Surgical navigation systems including reference and localization frames

Summary the invention

0001It An object of the invention to provide a system that a the Position of a medical or surgical instrument with respect to the body elements while the method representing generated illustration.

0002It is a further object of the invention to provide a system that a body member Locate and during of the method a representation of the position of the body member relative to an instrument, such as forceps, a microscope may issue or a laser, so that the instrument with respect to the body member precise can be positioned.

0003Other Objects and features will in part apparent and in part in will be discussed below.

0004the Invention includes an apparatus for use with a surgical navigation system having a sensor arrangement, as defined in Claim first

Brief Description of Figures

0005<figref idrefs="S31">1</figref> is an illustration of a Systems according to the prior art, in which a rigid fixation and not taking place Shifts in time between imaging and surgery a point-for-point adaptation between the recorded before surgery scan and the position while allow the operation.

0006<figref idrefs="S32">2A</figref> illustrates the operation a system in which the image data set produced before surgery according to the position during the operation is modified to a displaced and / or deformed to generate data representing the position during surgery.

0007<figref idrefs="S32">2 B</figref> is a block diagram one embodiment of the system.

0008<figref idrefs="S34">3</figref> is a representation of the occurring before the operation alignment of three body elements during the Scanens.

0009<figref idrefs="S35">4</figref> is a representation of the while surgery performed alignment of three body members according to <figref idrefs="S34">3</figref>,

0010<figref idrefs="S36">5</figref> is a plot of three body elements, of which at one, a reference frame and one registration Probe is attached.

0011<figref idrefs="S37">6</figref> illustrates the ultrasound registration according to the invention, in the ultrasonic emitter as a virtual reference and, optionally, the body of the patient as actual Reference be assigned.

0012<figref idrefs="S38">7</figref> is an illustration of a fluoroscopic invention Lokalisators for displaying an image of the body elements.

0013<figref idrefs="S39">8</figref> is an illustration of a Bohrführungsinstrumentes, wherein the position of a drill guide can be depicted.

0014<figref idrefs="S40">9</figref> and <figref idrefs="S41">10</figref> illustrate a stapled Reference frame or a wired reference frame.

0015<figref idrefs="S42">11</figref> is a schematic Representation of an embodiment a cranial surgical navigation system.

0016<figref idrefs="S42">11A</figref> is a plan view of an embodiment an arcuate cranial Framework.

0017<figref idrefs="S42">11B</figref> is a side view, partly in cross section, of an embodiment of an arcuate cranial Framework.

0018<figref idrefs="S42">11C</figref> is a circuit diagram of a embodiment an arcuate cranial Framework.

0019<figref idrefs="S45">12A</figref> is a plan view of an embodiment an arcuate spinal Framework.

0020<figref idrefs="S45">12B</figref> is a front view, partly in cross section, an embodiment of a curved spinal Framework.

0021<figref idrefs="S45">12C</figref> is a side view one embodiment an arcuate spinal Framework.

0022<figref idrefs="S45">12D</figref> is a plan view of an embodiment a thoracolumbar tool.

0023<figref idrefs="S45">12E</figref> is a front view, partly in cross section, an embodiment of a thoracolumbar tool.

0024<figref idrefs="S45">12F</figref> is a side view one embodiment a thoracolumbar tool.

0025<figref idrefs="S45">12G</figref> is a circuit diagram of a embodiment an arcuate spinal Framework.

0026<figref idrefs="S46">13A</figref> is a plan view to a preferred embodiment a localization frame according to the invention for a Biopsy guide.

0027<figref idrefs="S46">13B</figref> is a side view, partly in cross section, of a preferred embodiment of a localization frame according to the invention for a Biopsy guide.

0028<figref idrefs="S46">13C</figref> is a front view a preferred embodiment, a localization frame according to the invention for a Biopsy guide.

0029<figref idrefs="S46">13D</figref> is a plan view to a preferred embodiment a localization frame according to the invention for a Drill guide.

0030<figref idrefs="S46">13E</figref> is a side view, partly in cross section, of a preferred embodiment of a localization frame according to the invention for a Drill guide.

0031<figref idrefs="S46">13F</figref> is a plan view to a preferred embodiment a ratchets localization frame according to the invention.

0032<figref idrefs="S46">13G</figref> is a side view, partly in cross section, of a preferred embodiment of a localization frame ratchets-invention.

0033<figref idrefs="S46">13H</figref> is a plan view to a preferred embodiment a probe of the invention ventriculotomy including an integrated inventive Localization frame.

0034<figref idrefs="S46">13I</figref> is a side view, partly in cross section, of a preferred embodiment of a probe of the invention ventriculotomy including an integrated localization frame.

0035<figref idrefs="S46">13J</figref> is a circuit diagram of a preferred embodiment, a localization frame according to the invention.

0036Same Reference numbers in the drawings correspond to the same components.

Detailed Description of the Preferred Embodiments

0037Among with reference to <figref idrefs="S32">2</figref> becomes an overview of a surgical navigation system illustrated. Before a certain Operation, the body elements, will be the subject of the operation, scanned to their orientation, ie their preoperative to position determined. For example, the alignment as in <figref idrefs="S34">3</figref> be represented, after which the body elements <figref>10</figref>. <figref>20</figref> and <figref>30</figref> more are aligned or less parallel. These body elements may Bone or other rigid body be. In<figref idrefs="S34">3</figref> Three-dimensional skeletal elements <figref>10</figref>. <figref>20</figref>. <figref>30</figref> in two dimensions as depicted highly stylized vertebral body, with square swirl <figref>11</figref>. <figref>21</figref>. <figref>31</figref>, Small rectangular bands (English: pedicles) <figref>12</figref>. <figref>22</figref>. <figref>32</figref> and triangular Spinous processes <figref>13</figref>. <figref>23</figref>. <figref>33</figref>, While the image forming intervals are in scans by body parts <figref>10</figref>. <figref>20</figref>. <figref>30</figref> added, as shown in <figref idrefs="S34">3</figref> by means of nine straight lines is displayed, generally with the reference number <figref>40</figref> designated will. must through each of the body elements at least one scan will be made and assembled Scans give a three-dimensional pre-operative image data set.

0038<figref idrefs="S32">2 B</figref> is a block diagram of the system. about a scanner interface <figref>102</figref> takes the computing unit <figref>104</figref> the generated by the scanner pre-operative Image data set and stores this in the pre-operative image data set memory <figref>106</figref> from. the computing unit is preferably used <figref>104</figref> after image formation, a discrimination process on to the pre-operative image data set, so that only the body elements <figref>10</figref>. <figref>20</figref>. <figref>30</figref> in the memory <figref>106</figref> remain. If a discrimination method is employed, the computation unit <figref>104</figref> This conduct, while data from scanner the scanner interface <figref>102</figref> for storing in the memory <figref>106</figref> transfer will. Alternatively, the memory<figref>106</figref> for storing undiskriminierter data used and a separate memory (not shown) are provided for storing the discriminated data. would in this alternative the computing unit <figref>104</figref> to the scanner via the scanner interface <figref>102</figref> obtained Record in the memory <figref>106</figref> and then transferred in the memory <figref>106</figref> saved Data discriminate to a discriminated image data set to produce, which would be stored in the separate memory.

