Patent Application
20200030103
The present invention relates to a system for producing a cranial operculum for a living being.
The present invention further relates to a method for producing a cranial operculum for a living being.
In particular, the present invention relates to a system and a method for producing a cranial operculum for a living being during a surgical procedure involving a craniotomy.
Most neurosurgical procedures at the cranial level entail removing a bone flap of varying dimensions, adapted to perform the procedure, which is set back in place at the end of the procedure. It is often necessary to carry out surgical procedures intended to reconstruct the cranial wall by means of an artificial plate or operculum to fill in a bone gap in the skull (cranioplasty). For example, various types of surgical procedures on the human brain require the removal of a portion of the skull. By way of non-limiting example, surgical procedures to remove brain tumours, surgical procedures to reduce brain swelling (e.g. oedemas, neoplasms, infections, vascular lesions), and surgical procedures necessary to reconstruct damaged parts of the skull.
In surgery involving first removal and then reconstruction with cranioplasty prepared in the pre-surgery phase, precision is a must. If, due to a technical error, the craniectomy is larger than the artificial cranial operculum, it can prove very difficult to remedy this and the final result can be highly disappointing.
Before entering the operating room, neurosurgeons are in the habit of examining all or part of the neuroradiological material produced. Recently, this has been greatly helped by routine use of a neuronavigator, whose multiplanarity and the possibility of creating visualisation planes at varying depths from the surface makes it possible to devise mental simulations of surgical planning.
Thanks also to the possibility of overlaying computed tomography (CT) on brain magnetic resonance (MR) images in a single examination, the neuronavigator makes it possible to easily understand the best way to carry out a surgical approach.
The use of a neuronavigator is to be considered essential in all cases of removal and reconstruction performed during a single surgical procedure.
At present, the use of diagnostic imaging methods, i.e. techniques performed in order to obtain images that provide diagnostic information, plays an essential role in the performance of neurosurgical procedures, making it possible to plan a procedure better and enabling an anatomic and functional definition of the damaged region of the brain. Furthermore, diagnostic imaging methods can help to guide the neurosurgeon during the procedure. For example, intra-surgery uses of ultrasound in neurosurgery, in which the ultrasound probe is placed directly on the brain, enables an excellent definition of the anatomical situation in the surgical field.
The use of diagnostic imaging methods also continues in the post-surgery phase, in order to assess the entity of the brain resection and the effectiveness of adjuvant therapies. Such therapies, however, may have side effects, and are time-consuming and expensive in terms of financial and human resources. Furthermore, some patients may not respond to a certain procedure and/or adjuvant therapies, resulting in the need to continue monitoring and identifying the treatment area. Early identification of these cases, in addition to improving the treatment of those patients, would result in considerable cost savings.
Although ultrasound scanning is a tool widely used in the field of general radiodiagnostics, is limited to just a few areas in brain diagnostics. In fact, in post-surgery follow-up examinations, the highly hyperechogenic nature of the skull (i.e. it generates an echo when struck by an ultrasound beam during an ultrasound examination) prevents the ultrasound from penetrating into the cranial cavity, with the exception of the ocular region and the temporal acoustic window.
Furthermore, there are technologies which enable the irradiation of tissues of living beings with high-intensity focused ultrasound beams for the treatment of functional pathologies or in order to treat brain lesions. Focused ultrasound beams have the further effect on the brain of opening the blood-brain barrier and allowing better drug absorption.
The repositioning of the cranial bone flap removed following the neurosurgical procedure in fact creates an obstacle to ultrasound and precludes follow-up examinations of the patient using ultrasound or treatments with focused ultrasound beams.
Furthermore, though occasionally available, the present ultrasound treatment methods capable of passing through the skull do not yet enable an effective treatment and entail a very high delivery of energy.
One object of the present invention is to provide a system and a method for producing a cranial operculum for a living being that makes it possible to drastically reduce fabrication times and improve precision in the production thereof.
Another object of the present invention is to provide a system and a method for producing a cranial operculum for a living being which enables it to be produced at the time of surgery.
Another object of the present invention is to provide a system and a method for producing a cranial operculum for a living being that enables it to be produced based on planning carried out on a planning module that uses a CT or RM image as input.
