Computer-assisted functional neurosurgery

描述(申请人提供)：美国有超过500万人患有运动障碍。两种最常见的运动障碍类型是原发性震颤(ET)和帕金森病(PD)，前者影响超过400万人，后者影响超过50万人。这些疾病的现代治疗包括通过脑深部刺激(DBS)进行高频刺激。这种形式的治疗提供给那些已经开始看到标准药物治疗失败的患者，也提供给药物治疗效果不佳的患者。DBS程序涉及以毫米级精度将电极放置在被称为靶点的功能区附近。该程序的主要困难在于，感兴趣的目标在任何成像方式(例如，核磁共振或X射线CT)中都看不到或看不到。因此，DBS电极的植入过程是一个迭代过程。根据在MR图像中可见的相邻结构的位置，在手术前确定近似目标位置。随着病人的清醒，这一体位将在术中调整，这是一个漫长的过程。整个过程可能需要5-6个小时，需要神经外科医生、电生理学家和神经科医生的专业知识。这种综合的专业知识只在有限的几个中心提供，这就是为什么尽管可以从中受益的患者数量要多得多，但每年只进行3000例手术的原因之一。这个项目的目标是开发一种手术指导系统，帮助神经外科医生在术前识别感兴趣的靶点，并在术中调整靶点位置。如果成功，这个项目的结果将是一个系统，它将缩短程序的持续时间，提高其成功率，并使其在没有领先研究机构所具备的专业知识的地点可行

DESCRIPTION (provided by applicant): Movement disorders affect over 5,000,000 people in the United States. The two most common types of movement disorders are essential tremor (ET), which affects over 4,000,000 and Parkinson's Disease (PD), which affects over 500,000 people. Contemporary treatment of these diseases involves high-frequency stimulation through deep brain stimulation (DBS). This form of therapy is offered to patients who have begun to see failure with standard medical therapy and also to patients in which medical therapy is poorly effective. A DBS procedure involves the placement, with millimetric accuracy, of an electrode in the proximity of functional areas referred to as targets. The main difficulty with the procedure is the fact that targets of interest are not or poorly visible in any imaging modality (e.g., MRI or X-ray CT). Hence, the process of implantation of a DBS electrode is an iterative procedure. An approximate target position is determined pre-operatively from the position of adjacent structures that are visible in MR images. With the patient awake, this position is then adjusted intra- operatively, which is a lengthy process. The entire procedure can take 5-6 hours, and requires expertise from a neurosurgeon, an electrophysiologist, and a neurologist. This combined expertise is only available at a limited number of centers, which is one of the reasons why only 3000 procedures are performed annually despite the much larger number of patients who could benefit from it. The goal of this project is to develop a surgical guidance systems that will assist neurosurgeons in identifying targets of interest pre-operatively and in adjusting target position intra-operatively. If successful, the outcome of this project will be a system that will reduce the duration of the procedure, increase its rate of success, and make it feasible at sites that do not have the expertise found at leading research institutions