Evaluation of nonlinear approaches and manipulation space

在项目的初始阶段（FOR 1585，多端口骨手术作为耳基MUKNO的示例），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方法的规划和模拟。这些结果可以在人颞骨尸体模型上的仿真传输中得到验证。然而，在岩骨的较深部分中的进入路径的干扰以及操纵空间的设计（例如，在肿瘤的微创切除的情况下）仍然是有问题的。预计通过非线性途径将向前迈出重要一步，这些途径可以根据最短的途径进入感兴趣的区域，绕过关键区域。非线性钻孔轨迹的应用也允许与线性入路相结合，因为可能有更大的直径。必须对耳基底的非线性入路进行可行性分析。这必须是对这种新方法的潜在新适应症、应用范围以及安全性方面的评估，必须与以前的方法以及MUKNO在第一个供资期的发现进行比较。此外，我们必须定义具有最大操作空间的目标区域。这应该根据当前可用的仪器以及未来的致动器来完成。为了开发和规划颞骨内目的地的必要体积和可用性，创建骨骼的解剖空间使用分析作为对地图集的现有知识的补充。要开发的非线性钻井系统需要对第一阶段开发的钻井平台进行修改，并配备定位单元。这些应当在另一工作包中改变，即其可以用于线性的常规钻井系统，以及用于钻井的非线性系统，因为还应当安排钻井的非线性和线性轨迹的同步应用。此外，该平台应在完成钻孔工作后作为内窥镜固定系统在术中使用。在颞骨研究的基础上，必须评估新的微创手术解剖图谱知识，因为已知的探查手术标志对于新的内窥镜入路不再有效。这也应该解决现代内窥镜技术的各个方面，包括3DS切片和缝合与全景图像创建，并包括“看墙后”或“立体主义视图”。

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".