Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
  • A61B90/10—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis
  • A61B90/11—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis with guides for needles or instruments, e.g. arcuate slides or ball joints
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/34—Trocars; Puncturing needles
  • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
  • A61B17/3421—Cannulas
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/34—Trocars; Puncturing needles
  • A61B2017/348—Means for supporting the trocar against the body or retaining the trocar inside the body
  • A61B2017/3482—Means for supporting the trocar against the body or retaining the trocar inside the body inside
  • A61B2017/3484—Anchoring means, e.g. spreading-out umbrella-like structure
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
  • A61B90/10—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis
  • A61B2090/103—Cranial plugs for access to brain
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M39/00—Tubes, tube connectors, tube couplings, valves, access sites or the like, specially adapted for medical use
  • A61M39/02—Access sites
  • A61M39/0247—Semi-permanent or permanent transcutaneous or percutaneous access sites to the inside of the body

Definitions

• the invention relates to a holder according to the preamble of claim 1. This can be used in a wide variety of fields.
• biopsies are generally performed as stereotactic interventions.
• the biopsy path is defined based on the trepanation and target point chosen by the surgeon.
• stereotaxy rings and target arcs were used (e.g. the Kelly System, Riechert & Mundinger, CRW, BRW; see also: “Neurosurgery”, RH Wilkins and SS Rengachary, 2nd edition 1996, volume m, pages 4067 f ⁇ where a good overview about the current state of the art). These require a multi-point fixation in the tabula externa of the skull cap (outer layer of the skull bone). This stereotaxi ring fixed in this way must be worn by the patient for several hours, which means a considerable burden for the patient. In addition, the surgical radius of action for the surgeon is limited by the stereotaxy system.
• the invention solves tasks in the field of neurosurgery, for example, which arise from the further development of the magnetic resonance scanner or magnetic resonance device (MRI) to become an interventional magnetic resonance device (IMR).
• IMR interventional magnetic resonance device
• the IMR generates high-quality slice images of the body in real time and, as a technological innovation, allows interventions to be carried out on the patient while the image is being generated.
• individual images generated before the intervention are used as the calculation basis for planning the operation. This method cannot take into account changes between the generation of the slice images and the intervention.
• the fixed auxiliary reference system created and required by the conventional stereotaxic method is no longer required in the IMR since the patient is in the IMR with the reference system defined by the auxiliary device "Flashpoint System" (FPS) connected to the IMR during the entire procedure.
• FPS Flashpoint System
• the FPS is a two- or three-LED guide whose position in three-dimensional space is measured by three cameras.
• the FPS allows the planning of an intervention by defining an axis, which is included in the image generated by the IMR and displayed on a monitor at the same time.
• the virtual axis generated by the FPS is brought into line with the biopsy path.
• the task now is to maintain the found biopsy axis by fixing the FPS in three-dimensional space.
• the manufacturer of the FPS designed this for fixation on a gooseneck.
• the goosenecks known to date do not allow reliable fixation.
• the invention permits perfect fixation in three-dimensional space, since in the selected example it is fixed on the patient's skull. Furthermore, the invention takes up little space and reduces inconvenience and operational stress on the patient to a minimum.
• FIG. 1-18 show an application example of the invention in the field of medicine.
• An MR-compatible version for a biopsy in neurosurgery was chosen as an example. It shows: Fig. 1: Exploded view of the bracket.
• Fig. 2 Assembled and inserted into the skull cap 7 holder with inserted biopsy needle 6.
• Fig. 3 Explosion plan of the localizer.
• Fig. 4 Locator assembled; with attached FPS 10.
• Fig. 5 ram.
• Fig. 6 Exploded view of the combination tool: Duralos and measuring device.
• Fig. 7 Combination tool assembled.
• Fig. 8 Exploded view of the locking sleeve remover.
• Fig. 9 Locking sleeve remover assembled.
• Fig. 10 Insert piece 4 and preload wheel 5 screwed together, before insertion in
• Fig. 11 Insert 4 and preload wheel 5 inserted in skull cap 7.
• Fig. 12 Locking sleeve 3 is inserted with the aid of the plunger 11.
• Fig. 13 Fixing wheel 1 and guide sleeve 2 are inserted into the insert 4.
• Fig. 14 The holder is assembled and ready for use in the skull cap
• Fig. 15 Locking sleeve remover in a relaxed state before removing the
• Fig. 16 Locking sleeve remover snapped into locking sleeve 3 but not yet locked.
• Fig. 17 Locking sleeve remover locked by pressure on the head 15a.
• 18 Removal of the locking sleeve 3.
• the invention is based on the idea of inserting a self-locking holder into the borehole necessary for brain surgery.
• the holder uses the shape of a cylindrical borehole to find a hold without having to rely on third fixing points.
• the FPS 10 is placed on the target pin 9 of the locator (FIG. 4).
• the locator is assembled as shown in FIG. 3.
• the ball joint of the aiming pin 9b is guided through the upper la and lower 8c joint spans contained in the fixing wheel 1 and in the locating stand 8.
• the swivel radius of the target pin 9 is limited by the conical inner surface of the fixing wheel 1 as the guide sleeve in the fixing wheel 1 is later limited.
• the localizer is now held against the patient's head with the pedicles 8a and moved around until the target pin 9 or the axis calculated by the FPS point to the location to be operated.
• the flexible pedicles 8a now make it possible to press the central marker 8b onto the scalp by pressing on the locator and thus to mark the location where drilling is to be carried out.
• the drill and outer radius of the blades 4b are now selected to be the same size.
• the meninges are detached from the inside of the skull cap 7 using the duraloser 12 (FIG. 6).
• the thickness of the skull cap 7 (FIG. 7) can then be measured by means of the measurement scale 12a, which is attached to the duralosolator 12, and the optimum size of the insert 4 can thus be selected.
• the flexible lamellae 4b are reduced to a smaller radius by the protruding hooks 4c compressed.
• the flexible blades 4b spring back into their starting position, whereby the hooks 4c are pressed over the edge of the borehole (FIGS.
• the locking sleeve 3 is then inserted into the insert 4 with the aid of the plunger 11 (FIG. 12). Due to its fit with the inner radius of the flexible slats 4c, the locking sleeve 3 prevents the slats from springing back again.
• the skull cap 7 is clamped between the hook 4b and the preload wheel 5.
• the preload wheel 5 allows different wall thicknesses of the cap 7 to be taken into account.
• the locking sleeve 3 in turn is fixed in position by screwing on the fixing wheel 1.
• Locking sleeve 3 and screwed on fixing wheel 1 form the upper la and lower 3 a integrated joint spans for the ball joint of the guide sleeve 2b.
• the guide sleeve 2 can be pivoted through this joint 2b in a selectable radius. Cones are therefore recessed in the axis of the guide sleeve 2 in the fixing wheel 1 and the locking sleeve 3.
• the guide sleeve 2 can be fixed in its position by turning the fixing wheel 1 (FIGS. 13, 14).
• the biopsy needle 8 can now be inserted into the guide sleeve 2 and the sample removed (FIG. 14).
• the fixing wheel 1 is unscrewed.
• the locking sleeve 3 is then removed with the aid of the locking sleeve remover (FIGS. 8, 9) (FIGS. 15 to 18).
• the pin of the locking sleeve remover 15 is pressed as far as the upper stop of the locking pin 15b in the pin lock 14c.
• the locking sleeve remover can be inserted into the locking sleeve 3, since the expansion slats 14b can be pressed together (FIGS. 15, 16).
• the expansion slats 14b are fixed in their position (FIGS.