A further object of the present invention is to enable an artificial cranial operculum to be made with rigid, biocompatible, sterilisable, ultrasound-transparent materials.
Another object of the present invention is to enable an effective use of ultrasound in the field of post-surgery brain diagnostics.
A further object of the present invention is to enable the claimed device to be used as an interface on which other diagnostic and/or therapeutic devices can be easily applied, so as to enable follow-up examinations to be performed in the post-surgery period in order to monitor the course of the disease or recovery from the brain lesion and also for the administration of therapies.
Another object of the present invention is to provide a system and a method for producing a cranial operculum for a living being that enables specific surgical strategies to be devised rapidly and cost-effectively by reproducing the area of intervention concerned and simulating thereupon the procedure in the pre-surgery phase.
A further object of the present invention is provide a rapid, easy-to-implement method of simulating the production a cranial operculum.
These and other objects are achieved by a system for producing a cranial operculum for a living being according to what is disclosed in claim 1.
Advantageous aspects are disclosed in dependent claims 2 to 10.
These and other objects are further reached by a method for producing a cranial operculum for a living being, according to what is disclosed in claim 11.
Advantageous aspects are disclosed in dependent claims 12 to 16.
The invention also comprises a computer program that implements one or more steps of the method, according to what is disclosed in claim 17.
The invention achieves a plurality of technical effects:
The simulation step performed by the invention carries out technical functions typical of modern engineering work. It provides, in the pre-surgery phase, realistic predictions of the cranial zone involved in the procedure and of the optimal shape and size of the cranial operculum that must be accommodated, and thereby ideally enable the operculum to be developed so accurately that the possibilities of success of a prototype can be assured prior to its actual production.
The technical effect of this result grows with the speed of the simulation method, since this enables a broad range of designs to be tested and examined virtually in order to evaluate the correspondence before the process of fabrication of the cranial operculum begins.
Without technical support, an advanced test on a complex operculum and/or an accurate selection among many different designs would not be possible, or at least not possible within a reasonable time.
Consequently, the computer-implemented simulation methods for virtual tests are a practical part geared towards the practice of a neurosurgeon. What makes them so important is that, as a rule, there is no purely mathematic, theoretical or mental method that provides a complete and/or fast prediction of the performance of a cranial operculum, according to the parameters of the invention, which is different or diversifiable for every different patient.
The technical effects/advantages cited and other technical effects/advantages of the invention will emerge in further detail from the description provided herein below of an example embodiment and they are provided by way of approximate and non-limiting example with reference to the attached drawings.
The system for producing a cranial operculum for a living being according to the invention comprises an acquisition device configured to define an area of planned removal of cranial bone (i.e. in a simulation carried out in the pre-surgery phase) on the skull of a living being, a first three-dimensional (or 3D) detection device configured for 3D detection of the skull cap shape and, optionally, of the thickness of the skull to be removed which is included in said area of planned removal of cranial bone, a second detection device configured to detect the points of the margin of the crater in the cranial bone after removal of the part of skull cap included in said area of planned removal, a processing unit configured to process a 3D model of the operculum and send it to an electronic digital fabrication device configured to produce and/or process three-dimensional objects.
In the present description, the term “digital fabrication” (or “tabbing”) refers to the process whereby it is possible to create solid three-dimensional objects from digital files. This process exploits different fabrication techniques, both additive (such as 3D printing) and subtractive, such as laser cutting and milling.
With reference to
The processing unit 40 can preferably be connected to a display 60 configured to represent three-dimensional images of the skull 6 of the patient, the edge of the bone crater 4 and/or the cranial operculum 1.
The acquisition device 10 enables the system to approximately determine an area of intervention or planned removal of cranial bone Ap, before the surgical procedure (i.e. pre-surgery simulation phase), based on diagnostic images (for example, computed tomography, nuclear magnetic resonance and variants thereof) of the patient and based on the target zone for the surgical procedure (for example, removal of a primitive or secondary brain tumour, removal of skull base tumours, location of specific areas of the base nuclei for the treatment of functional pathologies).
The system is preferably configured to segment the region of interest (e.g. tumour, oedemas, neoplasms, infections, vascular lesions) and the skull cap. An algorithm will suggest the region of planned removal of the skull cap Ap, which can in any case always be corrected by the physician based on specific needs.