0039If the body members <figref>10</figref>. <figref>20</figref>. <figref>30</figref> discriminated and each as a single rigid body are defined, they can be repositioned by known software algorithms to the to form displaced image data set. Each rigid body member<figref>10</figref>. <figref>20</figref>. <figref>30</figref> have to be have at least three recognizable reference points on the pre-operative are images visible. These reference points must accurately detected during surgery will. For the body part <figref>10</figref> are reference points <figref>10A</figref>. <figref>10B</figref> and <figref>10C</figref> on the Spinous process <figref>13</figref> appropriate; for the body part<figref>20</figref> are reference points <figref>20A</figref> and <figref>20C</figref> on the vortex <figref>21</figref> and reference point <figref>20B</figref> is on the Spinous process <figref>23</figref> appropriate; for the body part<figref>30</figref> are reference points <figref>30A</figref> and <figref>30B</figref> on the spinous process <figref>33</figref> and the reference point <figref>30C</figref> on the vortex <figref>31</figref> appropriate. Each scan through the bone can be selected more than one point of reference, although the maximum accuracy Registration is achieved by the Reference point as far as possible are separated. For example it may in the case of posterior spinal surgery be advantageous to the reference points <figref>10A</figref>. <figref>10B</figref> and <figref>10C</figref> on to choose the spinous process, the while such surgery is charged. It is contemplated that the system software manual or automatic identification of these Points in the images of the body elements <figref>10</figref>.<figref>20</figref>. <figref>30</figref> allows. There <figref idrefs="S34">3</figref> a two-dimensional is representation of a three-dimensional process, the reference points are not limited to one as shown perfect sagittal plane.

0040After the imaging can the body parts <figref>10</figref>. <figref>20</figref>. <figref>30</figref> of move the skeleton at the joints or fracture lines up to today. In the space in which the process is carried out, such as an operating room or a room where a medical procedure accomplished is, the body elements after the patient for the surgical procedure has been positioned, a different taking geometry, such as in <figref idrefs="S35">4</figref> reproduced Geometry.

0041As Result of this movement reflects the in memory <figref>106</figref> saved Image data set consisting of the scans through the skeletal elements, the operative position of the skeletal elements not again, as in <figref idrefs="S35">4</figref> will be shown. By the scans shown by the elements form the skeletal elements true between imaging and surgery, however, agree because the elements are rigid bodies, as indicated by the lines <figref>40</figref> through each element in <figref idrefs="S35">4</figref> is indicated. Therefore the image data set must be modified to intraoperative Geometry of the skeletal elements reproduce. This modification is carried out, by the position of each reference point of each skeletal element in the operation area is identified. As in<figref idrefs="S32">2</figref> diagrammed shown, identifies a locator <figref>108</figref> (For details please refer <figref idrefs="S46">13</figref>, Below) Position and outputs this information, so that the preoperative Record to record shifted deformed or repositioned can be. Consequently, there is the shifted data in accordance with intraoperative position of the elements <figref>10</figref>. <figref>20</figref>. <figref>30</figref>, If the positions of the reference points by the localizer <figref>108</figref> certainly are, the computing unit <figref>104</figref>Forming part of the workstation is to apply a software that the images of the skeletal elements repositioned to the position of the actual elements in the operating room reproduce and thus the suspended sentence and the transfer between the suspended sentence and the intra-operative position to form.

0042Preferably is a three-dimensional digitizer as locator for determining the position and the area of ​​elements <figref>10</figref>. <figref>20</figref>. <figref>30</figref> during the Operation determined. In general, the digitizer would a reference arrangement <figref>110</figref> include emissions from a receives number of emitters. Usually are these emissions from any on of energy, such as Light, sound or electromagnetic radiation. The reference array<figref>110</figref> is of the elements associated with these, and in co-ordination positioned emitters spaced and determines the position of the Emitter. As is apparent, the emitters of the elements can spaced and the reference array <figref>110</figref> at to be fixed to be localized elements.

0043Among with reference to <figref idrefs="S32">2</figref> becomes described in the following an alternative embodiment of the system, which refers to the case in which the body elements are not rigid, but are more semi-rigid so that deformation of the shape of the body elements occur can.

0044In front a specific operation, the body elements of the subject surgery are scanned to their pre-operative position and shape to determine. For example, the orientation as shown in<figref idrefs="S34">3</figref> illustrated done, wherein the body members <figref>10</figref>. <figref>20</figref> and <figref>30</figref> more or less aligned parallel and have a defined shape. These body members can his soft tissues, such as the prostate or other semi-rigid Body.

0045After the imaging can the elements <figref>10</figref>. <figref>20</figref>. <figref>30</figref> against each other move and its shape can change. In the process space, such as an operating room or a room, in which a medical procedure is performed, the body elements after the patient for the surgical Engagement has been positioned, having a different geometry, such as in <figref idrefs="S35">4</figref> illustrated Geometry, and this geometry both the orientation (position) representing the elements as well as the mold.

0046as a result this changed Geometry are stored in the memory <figref>106</figref> stored pre-operative image data set the operative geometry of the body elements, in <figref idrefs="S35">4</figref> shown no again. In fact, , the shape as shown in the scans through the element of Body elements, changed in the period between the images and generating the operation because it semi-rigid body are. Therefore, the image data set must be modified to the current geometry the body elements reproduce. This modification is performed by changing the position of the Bezugspunkteauf each body member is identifed in the operation area. As diagrammed in<figref idrefs="S32">2</figref> is shown, identified an optionally with a computing unit <figref>104</figref> in connection standing localiser the position of the reference points and outputs Information, so that the pre-operative Data set can be converted to the shifted data set. If the position of the reference points is determined, the processing unit <figref>104</figref>. the part of the workstation is running a software program that the images of the body elements so modified such that the actual Geometry of the body elements is reflected in the operating room and thus the displaced Set and the transmission between the suspended sentence and the intra-operative position in accordance brings. Consequently, there is the shifted data in accordance with the intra-operative geometry of the elements <figref>10</figref>. <figref>20</figref>. <figref>30</figref>,

0047According to a preferred embodiment of the Invention, a frame of reference <figref>116</figref> at the beginning of the process on one of the body elements <figref>10</figref> appropriate. Various embodiments of Reference frames are detailed in the <figref idrefs="S42">11</figref> and <figref idrefs="S45">12</figref> shown. The Framework <figref>116</figref> is provided with a plurality of emitters <figref>114</figref> equipped, which together form a three-dimensional, intra-operative Koodinatensystem in terms of the body member <figref>10</figref> form. Commonly Expression defines the reference frame <figref>116</figref> the stereotactic space relative of the body member <figref>10</figref>, The emitter <figref>114</figref> communicate with sensors <figref>112</figref> on a reference array <figref>110</figref>Which in the operating room and of the reference frame <figref>116</figref> and the patient removed is. When the body of the patient during the surgical procedure is not immobilized, several Framework of Reference for each body member be necessary to define an operating area with respect to each element. The surgical area may alternatively by direct (or indirect, for example the the skin) fixing the frame emitters <figref>114</figref> the skeletal elements <figref>10</figref>. <figref>20</figref> or <figref>30</figref> defined will. In both cases emit emitter <figref>114</figref> a signal by the sensors <figref>112</figref> receive is. The received signal is used to calculate the position, for example, by triangulation, digitized. By means of such information can the localizer <figref>108</figref> or a digitizer, the part the Lokalisators <figref>108</figref> is the exact three-dimensional position the frame emitters <figref>114</figref> with respect to the sensors <figref>112</figref> determine. Thus, the localiser <figref>108</figref> or the computing unit <figref>104</figref> the position the reference frame <figref>116</figref> relative to the array, the exception, while the localization process, can move freely, determine. The emitter<figref>114</figref> of reference framework <figref>116</figref> are excited to radiation at the sensors <figref>112</figref> submit, which receive the radiation is and generates signals to the localizer <figref>108</figref> to Determining the position of the frame <figref>116</figref> with respect to the arrangement <figref>110</figref> be passed.

