Evaluation of nonlinear approaches and manipulation space

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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 application of non-linear trajectory of drilling allows also a combination with linear approaches as probably larger diameters are possible.It has to perform a feasibility analysis for non-linear access to the otobasis. This must be an evaluation of the potential new indications, the range of applications as well as security aspects of this new approach which has to be compared with previous methods, as well as with the findings of MUKNO from the first funding period. Furthermore, we have to define the target area with a maximum manipulation room. This should be done in terms of currently available instruments as well as future actuators. For the development and planning of the necessary volume and availability of destinations within the temporal bone, an anatomical space usage analysis of the bone is created as a supplement to the existing knowledge of the atlases. The non-linear system of drilling to be developed requires a modification of the drilling platform developed in the first period with the positioning unit. These should be altered in a further work package, that it can be used for linear, conventional drilling systems, as well as for the non-linear system of the drilling, because also the synchronous application of non-linear and linear trajectories of drilling should be scheduled. Also the platform should be used intraoperatively after completing drilling work as endoscope holding system. On the basis of temporal bone studies, a new minimally invasive surgical anatomical atlas-knowledge must be evaluated also because known surgical landmarks of exploratory surgery are no longer valid for the new endoscopic approaches. This should also address aspects of modern endoscopic techniques including 3DSlicing and stiching with panoramic image creation and included "look behind the wall" or "cubism view".