，例如，生物灭活肿瘤或通过消融。声动力消融术在医学上以压电外科的形式建立。在超声波范围内的微振动产生并在切削工具上传播。因此，它可以作为骨头的锯，同时保护软组织，因为软组织表现出不同的共振行为。到目前为止，还不可能通过超声波对软组织进行组织选择性操作。如果不同类型的细胞（如肿瘤细胞）与健康粘膜细胞相比表现出不同的共振，则可以对特定软组织进行选择性消融。这将有可能将声动力应用器与肿瘤连接起来，用特定频率的超声波刺激肿瘤，并在周围健康软组织的保护下打破细胞特异性结合。本项目进一步建议将项目1 - 5进行总结，并在人颅骨制备的基础上进行演示评估。对干预期间和干预后的非线性轨迹规划和控制的各个环节进行监测和计量分析。

In the initial phase of the project (FOR 1585, multi-port bone surgery as example of the otobasis MUKNO) a software-based planning and simulation of the multi-port approaches was developed by optimization of imaging, registration and risk assessment to different regions of interest within the otobasis. These results could be validated in the transmission of the simulation on a human temporal bone cadaver model. However, an interference of the access routes in deeper parts of the petrous bone, as well as the design of the manipulation space, e.g. in case of a minimally invasive resection of tumors remain problematic. A significant step forward is expected through non-linear pathways which could bypass critical regions in accordance with shortest access to the region of interest. The diameter of the possible drilling trajectory, as well as the space at the target area for the surgical manipulation in relation to the patients anatomy remains limited despite the feasibility of a MUKNO procedure. Therefore, a further condition for the implementation of a minimally invasive surgery in the petrous bone is also appropriate by flexible instruments for the non-linear access to operate safely despite a limited handling space at the destination. Other, in particular flexible microinstruments are required for this purpose. In addition, other physical methods of tissue modulation must be used because of missing linearity of the access routes on the basis of cable-guided applications, for example, to inactivate tumor biologically or by ablation. Sonodynamic ablation procedures are established in medicine in the form of piezosurgery. Micro-vibrations in the ultrasonic range are generated and transmitted on a cutting tool. It can thus serve as a saw for bone while it protects soft tissue at the same time, because this tissue shows a different resonance behavior. So far, no tissue-selective manipulation of soft tissue by ultrasound is possible. If different cell types such as tumor cells compared to healthy mucosa cells show a different resonance, a selective ablation of specific soft tissue will be possible. It would be possible to connect a sonodynamic applicator with a tumor, stimulate it by a specific frequency of the ultrasonic, and break cell-specific bindings under protection of the healthy surrounding soft tissue.The further propose of this project is to summarizes the projects 1 to 5 and evaluated in a demonstrator on the basis of human skull preparations. All parts of the planning and control of non-linear trajectory during and after the intervention will be monitored and metrologically analyzed.