0048As next it is necessary, the position of the body member <figref>10</figref>, the may be a skeletal member to which the reference frame <figref>116</figref> secured positioned or with respect to him to determine. especially should the position of the body member <figref>10</figref> in relation the reference frame <figref>116</figref> are determined, whereby the position of the body member <figref>10</figref> in by the reference frame <figref>116</figref> determined defined surgical field is. After the reference points<figref>10A</figref>. <figref>10B</figref>. <figref>10C</figref> one surgical Disektion were exposed, the reference points are with the top one having emitters <figref>120</figref> provided registration probe <figref>118</figref> touched. at contact each of the reference points <figref>10A</figref>. <figref>10B</figref>. <figref>10C</figref> by the tip of the probe <figref>120</figref>, The emitter for communication with the sensors <figref>112</figref> the reference array <figref>110</figref> excited. Through this communication, the localizer <figref>108</figref> the Position the registry probe <figref>120</figref> determine and thus the position of the tip of the probe <figref>120</figref>, And thus also the position of the reference point <figref>10A</figref>On which the top is positioned. touching each reference point <figref>10A</figref>. <figref>10B</figref>. <figref>10C</figref> on each body member <figref>10</figref>. <figref>20</figref>. <figref>30</figref>. the subject of the operation, are intra-operative geometry data generated and stored in memory <figref>121</figref> stored. These data the corresponding reference points in the pre-operative images of the same associated elements, namely by the computing unit <figref>104</figref>. performing a transformation by means of a software program, the the determination of the exact position, orientation, and shape in the operating range each body member allows while the in memory <figref>106</figref> stored pre-operative Image data set is modified to a displaced image data set to generate, in memory of <figref>122</figref> is stored. Of the displaced image data set in memory <figref>122</figref> reflects the Geometry of the actual elements <figref>10</figref>. <figref>20</figref>. <figref>30</figref> during the operation again. The computing unit <figref>104</figref> are the displaced image data set on a display <figref>124</figref> out to a pictorial representation the geometry of the body elements <figref>10</figref>. <figref>20</figref>. <figref>30</figref> during the create operation. This image is used during surgery to support them. It is additionally provided that an instrument, such as tweezers, a laser, a microscope, an endoscope or a radiation-generating System during the Operation would be used, can be modified by attachment of emitters. This modified Device when in the area of ​​the body elements <figref>10</figref>. <figref>20</figref>. <figref>30</figref> emotional will be activated so that its emitter connected to the reference array <figref>110</figref> communicate and thus the determination of the position of the instrument by the locator <figref>108</figref> enable. Consequently, the arithmetic unit <figref>104</figref> the display <figref>124</figref>. So modify for example by positioning a cursor, that the position of the instrument or of the focal point of the instrument in terms of the body elements <figref>10</figref>. <figref>20</figref>. <figref>30</figref> stated is.

0049It it is further provided that the Aufbrintion of emitters on a Instrument (effector) can be used with the system to a closed-loop control circuit for the active (in the case of robots) or passive control or monitoring of the instrument and to form its position. Such a control loop allows The supervision certain operations, such as the administration of the body with radiation or Using a drill, when the goal of the method is the focus of the instru mentes in a safe zone, ie a predetermined operational plan to keep. Such a control loop could also the operation of a robotically controlled instrument to monitor, the robot directly or indirectly via the computing unit <figref>104</figref> controlled could be, to regulate the position of the instrument. For example, the Butterfly instruct a robot arm, the position of a laser control. could Laser Position guarded example by emitters on the laser. The computing unit would with the control parameters for be programmed the laser so that it precisely a predetermined path would follow.

0050Of the reference framework <figref>116</figref> allows it that the patient during the operation can be moved without re-recording the position of each of the body elements <figref>10</figref>. <figref>20</figref>. <figref>30</figref> required is. It is assumed that the body elements during the Operation are fixed relative to each other. Since the reference frame<figref>116</figref> (Directly or indirectly) to the body member <figref>10</figref> fixed is leading the Movement of the patient to a corresponding movement of the reference frame <figref>116</figref>, Periodically, or after each movement of the patient, the arrangement emitter <figref>114</figref> are excited to the sensors <figref>112</figref> of reference framework <figref>110</figref> to communicate, so that the locator <figref>108</figref> the Position of the reference frame <figref>116</figref> may determine. That I the reference frame <figref>116</figref> at a known relative position the element <figref>110</figref> is and we have assumed that the Elements <figref>20</figref> and <figref>30</figref> in fixed relation to element <figref>10</figref> are, the locator can <figref>108</figref> and or the computing unit <figref>104</figref> determine the position of the elements and thereby maintain the registration (registration).

0051A Alternative to Touch the reference points A, B, C with the tip of the probe <figref>118</figref> would be the use of a contour scanner <figref>126a</figref> with associated emitters <figref>126b</figref>, Such a device in which some form of energy, such as For example, sound or light, is used, which emits, is reflected by the contour and subsequently detected, would Utilization of the contour of the body elements <figref>10</figref>. <figref>20</figref>. <figref>30</figref> enable, which could therefore serve as a plurality of reference points, a allow registration (registration) would. Of the Registration process is analogous to that shown below in connection described process with ultrasound-derived contours.

0052In certain situations on the skin surface provided marks are used as reference points to the Transforming the pre-operative to allow image data set into the displaced image data set. Conversely, used at the time of image formation on the skin surface mounted devices Reference are to the body repositioning and thus the prevailing during imaging Geometry to meet, as will be described in the following.

0053It may be desirable be the location of the body elements <figref>10</figref>. <figref>20</figref>. <figref>30</figref> without intraoperative exposure of the reference points A, B, C to this body members perform. Examples in which the spine is not too busy, are percutaneous biopsy of the spine or Discectomy, spinal fixation, endoscopy, percutaneous insertion of Spinal implants, percutaneous mergers, establishment of drug-eluting Systems and radiation treatments. In these cases the localization must Reference points on the body elements be determined by some form of imaging that a Localization by about lying discriminate against soft tissue and / or surrounding tissue and structures can. Currently there are two imaging techniques in a surgeon operating room or a doctor standing in an operating room available, the cost and are portable. These two imaging techniques that ultrasonography and X-ray radiography, can produce two- or three-dimensional images that present in the -Described manner can be used to a three-dimensional Form, such as a skeletal element register.

