Research And Development Of Real-time Structured Optical Neuronavigation And Preliminary Application Of Intracerebral Hemorrhage Surgery

BackgroundThe brain,central of nervous system,is one of the most complex organs of the human body.Neuro-diseases often require surgical treatment,such as removal of a hematoma and removal of a tumor.Because of the high dense nerve fiber structure in the brain which is non-reproducibility.So how to accurately remove lesions during surgery,reduce injury,shorten the operation time,and protect the function of the brain as much as possible,it is the goal of clinical doctors.With the development of medical Imaging technology,such as CT scan(Computer Tomography,computed Tomography),MRI(Magnetic Resonance Imaging,clinicians have been able to achieve early diagnosis and early treatment of some brain diseases.At the same time,relying on these advanced examination methods,the surgical approach design have changed from surgical experience to the surgical planning combined with the patient's individual image data.With the development of medical engineering,for example the neuronavigation system in the brain and spinal cord surgery,the preoperative surgical planning and the actual situation of the operation are registered and fused through image space technology,which also become an important feature in the field of minimally invasive surgery and is considered to be effective in reducing brain injury.The computer vision technology can obtain the three-dimensional information of the object in space.After filter the image of the target through different algorithms can obtain the region of interest,and provide anatomical information and/or spatial coordinate information for the surgeon.Structured light technology is one of the most commonly used computer vision technology,it can be more simple and rapid reconstruction of three-dimensional scene.The principle of structured light technology is to project a specific optical pattern into the detected scene,then capture these optical patterns through the camera,and decode the spatial information of the target through the algorithm.This three-dimensional structured light three-dimensional imaging technique can be used for scanning of surgical scenes,or high-precision static registration of surgical navigation.In the past,due to the limitation of the reconstruction speed,the researchs of structured light in surgical navigation is just applied to the preoperative high-precision label-free registration direction.In the past three years,artificial intelligence technology has developed rapidly,especially with the development of chip technology,the compute speed has been improved.The structured light real-time scanning and reconstruction technology,not only could track the motion of the instruments and objects in the operation,but also dynamically restored the three-dimensional scene in the operation.Therefore,it is possible to developing a navigation system for surgery based on real-time structured light technology theoretically.In order to design and implement a high-precision real-time structure light navigation system,this study researched its safety and effectiveness through laboratory research and cerebral hemorrhage surgery.The function of this navigation system includes that the registered method through non-mark registration based on the real-time structured light technology,the tracking of the rigid body structure.Finally,this system could take the real-time point cloud reconstruction and then augmented reality display the preoperative image.This study will be divided into four parts.Part ? The research of real-time structured light neuronavigation systemObjectiveBased on real-time structured light technology,a surgical navigation system was designed and implemented.MethodsBased on Intel sr305 coded depth camera and computer workstation,and the python platform programming,many library(TK,VTK,ITK,numpy,OpenCV,Open3D,Pyrealsense2)was used to develop the system software.Six functional modules in surgical navigation were designed finally.For different image data formats,a special DICOM data format conversion module was designed.For preoperative planning,the VTK volume rendering and head point cloud data reconstruction based on marching cubes algorithm;for the registration of non marker image data and 3D point cloud data,"Two Step" registration was developed,the first landmark based on the anatomical site of the rough registration and then automatically run the Iterative Closest Point registration(ICP);for the tracking of the navigation probe,this study extracted the color label based on HSV,and then calculate the three-dimensional coordinates;to reduce the environmental impact of the camera pattern jitter,we use Kalman filter and sphere fitting algorithm to calculate the real time position of the probe tip;for the three-dimensional augmented reality,each Actor was displayed by the multi-camera module of VTK.ResultsSurgical navigation system was success developed based on real-time structured light technology.The hardware was made of Intel's depth camera,and the software was generated by programming based on python platform.The system includes six core functional modules:1.The DICOM module that manages DICOM data.2.preoperative planning module,image data reconstruction can simulate the preoperative planning of the surgical approach,which could set the needle point and target point of the puncture operation.3.The real-time structured light navigation module wich could reconstructed the three-dimensional scanning point cloud image of the surgical area to assist in surgical navigation and positioning.4.the three-dimensional scanning and registration module can scan the patient's intraoperative face for non marker registration.5.computer aided design(CAD)module could create some simple three-dimensional models,such as cylinders,spheres,cubes,etc.,and could take Boolean operations for the three-dimensional models.6.The computer vision navigation module can scan the surgical area in real time through structured light,and guide the operation