JPS6194639A - Adaptor - Google Patents

Abstract

(57) [Summary] This bulletin contains application data before electronic filing, so abstract data is not recorded.

Description

[Detailed description of the invention] [Industrial field of application] The present invention is a patent application for measuring the position of brain structures by spatial coordinates in computed tomography and NMR examination methods, and transmitting the coordinates to a stereotaxic device. Is the adapter described in the preamble of claim 1 suitable for ear support and nasion support? - and said adapter? and a laterality indicator device that reproducibly secures to the patient's phase.

For example, computed tomography examinations of the brain and N
During examinations and surgeries of a patient's head, such as in MR examinations (NMR stands for nuclear magnetic resonance), the position of brain structures is determined by a reference device that can be repeatedly and reproducibly fixed in the same position on the patient's head. It is important to measure the

If this were possible, during repeated examinations it would be possible to consider whether brain structures have changed shape or position, e.g. due to tumor growth. Transferred to 1 surgical procedure (thalamotomy = thalamotoln7+
It is preferable to be able to carry out such procedures as n(ly procedures, electrode implantation, etc.) without using any air layer imaging or angiography. Stereotactic irradiation of brain structures is desirable.

An ideal adapter for the above purpose should satisfy the following criteria.

1. Do not damage the tissue (not fixed to the skull with screws).

2. It is easy to fix and loosen and is relatively convenient for patients.

3. Scales that are repeatedly fixed on the head in the same position 04. Scales that accurately determine the coordinates of the head relative to the adapter.

5. Scales for use with various types of stereotactic instruments.

6. Use one scale and the same adapter for all patients.

[Conventional technology]

Several well-known attempts have been made to solve the aforementioned problems, and these attempts can be categorized into three main types. In the first case, a computed tomography study is performed with the patient fixed in a stereotaxic device.

This method only satisfies the fourth criterion listed above.

Another method in computed tomography examinations is to use bony reference points in the skull and then use the same reference points in stereotaxic operations.

Although this method requires no equipment, it is often inaccurate because it is rare to find the same reference point in a computerized radiograph or a stereotactic radiograph.

Yet another method is to reproducibly secure the adapter to the patient's head, one method being based on a plastic mask molded to the patient's head, while the other is based on a set of dentures in the mouth. makes it easier to hold the mask in place.

Although this method satisfies criteria 1.3 and 4, it is inconvenient for the patient, makes stereotaxic operations cumbersome, and does not satisfy criteria 5 and 6 at all.

There are other known methods and devices for immobilizing a patient's head for 1N testing, but these do not take into account the location of brain structures. An example of the method and apparatus described above is disclosed in U.S. Patent No. 2,532.
, No. 967, No. 2.717.514, No. 2,84
6.587, 3,154,683, 3,5
No. 14.606 and No. 4256.112. However, none of the devices described in the aforementioned patents allow accurate determination of brain coordinates relative to the adapter and cannot be used with stereotactic instruments. The purpose is to determine the location of brain structures using a reference device that can be reproducibly and repeatedly fixed at the same location on the patient's head.
By providing an adapter of the type described in the preface of the unknown specification, which is fast at 11 times. Another object of the present invention is to measure the position of the brain structure by three-dimensionally defining the position of the B11C1 structure using three-dimensional coordinates with respect to a desired reference structure. Other objects of the invention are to satisfy criteria 1 to 6 above, reduce the time for computed tomography and NMR examinations to a minimum, and allow the use of existing stereotactic instruments in the neurosurgical facility. By providing an adapter. Another object of the invention is to provide an adapter that is inexpensive and easy to manufacture.Another object of the invention is to provide an adapter that is inexpensive and easy to manufacture.Another object of the invention is to provide an adapter that can be used for external stereotactic irradiation of intracranial targets using a conventional linear accelerator. , and also be able to use the same adapter in NMR testing.

These and other objects of the invention are achieved in that the adapter provides the features defined in the claims.

The invention will now be described in detail with reference to the accompanying drawings. EXAMPLE The adapter shown in FIG. 1 includes a framework secured to the patient's head by means of two ear supports and a nasion support. Preferably, the members of the framework are made of a suitable somewhat resilient material, such as plastic or light metal, for example a hard resilient aluminum alloy, although other materials are of course contemplated. An almond-shaped earpiece 10 rests on the triangular frame portion and is located rearward relative to the patient's face (Figure 4).
and one or more arms 16 connecting λ and the rear arm. Preferably, the ear support 10' is provided with air holes for ear pressure relief and patient interaction. The triangular frame portion 12.degree. 14.16 is a right triangle in the illustrated embodiment, with the rear arm 12 and the arm 16 forming the shorter 0Ill, while the front arm 14 forming the hypotenuse. The angle α between the arms 12 and 14 is an acute angle, and the preferred angle is between 10 and 6.
A range of 0 degrees is preferable, and a range of 20 degrees is most preferable. In addition to the arm 16 connecting the rear arm 12 and the front arm 14 of the ear support and being perpendicular to the rear arm 12, one
More than one lateral arm 18 is provided which is also perpendicular to the rear ear support arm 12 and extends all the arms 12, 14 from the ear to the rear ear support arm 12. - connect at a predetermined and known distance from the host.

