JPH0620467B2 - Stereotaxic surgery equipment - Google Patents

Description

Detailed Description of the Invention [Industrial applications]

The present invention relates to a stereotactic brain surgery (hereinafter, referred to as CT guided stereotactic brain surgery) apparatus that is preferably used in cooperation with a computer tomography apparatus.

[Prior art]

Conventionally, the above CT-guided stereotactic brain surgery has been performed in order to more easily and accurately treat a brain tumor, cerebral hemorrhage, and the like. With this means, a therapeutic needle is inserted into the affected area while grasping the position and range of the affected area by X-ray tomography with a computer tomography apparatus (hereinafter referred to as CT scanner), and suction / removal of the affected area is performed. Be seen. The outline of the apparatus used for this CT guided stereotactic brain surgery will be described below with reference to FIGS. 5 and 6. FIG. 5 is an exploded perspective view of this device. In the figure, 5
0 is a fixed frame of the patient's head, 51 is a head fixing pin, 52 is a marker, 53 is a treatment needle (not shown) attached to the treatment needle holder 54, and is translated in the X, Y, and Z directions of the drawing. ,
The moving frame is configured to be rotated in the A and B directions. The fixing frame 50 has through holes 55 through which the head of the patient is inserted in the central portion thereof, and the head fixing pins 5 are provided at four locations around the through hole 55.
A fixing pin mounting portion 59 including a boss 57 having one mounting hole 56 and a screw 58 is formed. Further, attachment portions 60 for the markers 52 are provided at a total of three locations on the upper side and both sides of the figure. Further, the movable frame 53 is provided on both sides of the fixed frame 50.
A slide guide groove 61 in the Y direction is formed. On the other hand, the movable frame 53 is slidably engaged with the slide guide groove 61 of the fixed frame 50 and can be positioned at an arbitrary position, and a Y-axis slider 62 formed on the Y-axis slider 62 in the Z-axis direction. Guide rail 63 and Z-axis slider 64, this Z
A U-shaped moving frame main body 66 held so as to be rotatable around the central axis a of the ring portion 65 with respect to the shaft slider 64,
An X-axis slider 67 whose position can be adjusted in the X-direction with respect to the moving frame main body 66, and further, moves the treatment needle holder 54 in the B-direction on a trajectory that moves simultaneously with the X-axis slider 67 and has a point O as a rotation center in the drawing. It is composed of a holder guide 68 to be moved. FIG. 6 is a plan view of the therapeutic needle holder 54, and as shown in the figure, the therapeutic needle holder 54 comprises a holder base 69 and a holder main body 70. In the holder main body 70, the central axis b of the therapeutic needle is moved by the holder base 69.
It is held at a height intersecting with the rotation center a of 3 and is fixed by a set screw 72 at an arbitrary position in the axial direction. Also,
The holder base 69 is positioned on the holder guide 68 by a fixing screw 71. The method of using this device is as follows. First, the fixed frame 50 is attached to a bed (not shown) of the CT scanner via a mounting base (not shown). Then, the head of the patient is fixed with a fixing frame 50 so that the top of the head is on the left side in FIG.
Then, the fixing pin 51 is fixed to the fixing frame 50 by attaching the fixing pin 51 to the pin attaching portion 59 of the fixing frame 50 in that state. Next, the three marker attachment parts 6 provided on the fixed frame 50.
Marker 52 is attached to 0 and X is set in the gantry (not shown)
Computed tomography with lines etc. is performed. Then, the affected area to be treated is determined as the target point on this captured image,
Measure and record the position. Further, the movable frame 53 is attached to the fixed frame 50, and the treatment needle holder 54 is moved to X, Y, Z and A, according to the measurement position.
The position is adjusted in each direction of B, and a therapeutic needle is inserted into the head to suction and remove the affected area. After that, when the suction / removal of the affected area is completed, the operation is completed by suturing the skin.

[Problems to be Solved by the Invention]

By the way, the affected area to be treated appears at various positions in the brain, but the position of the therapeutic needle to be inserted is such that brain damage does not occur and the operation needle can be easily inserted with a shallow depth of insertion. A position with a condition that can be performed is selected. Therefore, in order to satisfy these conditions, it may be preferable to perform an operation by inserting a needle from the side of the head. In order to insert the treatment needle from the side of the head like this,
The adjustment range in the direction B in the figure must be as large as possible, but in the conventional stereotactic brain surgery device, the adjustment range was set to about 30 ° to the left and right with respect to the central axis b. Therefore, the lateral insertion position of the treatment needle is considerably regulated. The reason for this is that the holder guide 68 of the moving frame 53 is provided so that a larger adjustment range can be obtained.
This is because even if the length of the arc is lengthened, a part of it may interfere with the gantry, or it may be difficult to operate the treatment needle due to space limitations. Therefore, the technical problem to be solved by the present invention is that in the stereotactic brain surgery device, the angle adjustment range with respect to the central axis b of the treatment needle is configured to be larger, and the treatment needle interferes with the gantry during the large angle adjustment. Or to prevent the operation from becoming difficult.