Alternatively, it will be the neurosurgeon who can enter the area of planned removal of cranial bone Ap into the system via a graphic interface, as illustrated in continuation, by tracing, on the segmented 3D reconstruction of the skull cap, the region of planned removal of the skull Ap. Optionally, the neurosurgeon can modify the area of planned removal Ap proposed by the system via the graphic interface. The data related to the area of planned removal of cranial bone Ap from the skull cap are sent to the processing unit 40 by said acquisition device 10.
The first 3D detection device 20 is configured to detect the skull cap shape Fc from one or more diagnostic images of the patient. Optionally, the first device 20 is also capable of detecting the thickness Sc of the portion of skull to be removed from said diagnostic images. By way of non-limiting example, the first device 20 is configured to perform a segmentation of the skull cap, preferably threshold based and adaptive level-set or fast marching.
The data related to the thickness Sc and shape Fc of the skull cap are sent to the processing unit 40 by said first 3D detection device 20. With the simulated data of the region of planned removal of cranial bone Ap, the thickness Sc and the shape Fc of the skull cap, the processing unit 40 is capable of processing a shape estimated in the pre-surgery phase from the skull cap dimensions.
Following removal of the part of skull cap included in said area of planned removal Ap, the second 3D detection device 30 detects the set of points of the margin 3 of the crater in the cranial bone 4, indicated in
The second detection device 30 for detecting the points of the margin 3 of the crater in the cranial bone 4 preferably comprises an anthropomorphic measuring arm 31 equipped with a sterile tip 32 capable of moving freely and with extreme simplicity and precision on the margin 3 of the area of removed bone 4, in such a way as to detect a set of points P_MRG. The tip 32 can preferably be made of polymer or another sterile, rigid material, such as, for example, steel, ceramics, titanium or aluminium. The anthropomorphic arm can preferably be of the type with 5 or more axes. Every time that the surgeon activates the controls provided, the measuring arm 31 sends to the processing unit 40 the three-dimensional coordinates of the point in space in which the tip of the stylus 32 is located.
As an alternative to the probing arm 31, the set of points P_MRG of the margin 3 of the crater in the cranial bone 4 can be detected by a three-dimensional scanning laser (or scanner) having at least 3 reference axes.
The first detection device 20 is configured to acquire the skull cap shape Fc and, optionally, the skull cap thickness Sc from one or more diagnostic images of the patient.
The first detection device 20 is further configured so as to obtain, from the computed tomography (CT) or from other diagnostic images of the patient (for example MR), first image data, subsequently performing the segmentation.
The first detection device 20 is preferably configured to acquire the skull cap shape Fc by means of a three-dimensional scanning laser (or scanner) having at least 3 reference axes.
The digital fabrication device 50 enables the three-dimensional operculum to be produced by additive fabrication or stereolithography or using subtractive technology, starting from a 3D digital model thereof.
As an alternative to 3D additive printing, the cranial operculum can be produced using subtractive technologies, for example using numerical control (CNC) machines, such as, for example, lathes or milling machines, preferably activatable by the surgeon or specialised hospital staff.
In such a case, based on the shape estimated in the pre-surgery phase from the skull cap dimensions, the processing unit 40 processes and suggests the type of “block of material” of dimensions sufficient to allow the numerical control machine to obtain an operculum of the predefined shape, dimensions and margin by removal of material. The block of material can be supplied inside sterilised bags and contain an RFID identifier containing information related to the production lot and the patient who will be selected to receive the implant.
The processing unit 40 subsequently communicates to the numerical control machine the type of material, dimensions, finish and features it is intended to give to the final piece. During machining, the CNC machine starts from the definitive 3D operculum model file and works on the block of material, which is milled internally or externally with tools differing from one another, depending on the material they are required to machine.
In order to produce the cranial operculum, the additive technology (3D printing) can preferably be combined with the subtractive technology. The combination of the two technologies produces excellent results, since by printing the operculum in 3D (additive technology) it could be envisaged to finish it using subtractive fabrication machines which mill it from the inside (subtractive technology).