A bearing bracket 20 is fixed to the pointed end of the frame parts 12 to 16, through which the split ends of two nasion support arms 22, 24 pass. The ends of said arms 22,24 run in the form of racks meshing with cogwheels, which are carried on bearing brackets 20 and can be operated from the outside by means of foils 26. The position of the arms 22, 24, each set by a foil 26, can be locked (by means of a locking foil 28). The ends of the arms 22.24 carried by the bearing bracket 20 are also provided with scales, for example graduated in millimeters, for reproducible adjustment of the arms. As previously mentioned, the support 30 is made of plastic or aluminum alloy and is shaped to rest against the upper part of the support (by virtue of its wide fit). Figures 2a to 2c. The Nasion support 30 is fixed to the Nasion support arm 22.24 by a joint like a pin 32.The arm 22.24 is fixed to the Nasion support arm 22.24 by a screw 34 above the joint 32. is attracted, while ear support 10
is simultaneously pushed into the auditory canal as the screw 34 is tightened. As the screw 34 is tightened, the joint 32
and the arms 22,24, mutually supported at their labyrinth-like ends (FIG. 2C), are pressed downwardly with the nasion support 30, as shown at the top of FIG. Because the Nasion Support Arms are made from a resilient, durable, shape-resistant material, their placement ensures a stable and patient-friendly pressure and position for the Nasion Support 30 and the ear support 10. and to be able to maintain it.

At the center of the joint 32, above the nasion support 30, as shown in FIG. The indicator is in the form of a rond and its bent or straight end engages the mounting member 36.

The functions of the rotary P38 will be explained in detail below.

In the middle part of the arm 16 in the triangular frame part there is a threaded bin with a rectangular base part, which is adjusted with respect to the longitudinal slot 40 of the connecting plate 42. In this way, the triangular frame part can be adjusted along the slot 40 and the set position is locked by a nut 44 in the form of a foil;
Since the set position is fixed, the triangular frame part 1
2.14ii generally perpendicular to the connection plate, and (
or) located in contact with the patient's skull.

In order to indicate the set position, the connecting plate 42 is provided with a scale by which the setting of the triangular frame part can be read. As shown in FIG. 1, a slit arm 4 is provided at the upper edge of the connection plate 42.
6 is arranged, and the rondo 3 is placed in the slit of the arm.
8 are engaged and fixed ◇The connecting plate 42 also has a mounting section 4B, which mounting section 48 is fitted with a locking screw 5
4 is fixed to the angle bracket 50.

The bracket 50 is adjustable by a slit so that the foil 56 engages another angled bracket 52 to enable locking of the adapter to the rectangular plate of the computed tomography table, as will be explained in detail below.

To indicate rear lateralization, a rear lateralization indicator is provided which consists of two symmetrical rectangular devices of metal wire 58, the ends of which are bent over and attached to the rear ear support arms. It can be fixed at a predetermined marked point in 12. At the rear of the indicator device marked #, an aluminum plate is provided on each side as a rear left-right difference indicator 5Ela. The left and right indicators 5B are attached to the rubber pan-60 behind the patient's head.
When connected, the aluminum pin is pressed against the skull (Figures 1, 3, and 4). When the arms 12 and 18 of the adapter and the laterality indicators 38 and 58a are constructed of plastic tubing filled with Hi:semigen, the adapter can be used to define the position of the piiim structure for NMR examination. Suitable.

As can be seen from FIGS. 6 and 4, the adapter is inserted into the plate 62 of the computer tomography table by means of the angle bracket 52. The angle bracket is inserted into a clamp arm 64 equipped with a locking foil 66t. To secure the patient's head to the computed tomography table, a rectangular plate 62 is provided, preferably made of plastic or plexiglass, with a concave shape that allows the back of the patient's head to rest comfortably. The 5-piece case with a tang has a square raised portion on the plastic surface. Thus, the adapter shown in FIG. : The patient's head is fixed on the 70-rate 62 of the computed tomography table. The aim is not to maintain the same position relative to the table during repeated examinations, but to keep the patient's part a stationary during the examination.