0054As described in US Patent Application Nos. 07 / 858.980 and no. 08 / 053,076 is, provides the coupling of a three-dimensional digitizer the effect with a probe of an ultrasonic device benefits that a contour can be obtained directly in relation to a reference system can be accommodated, the three-dimensional coordinates in the operational area defined. In the context of the present invention are pictures of a patient made before surgery, a pre-operative to generate image data set in memory <figref>106</figref> filed is. In the operating room the patient's body is immobilized, the spatial Relationship between the body elements <figref>10</figref>. <figref>20</figref>. <figref>30</figref> to stabilize. An operating system of reference, operational area, is for created the body, by a reference frame <figref>116</figref> on one of the body elements or is attached or otherwise emitter on the patient to Körperelementh, as described above, is to be introduced, or by the emitter on a device attached be that one of the body elements Track and thereby a known relationship to the body member can produce. This may for example by percutaneous placement similar to that described above Framework, by screwed on the elements radiopaque markers or be effected in that transmitter <figref>130</figref> directly on the skin be provided, as in <figref idrefs="S37">6</figref> illustrated is based on the assumption that the skin during the Procedure does not respect the body elements shifts.

0055A with at least three emitters <figref>130</figref> provided ultrasonic probe <figref>128</figref> becomes then over the interest body member arranged. The contour (either two or three dimensions may be) of the body member is then calculated using the ultrasonic probe <figref>128</figref> obtained. This contour may directly or indirectly in the by the reference system defined operational coordinates (operation range) are expressed. The transmitter <figref>130</figref> communicate with the sensors <figref>112</figref> the reference arrangement <figref>110</figref>To the position of the ultrasonic probe <figref>128</figref> specify. An ultrasound scanner <figref>130</figref>, The probe <figref>128</figref> excites determines the contour of interest and scanned body element. This contour information is sent to the arithmetic unit <figref>104</figref> to Storage in the intra-operative geometry data storage <figref>121</figref> delivered.

0056the In the storage room <figref>121</figref> stored intra-operative contour is then by means of a contour matching algorithm to a corresponding, from the memory <figref>106</figref> stored preoperative image data set obtained Contour compared. Alternatively, a pre-operative contour record In the storage room <figref>134</figref> be stored standing on a pre-operative Ultrasound scan is based, of before the operation from the scanner interface <figref>102</figref> in memory <figref>134</figref> has been entered. This comparison process is so long continued until a match for each of the elements has been found. Through this contour matching process is an adjustment between the images of each body element and the corresponding receive position of each element in the operation area, whereby the Education of the displaced image data set <figref>122</figref> is made possible, the for the localization and the image output is used. It is on noted that the contours used in the matching process only have to be sufficiently identical to an exact adaptation to reach; the contours must not the identical degree of body member have.

0057In certain cases may not apply the above-described ultrasonic registration be. For example, ultrasound penetrates not the bone, and the presence of overlying bone would exclude registration of an underlying skeletal element. Furthermore adopted the resolution ultrasound with increasing depth of the tissue to be imaged and can therefore not be particularly useful when the skeletal element so deeply is that no precise ultrasonically generated contour is obtained. In those circumstances displayed a radiological method, in which the greater penetration depth X-rays is utilized.

0058the preoperative Imaging is performed in the usual Manner, and in the image data set, the skeletal elements of discriminates against the soft tissue, as described above. In particular, could be a CT scan of the skeletal elements <figref>10</figref>. <figref>20</figref>. <figref>30</figref> in front the operation are recorded. The computing unit<figref>104</figref> can then discriminate the skeletal elements and the pre-operative Image data set in memory <figref>106</figref> lay down. Next the patient for Operation immobilized. By means of a radiographic apparatus, which is provided with detectable by the digitizer emitters, is an X-ray image the interest skeletal anatomy created. In<figref idrefs="S38">7</figref> is an example of a fluoroscopic locator <figref>136</figref> shown. The localizer<figref>136</figref> includes an X-ray-emitting Device, such as a tube <figref>138</figref>And a X-ray-sensitive umbrella <figref>140</figref>Which produces an image when x-rays is irradiated. This screen is a fluoroscopic plate designated. The emitter<figref>142</figref> can on the tube <figref>138</figref>, on fluoroscopic plate <figref>140</figref> or provided on both be. In devices in which the tube<figref>138</figref> firmly to the plate <figref>140</figref> is connected, the emitter need only either on the tube be provided or on the plate. Alternatively, the reference array<figref>110</figref> at the tube be fastened or the plate, whereby emitters on this element is not required are. By X-ray by the interest skeletal element <figref>141</figref> penetrate, is a generated on the bone density based two-dimensional image and recorded by the plate. The by the fluoroscopic locator <figref>136</figref> generated image by the angle of tube <figref>138</figref> in Respect to the plate <figref>140</figref> and the position of the intermediate determined skeletal elements and, with respect to the operation coordinates (area of ​​operations) To be defined. The fluoroscopic localizer<figref>136</figref> has a computing unit to which the image on the plate <figref>140</figref> digitized and the digitized image to the computing unit <figref>104</figref> for possible further processing and subsequent storage in intra-operative Geo metriedatenspeicher <figref>121</figref> forwards. The computing unit <figref>104</figref> the generation of this two-dimensional X-ray images simulated by a series of two-dimensional projections of the three-dimensional skeletal elements is generated in the memory <figref>106</figref> stored Image data set have been discriminated against. Each two-didimensional represents projection the passage of an x-ray beam through the body at specific angle and distance. To the shifted data to mold and so as to obtain registration, a repetitive Process used a two-dimensional projection through the -shifted data set that best matches the (the) in the memory <figref>121</figref> saved current radiographic image (s) fits, selects. The process described can use more than one radiographic image. Since the arithmetic unit<figref>104</figref> the Position of fluoroscopic Lokalisators due to the fixed thereon emitter <figref>142</figref>Which in communication with the locator <figref>128</figref> to stand, is known, the exact position of the skeletal element during the Operation determined.

0059As mentioned above, can through the operative reference system or the operating room for the body Attaching emitters to a device to be set up, the capable is one of the body elements to detect and track, ie to identify where they a known relation to the body member forms. For example, make the transmitter<figref>130</figref> along with or without the three emitters on the patient's body a kind of reference framework <figref>116</figref>, as in <figref idrefs="S37">6</figref> reproduced, the substantially to the body member <figref>10</figref> appropriate can be, by continuously or periodically in the intra-operative geometry data storage <figref>121</figref> saved Ultrasonic contour of the body member <figref>10</figref> on update brings what the computing unit <figref>104</figref> then used of the pre-operative memory <figref>106</figref> stored contour of the body member <figref>10</figref> to match, the in memory <figref>122</figref> stored shifted Picture record continuously or periodically updated is placed so that the registration with the operation position the body elements is maintained. It is contemplated that an actual running Framework may be using any number of devices a body member can detect or track, such as radiographic devices (fluoroscope), endoscopes or contour scanner.

0060the above solutions achieve registration by the formation of the memory <figref>122</figref> saved displaced image data set, the displacement of the skeletal member corresponds to the time of surgery. An alternative technique for Reaching the registration is that it is ensured that the positions of the skeletal elements during the operation identical which are at the time of imaging. This can be achieved in that a frame is used, the position of the the patient adjusts and immobilized. In the case of this technique, at least three marks applied to the skin prior to imaging. These marks must be used by the imaging technique and detectable are called "fiducials" means. A Plurality of fiducials is desirable to increase the accuracy.