The processing unit 40 is configured to process a three-dimensional (3D) digital model of the cranial operculum 1 based on the area of planned removal of cranial bone Ap determined by the acquisition device 10, the skull cap shape Fc and the skull thickness Sc detected by the first 3D detection device 20 and based on the margin 3 of the crater in the cranial bone 4 detected by the second 3D detection device 30.
The thickness Sc of the artificial operculum 1 is preferably uniform and predetermined, sufficient in any case to withstand pressure stresses. In this manner, one achieves the technical effects of rendering the passage of ultrasound for post-surgery imaging more homogeneous and of facilitating the calculations if used as a window for focused ultrasound therapies. Furthermore, the use of a predetermined thickness makes the reconstruction and 3D printing easier, in addition to improving the acoustic properties of the operculum.
In general, it should be noted that in the present context and in the claims herein below, the processing unit 40 is presented as being subdivided into distinct functional modules (memory modules or operating modules) for the sole purpose of describing the functions thereof clearly and thoroughly.
Actually, this processing unit 40 can be constituted by a single electronic device, suitably programmed for performing the functions described, and the various modules can correspond to a hardware entity and/or routine software that are part of the programmed device.
Alternatively or additionally, these functions can be performed by a plurality of electronic devices over which the above-mentioned functional modules can be distributed.
The processing unit 40 can also make use of one or more processors for executing the instructions contained in the memory modules.
Said functional modules can also be distributed over different local or remote computers, depending on the architecture of the network in which they reside.
The systems further comprise all the memory and/or operating means and/or modules necessary for implementing the functions described in the respective methods disclosed.
According to the invention, the processing unit 40 comprises a first processing module 410 configured to generate a first three-dimensional digital model M1 of the artificial cranial operculum 1, processed on the basis of the data related to said area of planned removal Ap, said skull thickness Sc and said skull cap shape Fc in said area of planned removal Ap, a second processing module 411 configured to generate a three-dimensional digital margin model M_Mrg on the basis of the points P_Mrg of the margin 3 of the crater in the cranial bone 4 detected by said second detection device 30, a third processing module 412 configured to generate a second three-dimensional digital model M2 of the operculum 1 processed on the basis of said first three-dimensional digital model M1 and said craniectomy margin model M_Mrg and a data transmission module 413 configured to transmit at least said second three-dimensional digital model M2 to said electronic digital fabrication device 50.
Optionally, between said third processing module 412 and said data transmission module 413, it is possible to interpose a memory module 414 configured to memorise at least the second digital model M2 before transmission to the digital fabrication device 50 or to other electronic devices external to the processing unit 40.
The first digital model M1, processed before the surgical procedure, can be used by the neurosurgeon to simulate the removal of the cranial operculum 1a from the skull 6 of the patient and/or to propose to the neurosurgeon some geometries of the artificial operculum 1 that enable different points and fixation methods, leaving it up to the surgeon to choose best type of procedure.
The second processing module 411 is configured to generate a digital margin model 3D M_Mrg on the basis of the set of points of the margin P_Mrg of the crater in the cranial bone 3 acquired by said tip 32 or by said laser scanner.
Optionally, the processing unit 40 comprises a user interface module 414 in data communication with the modules 410, 411, 412 and 416; the user interface module 414 is configured to enable the neurosurgeon to perform one or more of the following operations:
If the subtractive digital fabrication technology is involved, the user interface module will display the type and dimensions of the block of material to be machined in the CNC machine before the surgery phase.
The system can optionally comprise a simulation module 416 configured to simulate the removal of the cranial bone 1a and to define said area of planned removal of cranial bone Ap on the basis of the type of procedure entered by the neurosurgeon. The simulation module 416 can preferably be comprised within the processing unit 40 as illustrated by way of example in
Once the virtual reconstruction of the artificial operculum 1 has been completed, the simulation module 416 preferably allows it to be verified that the 3D model of the missing bone flap (reduced in size if necessary and appropriately smoothed on the surface) fits the 3D model of the skull by means of a graphic assembly of both 3D models. In this manner it is possible to check the correct matching of the artificial operculum 1 with the rest of the skull, as well as its aesthetic impact.