The above-mentioned adapter is as follows [Figure 1 to Figure 4]
is fixed to the patient's head. The adjustment screws of the nanoon support 30 should not be loosened, and the nanoon support arms 22, 24 should be placed in the outermost position on the bearing bracket 20. The connecting plate 42 should be loosely fixed to the arm 16 of the triangular frame part, while the The shaped ear support 10 is pushed into the ear canal, first from one side of the head and then to the other side. Once the two ear supports 10 are inside, the adjustment screws 34 of the ear supports 30 are tightened and the ear supports are stabilized within the ear canal. The nasion support 30 is then pressed against the patient's nasal bridge as the cogwheels 26 on both sides are rotated simultaneously. Adjustment screw 3
After 4 is further tightened or the cogwheel is also tightened,
The gear is fixed by a lock screw 28. The triangular frame part is then adjusted until the connecting plate 42 is located symmetrically and perpendicular to the arms 16 of the frame part, or approximately until the arms are located close to the skull on each side. In this way, the adapter is positioned at a reproducible position on the patient's head and all four scales are adjusted.

That is, the adjustment values of the scales in degrees at the ends of the two nasion support arms 22, 24 degrees and the connecting plate 42 are recorded. The left/right difference indicator 58 of the & section is symmetrically clamped to the rear ear support arm 12 at an appropriate height.

Then, the front indicator, i.e., the rod 38, is fixed between the nasion support 36 and the slit of the mounting part 46, and while the adapter is repeatedly fixed in this way, the # part and the rear left-right difference indicator are the same in MW. Always located in a reproducible position. Additionally, these indicator devices are used to indicate the midline of the adapter on the patient's head, increasing the stability of the adapter and allowing two coordinates to be correlated during computed tomography examinations and surgeries.

In this column, the patient is positioned in the depression of the back T-ridge 68 of the head, the head is rotated and the computer is positioned on the lateral arm 18.
The section can be made parallel to and therefore at right angles to the rear ear support arm 12. The adapter is now firmly secured to the table by brackets 50, 52 and 64.

The computer and NMR coordinates for the desired eye IT are as explained below with reference to FIG. 5, which schematically shows a section of the patient's head parallel to the lateral arm 1B of FIG. 0 Moebe ear support arm 1 reached in the manner of
4 and the shadow of the rear ear mate arm 12 indirectly dictates the X coordinate and 1 the Y coordinate is most often referred to as the height of the lateral arm 18 of which the entire arm is visible. In other words, the PIJ horizontal arm 18 is the arm 1.
It is also used to inspect faults that fall at the same level.

If the arm 18 is seen at different heights on the left or right side, the difference should be taken into account to define the Y coordinate t for the sulcus located at varying distances from the midline. The lateral arms make it possible to relate the tomographic level to the adjacent arm, thus improving the accuracy of the X coordinate definition. This occurs when the front left-right difference indicator, that is, the rondo 38, which measures the distance of the target T from the line 71 that joins with , 2 coordinates are shown as the distance of the target T from the median line γ2 0 When the computed tomography coordinates are transferred to the stereotactic device shown schematically in FIGS. 6 and 7, the adapter It is fixed to the head in a similar manner and the same readings are taken on the four scales as during the previous computed tomography examination. During computed tomography examinations, the posterior laterality indicator 58 should also be fixed at the same height as the posterior ear support arm 12. The stereotaxic device I is then fixed to the patient's head by screws t-m. front(
Anterior-posterior) radiographs (Fig. 6) show anterior 3
8 and the rear 58a appear, and the computer target's left-right difference with respect to the midline γ2 of the adapter can be derived and projected onto the two-axis shadow of the localization device 6. In the lateral X-ray photograph (Fig. 7), the ear support arms of the anterior part 14 and the posterior part 12 of 18% in the lateral direction appear, and the plane 71b-b of both ears and the basic diverting plane of the X coordinate (@ direction arm) are shown. Plane t) t - Mouth that can be pulled out Then the computer eye iT is pulled out according to the X coordinate and is projected onto the X-axis shadow B-B of the stereotaxic device S. In this regard, it is not necessary to go into details about the influence of the magnification of the radiograph and the direction of irradiation on the pure stereotaxic coordinates ffl+. , with a stereotactic device fixed to the patient's head, the same base device can be used to transfer the computer coordinates to the stereotactic X-ray, so the brain's desired target can be captured with a high degree of precision. It is possible to obtain a reference device that can be reproducibly fixed at the same position relative to the patient's head at the same time for both computerized tomography and IMF examination of the brain. As can be seen, this is achieved with five spatial coordinates X, Y and 2 for a given reference structure. The adapter also satisfies all radicals listed in the introduction to this specification as desirable for adapters. For satisfactory functioning of the adapter for stereotaxic operations, it is important that the adapter requires a minimum amount of space within the stereotaxic device. It is also clear that the adapter of this patent in this regard is designed with maximum precision.