0061During the Operation is the body the patient on a precise enabling positioning placed frame. Such frames are commonly used for spinal surgery uses and can be modified to them during the Imaging to use, and they could for repositioning of the patient during the operation may be used. These frames can with driving mechanisms be provided by a slow displacement of the body enabling a plurality of positions. The at the time of imaging applied fiducials are Emitter replaced. By the driving mechanism of the frame is actuated, , the exact position of the emitter is determined during surgery and with the position of the fiducials in the pre-operative image data set, the in memory <figref>106</figref> is stored, are compared. If the emitter one of the geometry of the fiducials of the image data set adopt identical geometry, it can be assumed that the Skeletal elements in a geometric relationship are, the same position during the pre-operative Scans, and the method may be performed using the unaltered, In the storage room <figref>106</figref> stored image data set can be performed.

0062in the Generally, the instruments used in surgery on the skeleton slightly different from those used for cranial applications will. Instead of dealing with the current position, typically includes surgery on the skeleton transfers "Hardware" by bones Taking a biopsy through the bone, or the removal of Fragments. whereas, the instruments for this application to be adapted.

0063A commonly used instrument is a drill. By emitters on a surgical drill are provided and a fixed relationship between the body of the Drill and its tip (usually a drill bit) is created, the direction and the position the drill bit can be determined. There are at least three emitters on the Drill required, as most drills a complex three-dimensional have form. Alternatively, Emitter on a drill guide tube <figref>800</figref> With emitters <figref>802</figref> be provided and the direction <figref>804</figref> the positioned screw or the hole produced by the can be determined and digitizer shown in the image data set (see <figref idrefs="S39">8</figref>). The skeleton member<figref>806</figref> also contributes Emitter to indicate its position.

0064apart of the modification given instruments are new instruments required an above-discussed surgical reference system to accomplish. These reference frames, each having at least three provided emitters, require fixation to the bone, the a shift or rotation excludes.

0065For open surgery, a clamp-like configuration as in <figref idrefs="S40">9</figref> reproduced used will. A bracket<figref>900</figref> having at least two points <figref>902</figref>. <figref>904</figref>. <figref>906</figref>. <figref>908</figref> provided, the fixation to a projection <figref>910</figref> a skeletal element create. Applying is at least a two-point fixing the clip <figref>900</figref>Which serves as a reference frame, with respect to the Skeletal elements do not rotate. The clamp includes emitters<figref>912</figref>. <figref>914</figref>. <figref>916</figref> on, which communicate with the array to indicate the position of the skeletal element in its displacement during specify the operation.

0066Lots Operations affecting bone fragments <figref>940</figref>That during the surgery are not affected, but simply with wires or screw <figref>950</figref>. <figref>952</figref>By the skin <figref>954</figref> be introduced, be fixed. <figref idrefs="S41">10</figref> shows a reference platform <figref>956</figref>That in such through the skin <figref>954</figref> protruded wires or screws <figref>950</figref>. <figref>952</figref> is attached. The platform<figref>956</figref> includes a Variety of emitters <figref>958</figref>. <figref>960</figref>. <figref>962</figref>. <figref>964</figref> on, which communicate with the array to indicate the position of the bone fragment <figref>940</figref> at its movement during the indicate operation.

0067Of the Framework can the protruding screws or wires pulled or those be fixed to provide a reference system. Alternatively, be attached to only one wire of the frame, as long as the type of Attaching the frame to the screw or wire rotation is prevented, and also prevents the wire or screw twist within the attached skeletal element.

REFERENCE AND LOCALIZATION FRAMES

0068<figref idrefs="S42">11</figref> is a schematic Representation of an embodiment a cranial surgical navigation system. The portable system cabinet<figref>102</figref> includes a surgical workstation <figref>104</figref> one that is so worn, that they used the system by the surgeon or technician can be viewed. The workstation<figref>104</figref> includes a screen <figref>106</figref> for the representation the various scans and is connected to a personal computer <figref>108</figref> connected, of the monitor <figref>106</figref> controls. The system also includes an optical digitizers a, of a camera assembly <figref>110</figref> includes a camera stand <figref>112</figref> to the Supporting the arrangement in line of sight with the patient, and from this away, a digitizer control unit <figref>114</figref> on the portable system cabinet <figref>102</figref>Associated with the computer <figref>108</figref> connected is a footswitch <figref>116</figref> for process control of the system as well as a junction box <figref>118</figref> for the compound footswitch <figref>116</figref> With the digitizer control unit <figref>114</figref>,

0069About the junction box <figref>118</figref> is also a reference frame assembly <figref>120</figref> connected, the one reference frame <figref>122</figref> with the junction box <figref>118</figref> connected Cable, a vertical support assembly <figref>124</figref>, A head clamp assembly <figref>126</figref> and a horizontal support assembly <figref>128</figref> includes. the optical probe <figref>130</figref> (Illustrating a localization framework) is also about Cable and the junction box <figref>118</figref> the digitizer control unit <figref>114</figref> connected.

0070at the operation is the head of a patient (or another "rigid" body element) at the head bracket assembly <figref>126</figref> attached. To the position the optical probe <figref>130</figref> with respect to the head within the head bracket assembly <figref>126</figref> to determine the surgeon enters a pedal <figref>116</figref>To the emitter of the reference frame <figref>122</figref> excite. The emitters generate a light signal generated by the camera assembly <figref>110</figref> recorded and subjected to the determination of the position of the head of a triangulation is. The emitters of the optical probe<figref>130</figref> are also excited to emit light signals obtained by the camera assembly be recorded to indicate the position of the optical probe <figref>130</figref> to determine. Based on the relative position of the head and the probe <figref>130</figref> created the control unit <figref>114</figref> a pre-operative Scan on the screen of the monitor <figref>106</figref>, The position the probe relative to and / or indicative within the head.

0071<figref idrefs="S42">11A</figref> is a plan view one embodiment an arcuate cranial Framework. reference framework<figref>122</figref> is intended for use provided with a surgical navigation system, such as the in <figref idrefs="S42">11</figref> shown, the sensor assembly, such as a camera assembly <figref>110</figref>. which cooperate with the reference frame <figref>122</figref> communicates, to identify its location. The Framework<figref>122</figref> includes a base member <figref>132</figref> With an upper base <figref>134</figref> and a base plate <figref>136</figref> on, each semicircular are and by means of screws <figref>138</figref> are connected to each other, to a cavity <figref>140</figref> to form. The base and the plate can be made of anodized Aluminum or other autoclavable material. The top the upper base may be with one or more spring clips <figref>142</figref> provided be, are brought into engagement with a Leyla retractor can. As in <figref idrefs="S42">11A</figref> shown, the upper base with five featherclinch <figref>142</figref> provided.

0072Each or both ends of the reference frame <figref>122</figref> can a bayonet connection <figref>144</figref> be fitted to a bracket receive, which also engages with a Leyla retractor. At least one end of the reference frame <figref>122</figref> is a radial extension <figref>146</figref> educated, a screw <figref>148</figref> to wear, and the handle <figref>150</figref> becomes used to the reference frame to a head clamp, for example, the in <figref idrefs="S42">11</figref> shown head bracket <figref>126</figref>to fix, or a Mayfield clamp. this makes possible it, the frame of reference <figref>122</figref> in a fixed position in position relative to the head so that any movement of the head also a corresponding movement of the reference frame <figref>122</figref> would include.