Finally, the system according to the invention can comprise a memory or server 70 in which one or more among said first model M1, said second model M2 and said parameters Ap, Sc, Fc associated with the data of the living being are memorised. By way of example, the data memorisable in the memory 70 also comprise: personal data, medical history and diagnosis of the patient, a patient file according to the standard “Digital Imaging and Communications in Medicine” (or DICOM format), reconstructed 3D volume of the diagnostic images, 3D volume of the artificial operculum generated and segmentation of the skull.
The processing unit 40 is preferably connected to the 3D printer or milling device 50, the server 70 and other electronic devices via a computer network.
The artificial cranial operculum 1 produced by the 3D printer or milling machine 50 consists of a cap made of rigid material that will replace a bone operculum 1a removed following a craniotomy, or following the procedure that enables access to the inside of the skull 6 of a living being in order to remove a brain tumour or reconstruct damaged parts of the skull.
For this reason, the artificial cranial operculum 1 must be an exact replica of the native bone operculum 1a so as to be able to fit perfectly with the rest of the skull 6. Preferably, the thickness of the artificial operculum 1 can be uniform and predetermined, without having to follow the thickness of the native bone. In order for the artificial operculum to be metabolised without any harmful effect for the patient, it is necessary for it to be made of a biocompatible material and it must likewise be sterilisable prior to application.
The artificial operculum 1 according to the invention can be produced by the electronic digital fabrication device 50 in such a way as to be able to incorporate and interface with one or more therapeutic and diagnostic instruments, i.e. “modules”, while at the same time maintaining the ability to monitor the patient's brain using an ultrasound instrument. In particular, use can be made of existing intracranial monitoring devices or ones specifically developed for use with the artificial operculum.
As shown in
Optionally, the artificial operculum 1 can be produced by the electronic digital fabrication device 50 with the presence of a texture visualisable by means of computed tomography (CT) and magnetic resonance (MR) in order to provide a specific and precise reference of the anatomical structures inside the artificial operculum. The texture must not be dense, but such as to enable the use of ultrasound.
With the system according to the invention, it is likewise possible to produce the artificial operculum 1 with the presence of known attachment points (“placeholders”) which serve to position a marker for augmented reality, also, but not only, in reference to the visible texture as per the previous paragraph. Examples of markers that can be housed in the placeholder are crosses, Aruco markers and the like.
Optionally, the artificial operculum 1 can be produced in such a way as to incorporate at least one pressure and temperature sensor activatable by induction also through portable instruments. In such a manner, it is possible to enable monitoring of the endocranial pressure and temperature.
As an alternative to the above-mentioned pressure sensor, it is possible to incorporate a pressure sensor characterised by a fin made of polymethylmethacrylate (abbreviated as PMMA) or another non-ultrasound-transparent material, whose position varies with variations in the intracranial pressure. This sensor renders the pressure variation visualisable by means of a simple ultrasound scan, without the need to use an electronic apparatus or complex devices.
Once the artificial operculum 1 has been produced, before the surgical use thereof, it is automatically transferred into a sterilisation chamber that is an integral part of the body of the digital fabrication machine 50. Through sterilisation methods (UV or gamma radiation or gas plasma), the artificial opercula produced, already intrinsically sterile given the fabrication process and materials used, are further sterilised to eliminate the presence of any contaminants that may have contacted the printing surface.
Optionally, the artificial opercula may be produced in a number of copies, and each operculum is automatically transferred into a sterile bag and sealed.
In the follow-up phase the surgeon can use an ultrasound scan, optionally fusing, thanks to the various modules of the processing unit 40, the ultrasound images with CT or MR images. This fusion is facilitated and referenced thanks to the presence of the “texture” as per the previous passages.
In the event of the need for intervention, the system is capable of converting the diagnostic image into a 3D volume from which it is then possible to acquire the skull cap shape Fc and, optionally, the skull thickness Sc to be removed.
Optionally, the system can activate an augmented reality function through the use of appropriate markers that can be housed in the above-mentioned placeholders. The surgeon can thus focus on the marker and, via the system functions, visualise, also for training purposes, the corresponding three-dimensional images overlaid on the patient's skull.
The artificial cranial operculum is produced by using polymeric materials such as, for example, polyethylene (PE), polystyrene or polymethylpentene (TPX), or polyethylene terephthalate (PET). Preferably, a high-density polyethylene (HDPE 300—High Density PE) can be used.