[Brief explanation of the drawing]

FIG. 1 is a perspective view of the adapter according to the invention; FIG. 2a is a sectional view of the bearing of the nasion support along line II-It in FIG. 2b; FIG. 2b is a positive view of the nasion support; FIG. 2C The figure is the second
A plan view of the support shown in Figures a and 2b; Figure 6 is a diagram showing how to secure the adapter of Figure 1 to a computer tomography table; Figure 4 shows how the adapter of Figure 1 is attached to the patient's head; Side view of the adapter fixed to the tomography table: Figure 5 shows how the computed tomography coordinates are formed on the computed radiograph; Figure 6 shows how the computed tomography coordinates are transferred to the stereotactic radiograph. FIG. 7 is a schematic front view of the patient's head showing how to perform the procedure, and FIG. 7 is a schematic side view corresponding to the front view shown in FIG. 10... Ear support? 2,14,16.18... Arm 20... Bearing bracket 22.24... Nasion support 30... Nasion support 32... Bin 34.
...Adjustment screw 38...Indicator 42...i
! l! Plate 45...Slit arm 36.4
8...Mounting part 50...Angle bracket 52...Angle bracket

Claims (12)

[Claims] (1) An adapter for detecting the position of brain structures in a patient's head using spatial coordinates in computed tomography and NMB examinations and transmitting the coordinates to a stereotaxic device, the adapter comprising:
ear supports (10) supported by arms (12) of
) and another support (30) for reproducibly fixing the adapter to the patient's head, wherein the two lateral frame parts are adapted to fit on either side of the patient's head; a triangular lateral frame structure (12, 14) extending at an angle to one arm (12) and together with said first arm (12) and another third arm (16);
, 16), said lateral frames on each side of the patient's head being connected to a connecting device (22).
, 24, 42), the connecting device is connected to another support (30) and a front lateralization indicator (38) and two rear lateralization indicators for detecting a reference plane passing through the midline of the adapter. (58a); and a left-right difference indicator device (38, 58a). (2) In the adapter according to claim 1, the other support (30) is a nasion support,
The Nasion support is a Nasion support arm (22,
24), the arms of which are adjustably connected to the ends of the triangular lateral frame parts (12-16). (3) An adapter according to claim 2, in which the lateral frame parts (12, 14, 16,) are adjustably connected at their other ends by a connecting plate (42). Features an adapter. (4) In the adapter according to claim 2, the nasion support arms (22, 24) are connected to the frame portions (12, 14, 16) by bearings (20) disposed on the frame portions. ), and the rack of the nasion support arm (22, 24) meshes with the cogwheel (26) of the bearing device (20), and the nasion support arm (22, 24) is connected to the bearing bracket. (20) Adapters, characterized in that they are lockable at (20) and their position on the bracket is readable on a scale. (5) In the adapter according to any one of claims 1 to 4, the nasion support arms (22, 24) are connected by a bearing (32), and the bearing is adjustable. The screw (34) connects the nasion support arm (2) made of a hard, slightly elastic material.
2, 24) and therefore the side frame parts (12-1
6) are pressed against each other to generate a lever action that pushes the ear support (10) into the patient's auditory canal. (6) In the adapter according to any one of claims 1 to 5, the left-right difference indicator device is connected to the nasion support (30) and the connection plate (42).
) and a front elongated left-right difference indicator (38) fixed between the mounting portion (46) of 1 and a device (60) for pressing the rear laterality indicator (58a) against the patient's head. (7) In the adapter according to claim 6, the rear left-right difference indicator is arranged on the arm (
58), and the rear left-right difference indicator (58a)
An adapter characterized in that the device for pressing the indicator against the patient's head consists of an elastic band connecting the indicator. (8) In the adapter according to any one of claims 1 to 7, the attachment device (48, 50,
52). (9) In the adapter according to any one of claims 1 to 8, the side frame portions (12, 14, 16) have a right triangular shape, and the first
An adapter characterized in that the arm (12) and the third arm (16) constitute a short side, and the second arm (14) constitutes an oblique side. (10) An adapter according to claim 9, in which the one or more transverse arms (18) are connected to the third arm (
16) and located at a known distance from the ear support (10). (11) In the adapter according to claim 9 or 10, the triangular side frame portions (12,
14, 16) the acute angle is between 10 and 30 degrees, preferably 20
An adapter characterized by a degree of (12) The adapter according to any one of claims 1 to 11, including a front left-right difference indicator (38), a rear left-right difference indicator (58a),
First arm (12) and transverse arm (18) or N
An adapter characterized in that it consists of a tube filled with a liquid that emits an NMR signal during an MR examination.