0073Of the radial extension <figref>146</figref>, the screw <figref>148</figref> and the Handle <figref>150</figref> form a coupling on the base member <figref>132</figref>. the fixed engaging a on a body part (on the head) Structure can be placed, whereby a fixed reference with respect to the Head is provided to the base member <figref>132</figref> in a keeping fixed relation to the head.

0074Evenly over the reference framework <figref>122</figref> is distributed a plurality of LEDs <figref>152</figref>. with the camera assembly <figref>110</figref> communicates. The LEDs<figref>152</figref> are in the upper base <figref>134</figref> fixed holes provided, wherein the holes <figref>154</figref> in Connection with the cavity <figref>140</figref> are. At each port of LEDs <figref>152</figref> are cable <figref>156</figref> connected, the inside of the cavity <figref>140</figref> . are The other ends of the cables are connected to a connection 158, the one on the digitizer <figref>114</figref> the surgical navigation system can take control cable. The cable transmits signals for the activation the LEDs <figref>152</figref>, The connection<figref>158</figref> is at a Blade extension <figref>160</figref> fixed, extending from the base plate <figref>136</figref> extends. This support extension<figref>160</figref> has a channel on which the connection connecting the cable <figref>158</figref> allows. <figref idrefs="S42">11A</figref> is a circuit diagram of a preferred embodiment, the reference frame according to the invention <figref>122</figref>, As in <figref idrefs="S42">11C</figref> shown, each LED connected to a separate pin of the connection <figref>158</figref> connected. Although the invention is illustrated as a connection for the Receiving the cable is provided, it is also provided that the reference frame <figref>122</figref> can be battery operated, so no cable is required.

0075Of the reference framework <figref>122</figref> is substantially a semicircular arc, so that it can be arranged around the patient's head around, a communication of the plurality of LEDs <figref>152</figref> on the reference framework <figref>122</figref> with the camera assembly <figref>110</figref> to enable. The plurality of LEDs <figref>152</figref> on the reference frame <figref>122</figref> is arranged in a precisely known geometric arrangement so that the calibration of the camera assembly <figref>110</figref> are continuously reviewed can, by the by the digitizer <figref>114</figref> calculated geometric positions of LEDs with these exactly known geometrical Positions are compared. Inconsistency between these Information indicates that it is necessary, the system again to calibrated or the reference frame <figref>122</figref> to reposition, so it better with the camera assembly <figref>110</figref> communicate can. The frame<figref>122</figref> also includes a calibration recess <figref>162</figref> on. especially is the calibration recess <figref>162</figref> a precisely positioned Well within the upper base <figref>134</figref> and is used to Calibration or for checking the Calibration of the position of the probe tip during medical or surgical procedure used. The exact location of each LEDs<figref>152</figref> in Reference for calibrating recess <figref>162</figref> is known. Therefore allows the positioning of a tip of a localization frame probe in the calibration groove <figref>162</figref> calibration or checking the Calibration of the probes in the following manner. The tip of the probe is in the calibration groove <figref>162</figref> positioned and the LEDs on the probe are excited to light signals to the camera assembly <figref>110</figref> dispense. The LEDs on the reference frame <figref>122</figref> are also encouraged to the camera assembly <figref>110</figref> to communicate. Among Using the known position of the recess <figref>162</figref> regarding the by the digitizer <figref>114</figref> calculated position of each the LEDs is the position of the calibration groove <figref>162</figref> With the position of the probe tip compared that by the digitizer is calculated using the LEDs on the probe in order to confirm that no impairment the probe tip relative to the recess <figref>162</figref> occurs. A distortion of the probe tip indicates that it required is to recalibrate the probe so that it precisely with the camera assembly <figref>110</figref> communicate can, or to replace the probe.

0076<figref idrefs="S45">12A</figref>. <figref idrefs="S45">12B</figref> and <figref idrefs="S45">12C</figref> illustrate a another embodiment the reference frame in the form of a spinal arcuate Framework <figref>200</figref>, As the reference frame <figref>122</figref> has the spinal arcuate Framework <figref>200</figref> a upper base <figref>202</figref>Which in engagement with a base plate <figref>204</figref> stands, to an intermediate cavity <figref>206</figref> to form. As in<figref idrefs="S45">12A</figref> shown, has the spinal arcuate Reference frame 200 is substantially a U-shaped configuration, LEDs <figref>208</figref> at the ends of the legs <figref>209</figref> the U-shaped element, and on the transition area of the legs and the base <figref>211</figref> the U-shaped element provided are. Laterally from the base<figref>211</figref> extends a clutch <figref>210</figref>. with a thoracolumbar Instrument <figref>212</figref>As shown in <figref idrefs="S45">12D</figref>. <figref idrefs="S45">12E</figref> and <figref idrefs="S45">12F</figref> shown, can be brought into engagement. On the base<figref>211</figref> is also a calibration recess <figref>214</figref> provided that have the same Purposes as the calibration pit <figref>162</figref> the reference frame <figref>122</figref> serving Depression. The coupling<figref>210</figref> has 24 evenly spaced teeth <figref>216</figref> on, the in circular Shape are arranged to the 24 equally spaced teeth <figref>218</figref> of bring thoracolumbar instrument engaged. This makes it possible that the spinal arcuate reference framework <figref>200</figref> can be positioned so that it different angles relative to the instrument <figref>212</figref> occupies. It is contemplated that any other connection for connecting the spinal arcuate reference framework <figref>200</figref> and the instrument <figref>212</figref> used can be, which allows variable positioning. The baseplate<figref>204</figref> has an opening on, with a compound <figref>220</figref> engaged can be to a digitizer to control unit <figref>114</figref> leading take cable. The LEDs<figref>208</figref> are connected to the connection <figref>220</figref> by means of wires <figref>222</figref> connected, as in the diagram in <figref idrefs="S45">12G</figref> shown.

0077Referring on the <figref idrefs="S45">12D</figref>. <figref idrefs="S45">12E</figref> and <figref idrefs="S45">12F</figref> includes thoracolumbar Instrument <figref>212</figref> a clamp shaft <figref>224</figref>Which is provided with an axial bore is, within which an actuating shaft <figref>226</figref> scheduled is equipped with a behind the end of the clip shank <figref>224</figref> extending operating knob <figref>228</figref> connected is. The end of the operating shaft<figref>226</figref> Has the operating knob <figref>228</figref> opposite an inner threaded bore <figref>230</figref>That engages with the external thread of an actuating screw <figref>232</figref> stands. A U-shaped head <figref>234</figref> on the screw <figref>232</figref> carries a pivot <figref>236</figref> between his thighs. The pivot pin extends through the Kelmmbacken <figref>238</figref>So that the clamping jaws <figref>238</figref> themselves around the pivot <figref>236</figref> rotate relative to each other and move, whereby a receiving area <figref>240</figref> is defined, in which a Spinalknochen or other body part to be clamped can. The jaws<figref>238</figref> have teeth <figref>239</figref> for detention a Spinalknochens or other body part and are spring loaded and by means of springs <figref>242</figref> in its open position kept. When the operating knob<figref>228</figref> turned is to be in engagement with the thread of the screw actuator <figref>232</figref> to come, the screw <figref>232</figref> in the hole <figref>230</figref> drawn, wherein the clamping jaws are also in a housing <figref>246</figref> to be pulled. this leads to cause the shoulder surfaces <figref>244</figref> of housing <figref>246</figref> With the jaw surfaces <figref>248</figref> the jaws <figref>238</figref> come into engagement and the clamping jaws and the receiving area <figref>240</figref> are closed when the Clamping jaws in the housing to be pulled.