The block or step 200 presents the physician (or another health worker) with a list of patients, along with the corresponding DICOM files and their creation date. The user can manage the list, for example by deleting or adding new patients. Furthermore, by selecting a given patient from the list, it will be possible to go to the simulation branch (pre-surgery phase) or to the branch of the sequence of steps carried out in the surgery phase, which eventually lead to the production of the cranial operculum during the procedure. In the block or step 210 it is possible to load the DICOM file of a given patient. An external file can be loaded or the file can be supplied from one of the above-described devices.
In the pre-surgery simulation branch, in the block or step 220 the computed tomography image is visualised and the cranial bone of the patient is segmented. In the block 230 the anatomical or artificial operculum landmarks (points of repere) are identified and the operculum model is generated (in the pre-surgery phase), with the associated dimensions and characteristics.
In the “surgery” branch of
The system will call up and display the model of the operculum simulated in the pre-surgery phase and adapt it (image registration) based on the data acquired in situ during the procedure in the operating room.
The system for producing a cranial operculum 1 for a living being comprises an acquisition device 10 configured to define an area of planned removal of cranial bone Ap on the skull 6 of the living being and a first 3D detection device 20 configured for 3D detection of the shape Fc of the skull cap to be removed which is included in said area of planned removal of cranial bone Ap. The devices 10 and 20 are related to a pre-surgery simulation phase that takes place before the actual removal of the cranial operculum of the patient. The system further comprises a second detection device 30 configured to detect the points P_MRG of the margin of the crater in the cranial bone 3 following removal of the part of skull cap included in said area of planned removal Ap; an electronic digital fabrication device (i.e. via 3D printing or milling, “digital fabrication”) 50 configured to produce three-dimensional objects; a processing unit 40 in data communication with said acquisition device 10, said first 3D detection device 20, said second detection device 30 for detecting the points of the margin 2 of the crater in the cranial bone 3 and said electronic digital fabrication device 50, wherein said processing unit 40 is configured to define (prior to a surgical procedure of craniotomy) a 3D digital model of the cranial operculum 1 based on the skull cap shape Fc, skull thickness Sc detected by said first 3D detection device 20 and based on the margin 2 of the crater in the cranial bone 3 detected by said second detection device 3D 30, the processing unit 40 comprising: a first processing module 410 configured to generate (prior to the performance of a surgical procedure of craniotomy) a first 3D digital model M1 of the cranial operculum 1 processed on the basis of said area of planned removal Ap, said skull thickness Sc and said skull cap shape Fc in said area of planned removal Ap; a second processing module 411 configured to generate (in the intra-surgery phase, following removal of part of the skull cap) a 3D digital margin model M_Mrg on the basis of the points P_MRG of the margin 2 of the crater in the cranial bone 3 detected by said second detection device 30; a third processing module 412 configured to generate a second digital model 3D M2 of the operculum 1 processed on the basis of said first digital model 3D M1 and said craniectomy margin model M_Mrg; and a transmission module 413 configured to transmit said second digital model 3D M2 to said electronic digital fabrication device 50. In particular, the invention also relates to a method for producing a cranial operculum 1 for a living being comprising the steps of: before carrying out a surgical procedure of craniotomy,
The method for producing a cranial operculum 1 optionally comprises a simulation step for simulating the removal of cranial bone 1a and defining said area of planned removal of cranial bone Ap on the basis of the type of procedure entered by the neurosurgeon before the surgical procedure of craniectomy.
The step of detecting the skull thickness Sc in said area of planned removal of cranial bone Ap can be carried out by using a probing arm 31 equipped with a tip 32 which is made to pass over the margin 2 of the area of removed bone.
Alternatively, the steps of detecting the skull cap shape Fc or the set of points P_Mrg of the margin 2 of the crater in the cranial bone 3 are carried out by means of a three-dimensional scanning laser (or scanner) having at least 3 reference axes.
In a further alternative, the steps of detecting the skull cap shape Fc or the skull thickness Sc are achieved by means of one or more diagnostic images of the living being.
| Number | Date | Country | Kind |
|---|---|---|---|
| 102017000020563 | Feb 2017 | IT | national |
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/IB2018/051102 | 2/22/2018 | WO | 00 |