through multi-view three-dimensional augmented reality display.ConclusionSurgical navigation system can be developed based on real-time structured light technology.The system can register the image data of the patient without markers,can track the navigation probe in the space,scan the three-dimensional cloud scene in real time and display the image model through multi-view augmented reality.Part ? Experimental study of real-time structure light navigation systemObjectiveIn the last part,we designed and implemented a navigation system based on real-time structured light technology.This part will further explore the accuracy of the system for clinical application.Methods3D printed head models were used to analyze the real-time structured light system.The electromagnetic navigation system as the control group,positioning accuracy and angle error were the main observation,the cost of the equipment(including time and costs)and the user's intention score were used as secondary observation.ResultsThe 3D printed models were used to the electromagnetic navigation and real-time structured light navigation system analysis.The registration of electromagnetic navigation was marked by point-to-point registration,and the error was 3±2.0 mm,while the structured light navigation was no marked registration,and the error was 2.0±1.5,and there was no significant difference between the two groups;the actual positioning error of electromagnetic navigation was 3±2.5,while the actual error of the structured light navigation(3DCV)Group was 4±3.5,the difference was no statistically significant.The relative angle error between the two groups was 1.0±0.9 degrees.Both groups completed the procedure within 10 minutes(3DCV.MN,6±3min.8±4min),the difference was not statistically significant;Cost analysis of 3DCV equipment cost a total of about 10,000 yuan,but the electromagnetic about 10,000,00 yuan;Satisfaction survey showed no difference between the two(3DCV.MN,8±2.4.8±2.0).ConclusionReal-time structured light technology is a high-precision navigation method,which can be registered in the navigation without markers,also has the characteristics of simple operation and low cost.Part ? Application of real-time structured light navigation in puncture and drainage of intracerebral hemorrhageObjectiveThe experimental study on the real-time structured light navigation system,proved that it is a high precision navigation.This part of the study will analyze its safety and effectiveness through the application of intracerebral hemorrhage puncture and drainage surgery.MethodsTo explore the safety and effectiveness of the application of real-time structured light navigation(3DCV)in the puncture and drainage of intracerebral hemorrhage with the electromagnetic navigation system as the control group(3Dprinting).ResultsA total of 61 patients with cerebral hemorrhage were enrolled after inclusion and exclusion criteria,including 35 in the electromagnetic navigation group(MN)and 26 in the 3DCV group.The Age,preoperative GCS score and gender of the enrolled patients were no statistically different.All patients were successfully treated with puncture and drainage of cerebral hemorrhage surgery.The postoperative GCS of the two groups were improved compared with the preoperative,the pre&post surgery GCS scores of the MN group were 8± 1.8 VS.12±2.1,and 3DCV group were 8±1.5 VS.12±3.2,but there was no significant difference between the two groups;The mRS score in the MN group(2±1.22)and in the 3DCV group(2±1.19),was no significant difference between the two groups,and the operation time(3DCV VS.MN,5±2.5h VS.2±1.5h),was statistically significant;The average positioning error of MN group(3.7±3.2)was better than that of 3DCV group(4.5±2),but there was no significant difference;there was no significant difference in postoperative complications between the two groups.ConclusionThe real-time structured light navigation can be used to assist the puncture and drainage of cerebral hemorrhage.It can be used for non Mark registration and positioning through real-time navigation and three-dimensional augmented reality.It is a safe and effective navigation method.Part ? Application of real-time structured light navigation in endoscopic surgery of intracerebral hemorrhageObjectiveIn order to further verify the safety and effectiveness of real-time structured light navigation system in clinical applicationMethodsTo explore the application of real-time structured light navigation(3DCV)in endoscopic hematoma removal of intracerebral hemorrhage,the electromagnetic navigation group was used as the control group(MN).ResultsThrough the inclusion exclusion criteria,46 cases were finally included in the analysis,including 29 cases of(MN)and 17 cases of patients using real-time structured light navigation.All patients with basal ganglia hemorrhage,aged 35-73 years.All patients successfully completed the hematoma removal surgery.GCS was improved in all patients after Operation.The GCS score of MN group before and after Operation(8±1.8 vs.10±2.1,p<0.05),and 3DCV group preoperative and postoperative score(7±2.5 vs.10±2.4,p<0.05),no significant difference between the two groups;MN Group of mRS score was 2±0.29,3DCV group was 2±1.19,there was no significant difference between the two groups.The mean residual rate of hematoma in MN Group was 9%,while in 3DCV Group was 8%,but there was no significant difference between the two groups.The time of the 3DCV Group was 2±1.33h,while the time of the MN Group was 4±1.14h.The time of the structured light navigation group was significantly shorter than that of the MN Group,and the difference was statistically significant;there was no difference in postoperative complications between the two groups.ConclusionThe real-time structured light navigation technology can assist the endoscopic surgery of cerebral hemorrhage,facilitate the removal of cerebral hematoma,and shorten the operation time,further verify the safety and effectiveness of the real-time structured light navigation technology.This provides a theoretical for the next clinical promotion.