0078The other end of the clamping shaft <figref>224</figref> has vertical extension <figref>250</figref>, The teeth <figref>218</figref>. with the teeth <figref>216</figref> the coupling <figref>210</figref> the arcuate spinal Framework <figref>200</figref> are brought into engagement, wearing. A screw <figref>252</figref> the arched spinal Framework runs through the arrangement of the teeth <figref>218</figref> and is in engagement with a threaded opening <figref>254</figref> in the coupling <figref>210</figref> the frame <figref>200</figref>, The screw<figref>252</figref> is in engagement with the opening <figref>254</figref> and clamps the teeth <figref>216</figref> and the teeth <figref>218</figref> together, the angle between the arched spinal Framework <figref>200</figref> and the thoracolumbar Instrument <figref>212</figref> to fix. If that instrument <figref>212</figref> is connected to a bone by the bone in the receiving area <figref>240</figref> positioned and the operating knob <figref>228</figref> turned is to the clamping jaws <figref>238</figref> and the receiving area to conclude, the frame is <figref>200</figref> consequently in a fixed Position with respect to the bone, the held by the clamping jaws is. Any movement of the bone results in movement of the frame <figref>200</figref>By the camera assembly <figref>110</figref> detected can be.

0079Among Referring to <figref idrefs="S46">13A</figref>. <figref idrefs="S46">13B</figref> and <figref idrefs="S46">13C</figref> A preferred embodiment a localization biopsy guide frame according to the invention <figref>300</figref> illustrated. Generally includes the frame <figref>300</figref> a localization framework <figref>302</figref> on, of a biopsy guide <figref>304</figref> as a retaining pin <figref>306</figref> wearing. The localization framework <figref>302</figref> includes an upper base <figref>308</figref> and a base plate <figref>310</figref>Which are connected to each other a cavity or synonymously recess <figref>312</figref> to form, within the the LEDs <figref>316</figref> connected Drählte <figref>314</figref> scheduled are. As in<figref idrefs="S46">13A</figref> shown, the localization framework includes an extended portion <figref>318</figref> and a substantially V-shaped Area <figref>320</figref> with legs <figref>322</figref> and <figref>324</figref>, An LED <figref>316</figref> is at the end of each leg <figref>322</figref> scheduled and an LED <figref>316</figref> is also at the end of the extended region <figref>318</figref> provided. Consequently, the four LEDs<figref>316</figref> a rectangular array. The underlying localization frame<figref>302</figref> Has However, no rectangular configuration so as for other Applications can be customized, such as a drill guide, in the following with reference to <figref idrefs="S46">13D</figref> and <figref idrefs="S46">13E</figref> illustrated and described is. The V-shaped area<figref>322</figref> extends extending substantially laterally extended from the area <figref>318</figref>. to the rectangular configuration of the LEDs <figref>316</figref> to enable. It should be noted that the rectangular configuration of the LEDs <figref>316</figref> not is required, and a trapezoidal configuration, the LEDs <figref>316</figref> advantageous may be to change the orientation of the localization framework <figref>302</figref> clearly be able to recognize. The retaining pin <figref>306</figref> extends through the upper base <figref>308</figref> and is substantially parallel in prolonged by the Area <figref>318</figref> defined linear axis. The retaining pin<figref>306</figref> serves to put the clamps engaged, so that the localization biopsy guide frame <figref>300</figref> in a particular position relative to are positioned a body part can to guide a biopsy needle.

0080to guide a biopsy needle is the localization framework <figref>302</figref> With a biopsy guide <figref>304</figref> together, the at the top of the upper base <figref>308</figref> fixed and a bracket <figref>328</figref> is held, the means of four screws <figref>330</figref> in Engagement with the upper base <figref>308</figref> is. The upper base<figref>308</figref> has also a semicircular channel <figref>332</figref> on which a receptacle for receiving the biopsy guide <figref>326</figref> forms. The leadership <figref>304</figref> includes a hollow tube <figref>334</figref> with a collar <figref>336</figref> at one of its ends, a threaded circular opening for Receiving the locking screw <figref>338</figref> having.

0081the baseplate <figref>310</figref> with a compound <figref>340</figref> provided, the one to the digitizer <figref>114</figref> connected cable to transfer signals for excitation of the LEDs <figref>316</figref> can absorb. <figref idrefs="S45">12G</figref> illustrates a preferred embodiment of a Circuit, the compound has the <figref>340</figref> and four LEDs each connects.

0082Of the localization framework <figref>302</figref> consists of the same material as the reference frame <figref>122</figref>Ie the autoclavable ULTEM <figref>1000</figref> black. The biopsy guide <figref>304</figref> can stainless steel or any other autoclavable metal or plastic consist. As the reference frame, the localization framework batteries be, whereby a cable or a connection for receiving the cable not required are.

0083<figref idrefs="S46">13D</figref> and <figref idrefs="S46">13E</figref> illustrate another localization device in the form of a localization drill guide assembly <figref>350</figref>, The order <figref>350</figref> includes a localization framework <figref>302</figref> on, of the in the localization biopsy guide frame <figref>300</figref> used Frame corresponds, with the exception that it does not support pin <figref>306</figref> having. He has a semicircular channel <figref>332</figref> in the upper base <figref>308</figref> on which a Handle and drill guide assembly <figref>354</figref> instead the Biospieführungsrohranordnung <figref>304</figref> receives. The order <figref>354</figref> includes a handle <figref>356</figref> on, that of the performing the operation Surgeon, doctor, technician or nurse is used. The handle <figref>356</figref> has a bore <figref>358</figref> to record a shank <figref>360</figref> on the inside of the semicircular channel <figref>332</figref> sitting. Of the Stem ends in an integral collar <figref>362</figref>, Of a Bohrführungsröhre <figref>364</figref> wearing. the Axis of Bohrführungsröhre <figref>364</figref> is thereby at an angle relative the axis of the shaft <figref>360</figref>To the orientation of the Bohrführungsröhre <figref>364</figref> regarding the Point where the drill bit is penetrating the patient's body, to facilitate. According to a preferred embodiment, is the handle and drill guide assembly <figref>354</figref> on commercial Instrument in the channel <figref>332</figref> the localization framework <figref>302</figref> secured is. The handle and drill guide assembly<figref>354</figref> can For example, a Sofamor Danek Part <figref>870</figref>-<figref>705</figref> be. screw <figref>366</figref> (Whose heads are insulated with high temperature RTV mass) securing the shaft <figref>360</figref> at the upper base <figref>308</figref> the localization framework <figref>302</figref> and Fasten the shaft <figref>360</figref> within the channel <figref>332</figref>, As stated above, forming the V-shaped Area <figref>320</figref> the localization framework <figref>302</figref> an opening <figref>368</figref> in between the legs <figref>322</figref> and <figref>324</figref>So that the Bohrführungsröhre <figref>364</figref> intervening can be placed and located downstream from the through the localization framework <figref>302</figref> defined Plain stretches. this makes possible the surgeon, the position of the Bohrführungsröhre <figref>364</figref> appreciated by passing through the tube looks. The connection<figref>370</figref> is the compound <figref>340</figref> similar, That they brought an angle except the cable engaged may be, whereby the localization drill guide assembly <figref>350</figref> a greater freedom of movement is awarded. As the localization framework described above is the frame itself from autoclavable ULTEM <figref>1000</figref>, The handle can be wooden, plastic or any other autoclavable material and the shaft, collar and drill guide may be metal, plastic or other autoclavable material such as stainless steel, are made. <figref idrefs="S46">13K</figref> illustrates a preferred embodiment a circuit for the localization drill guide assembly <figref>350</figref>,