Landscapes

• Health & Medical Sciences (AREA)
• Surgery (AREA)
• Life Sciences & Earth Sciences (AREA)
• Heart & Thoracic Surgery (AREA)
• Molecular Biology (AREA)
• Oral & Maxillofacial Surgery (AREA)
• Engineering & Computer Science (AREA)
• Biomedical Technology (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Medical Informatics (AREA)
• Pathology (AREA)
• Animal Behavior & Ethology (AREA)
• General Health & Medical Sciences (AREA)
• Public Health (AREA)
• Veterinary Medicine (AREA)
• Surgical Instruments (AREA)
• Prostheses (AREA)
• Magnetic Resonance Imaging Apparatus (AREA)
• Connection Of Plates (AREA)

Applications Claiming Priority (3)

Publications (1)

Family

ID=4237144

Family Applications (1)

Country Status (7)

Families Citing this family (17)

Family Cites Families (5)

• 1997
  • 1997-10-13 IL IL12508497A patent/IL125084A0/xx unknown
  • 1997-10-13 CA CA002240456A patent/CA2240456A1/en not_active Abandoned
  • 1997-10-13 WO PCT/CH1997/000386 patent/WO1998017191A1/de not_active Application Discontinuation
  • 1997-10-13 JP JP10518768A patent/JP2000502279A/ja active Pending
  • 1997-10-13 EP EP97942749A patent/EP0884980A1/de not_active Withdrawn
  • 1997-10-13 AU AU44493/97A patent/AU4449397A/en not_active Abandoned
• 1998
  • 1998-06-22 NO NO982899A patent/NO982899L/no not_active Application Discontinuation

Non-Patent Citations (1)

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