0084<figref idrefs="S46">13F</figref> and <figref idrefs="S46">13G</figref> illustrate another localization device in the form of ratchets localization framework <figref>400</figref>, This framework <figref>400</figref> includes a localization framework <figref>302</figref> on, of the same configuration as the localization frames for the localization biopsy guide frame <figref>300</figref> and the localization drill guide assembly <figref>350</figref> Has. From the underside of the base plate <figref>310</figref> extends a be holding member <figref>402</figref>That a ratchets <figref>404</figref> in a plane considers that substantially perpendicular to the frame by the localization <figref>302</figref> defined plane is. The coat hanger<figref>404</figref> is essentially a collar which on housing a Rex-drill fit and secured thereto by a set screw <figref>406</figref> firmly fixed is. The ratchets localization framework<figref>400</figref> allows, that the drill housing for the use while a surgical procedure can be positioned accurately.

0085The holding member <figref>402</figref> wearing a connection <figref>408</figref> for receiving a cable, the the digitizer control unit <figref>114</figref> affiliated is. The retaining member<figref>402</figref> has a hollow channel, that the compound <figref>408</figref> to the wires <figref>410</figref> affiliated can be applied to the LEDs <figref>316</figref> are connected. <figref idrefs="S46">13J</figref> illustrates a preferred embodiment a wiring between the LEDs <figref>316</figref> and the compound <figref>408</figref>,

0086<figref idrefs="S46">13H</figref> and <figref idrefs="S46">13I</figref> illustrate another localization device in the form of a ventriculotomy probe <figref>500</figref>, The probe<figref>500</figref> includes a handle <figref>502</figref> on, of a bore <figref>504</figref> for receiving a support shaft <figref>506</figref> having, of a catheter guide tube <figref>508</figref> along an axis carries, parallel to the axis of the handle <figref>502</figref> is. The handle includes three LEDs <figref>510</figref> a, which are arranged along its upper surface are to the camera assembly <figref>110</figref> to communicate. The handle <figref>502</figref> has a hollow channel in a drilling <figref>512</figref> for receiving a connection <figref>514</figref> ends. The connection <figref>514</figref> with wires <figref>516</figref> connected, to the terminals the LEDs <figref>510</figref> are connected. <figref idrefs="S46">13J</figref> illustrating a preferred embodiment a circuit for the compound of the compound <figref>514</figref> with LEDs <figref>510</figref>, In operation, the tube <figref>508</figref> within the body, For example, the brain, is positioned so that a catheter in the body can be used. The tube<figref>508</figref> includes a upper slot <figref>518</figref> a, by a catheter inserted can be. Preferably, the center of the tube tip is collinear with the height of three LEDs <figref>510</figref>So that between them defines a straight axis is. Based on this straight axis and the previously obtained Knowledge of the distance between the tip and the LEDs <figref>510</figref>. can the camera assembly <figref>110</figref> and the digitizer <figref>114</figref> the Position of the tip at any instant during a surgical or medical intervention determine.

0087The inventive system can be used in the following manner. A Frame of Reference is on a body part attached. For example, the arcuate craniale Framework<figref>122</figref> over a Head bracket, such as a Mayfield clamp, directly a head or the arcuate spinal Framework <figref>200</figref> via the thoracolumbar Instrument <figref>212</figref> directly be attached to a Spinalknochen. After leading a movement of the body portion to a corresponding movement of the attached reference frame. The position of the body part can be followed by excited the LEDs of the reference frame be a signal to the camera assembly <figref>110</figref> deliver, so that the arrangement, the position of the reference frame and thus the Position of the body part can determine and track.

0088On Localization frame is used to an instrument with respect to the body part precisely position. For example, a localization biopsy guide frame<figref>300</figref> used be to position a biopsy needle relative to the body part. Alternatively, a localization drill guide assembly <figref>350</figref> used are to a drill bit with respect the body part position. Alternatively, a localization framework ratchets-<figref>400</figref> used be to position a drill relative to the body part. Alternatively, a probe ventriculotomy <figref>500</figref> be used, a catheter with respect to position on a body part. The position of the instrument can be followed by the LEDs the localization framework to emit a signal to the camera assembly <figref>110</figref> animated , so that the arrangement of the position of the localization frame and can thus determine the position of the instrument and track.

0089During the Calibration of the system is the position of the reference frame with respect to the body portion certainly. During pre-operative Scanning marks used are the coordinates of the by the reference frame defined operating field indicated. It Note that anatomic landmarks used as labels can be. This is a relationship between the area of ​​the pre-operative scans and the surgical site prepared. If the relationship established is, the system knows the position of pre-operative scans with respect the reference frame and thus can generate scans which position the the localization frame and the instrument relative to the body part play. In other words, through the system, an image-guided surgery achieved. The system is ideally suited to small, deep-seated Vascular lesions and to localize tumors and the extent of the microsurgical section to diminish. It is also to identify border areas suitable. For example, a surgeon attempt a border area between normal brain tissue and large supratentorial gliomas identify which might significantly in the pre-operative Scans is shown in the operating room during surgery, however, it is difficult to visually locate. The surgeon can then localization probe take and position it close to the border area. The LEDs of the Reference frame and localization probe by operating the footswitch <figref>116</figref> activated. As a result, the monitor <figref>106</figref> an image of the position of the probe relative to a preoperative Output Scan. By observing the monitor, the surgeon can now determine the direction in which the probe has to be moved to the border area specific to locate. If the border area is localized, small cotton-like markings (English: microcottonoid markers) to positioned the displayed on the monitor the border area of ​​the tumor , before proceeding with the resection. Also placing ventricular catheter Shunts or for the ventriculotomy and containers is using facilitates the system, particularly in patients who are small have ventricle or a coagulopathy (eg, liver disorders, AIDS) are subject, in which a single engagement desirable is. The system is also for the implementation stereotactic biopsies suitable. be for more, the systemapt Information is referred to the following articles, herein be added to entire circumference with reference: Germano, Isabelle M., The Neuro Station System for Image-Guided, Frameless Stereotaxy, Neurosurgery, Bank. 37, No. 2, August 1995.

0090Smith et al., The Neuro station^TM - A Highly accurate, Minimally Invasive Solution to Frameless Stereotactic Neurosurgery, Computerized Medical Imaging and Graphics, Vol. 18, No. 4, pages 247-256, 1994th

0091In Given the above description it is clear that the various dissolved objects of the invention and other advantages are achieved.

0092There the above constructions, products and processes often changed can be, without departing from the scope of the invention, the entire content the above description and the accompanying drawings only as illustrative and not to be regarded as limiting.

0093In Given the above description it is clear that the various dissolved objects of the invention and other advantages are achieved.

0094There the above constructions, products and processes often changed can be, without departing from the scope of the invention, the entire content the above description and the accompanying drawings only as illustrative and not to be regarded as limiting.