[Means, actions and effects for solving the problems]

In order to solve the above technical problem, according to the present invention, a holder main body is mounted on a holder base, a main body part is also on the rotation center side of the holder base, and the holder base and its rotation center are A holding portion that is arranged so as to be displaced from the connecting straight line in the movement direction of the holder base and that holds the treatment needle so that the insertion tip of the treatment needle is directed to the rotation center, and this holding portion in the axial direction of the held treatment needle. There is provided a stereotactic brain surgery device comprising an axial position adjusting means for movably positioning the body relative to the main body. In this configuration, the treatment needle is deviated from the straight line connecting the holder base and its rotation center (this straight line coincides with the axis of the conventional treatment needle), and the insertion tip is directed toward the rotation center. By setting the angle formed by the straight line and the treatment needle to be, for example, 30 ° by being held by the holding portion, the treatment needle has a piercing tip when the holder body is mounted on the holder base. The position of the center of rotation is not changed, and the position of the needle is positioned with an angle difference of 30 ° with respect to the position of the conventional treatment needle. Since the position of the treatment needle can be continuously adjusted, the adjustment range of the conventional treatment needle is expanded by 30 ° in the above-mentioned deviation direction. The treatment needle can be moved in the axial direction, that is, toward the center point side by moving the holding portion with respect to the main body portion by the axial position adjusting means. On the other hand, even when this therapeutic needle holder is attached to the holder guide of the CT guided stereotactic brain surgery device, there is a gantry for tomography around the holder guide, but the holding part is located closer to the center point than the holder guide. Therefore, even if the position of the therapeutic needle is adjusted to the maximum angle, it is possible to prevent the needle from interfering with the gantry and being difficult to operate.
Therefore, stereotactic brain surgery can be performed more easily and accurately. In the above configuration, the main body is
It is preferable that the apparatus is mounted so as to be rotatable about a rotation axis passing through the rotation center and has a rotation position adjusting means for positioning the rotation position. In this configuration, since the main body can be pivotably positioned with respect to the holder base about the rotation axis passing through the rotation center, the treatment needle holder is left and right with respect to the center of the fixed frame or the movable frame. It is possible to selectively determine the position of the main body with respect to the axis of the holder base depending on which of the two. Therefore, it is not necessary to replace the holder main body irrespective of whether the treatment needle holder is located on the left or right side, and one treatment needle holder can provide a large adjustment range. Further, in the above configuration, the axial position adjusting means is pivoted to the rack arranged in the main body portion in parallel with the axis of the treatment needle held in the holding portion and the holding portion so as to mesh with the rack. It is preferable that the pinion is rotatably supported, and an operation knob that rotates integrally with the pinion. In this configuration, since the treatment needle can be moved in the axial direction by simply rotating the knob, the operation is extremely easy, and if a scale indicating the movement amount of the holding portion is provided near the rack. The operation can be performed more easily. When the main body is configured to be rotatable around the axis of the holder base as in the above-described configuration, it is preferable that the operation knobs are provided on both sides of the pinion because the upper and lower sides of the holding section are interchanged. . Further, in the above structure, the main body portion is fixed to the holder base about the rotation axis as a central axis, and the fixed axis is connected to the holding portion, and the rotation axis is fixed to the fixed axis. Preferably, the rotational position adjusting means is configured as a means for positioning the rotational position of the connecting portion with respect to the fixed shaft. In this configuration, since the fixed shaft is fixed to the holder base instead of the conventional holder main body, replacement or the like can be easily performed, and the treatment can be performed while the fixed shaft is fixed to the holder main body by the rotation position adjusting means. Since the position of the needle can be adjusted, the operability is further improved.

【Example】

An embodiment of the present invention shown in FIGS. 1 to 4 will be described below in detail. FIG. 1 is a partially cutaway plan view of a holder main body 1 which constitutes a therapeutic needle holder of a stereotactic brain surgery device according to an embodiment of the present invention, and FIG. 2 is a sectional view taken along line II-II of FIG. FIG. 3 and FIG. 3 are sectional views taken along line III-III in FIG. Further, FIG. 4 shows a plan view of the holder body 1 attached to the holder base 69 and attached to the moving frame of the conventional stereotactic brain surgery device via the arc-shaped holder guide 68. ing. As shown in FIG. 4, the holder base 69 is exactly the same as that described in the conventional example. The holder main body 1 has a first mutual angle of 30 °.
A substantially triangular connecting member 2 having a side 5 and a second side 15,
The fixed shaft 4 that projects from the connecting member 2 in the direction in which the first side 5 extends and is mounted on the holder base 69, and the mounting hole 25 for the treatment needle are formed at the tip end along a direction parallel to the second side. Arm 3 as a holding portion for the treated treatment needle. It should be noted that the mounting hole 25 has its central axis oriented toward the point O (FIG. 5) shown in the conventional example when the holder body 1 is mounted on the holder base 69 and mounted on the stereotaxic apparatus. Has been formed. The fixed shaft 4 is a holder body 7 shown in FIG. 6 as a conventional example.
Cylindrical portion 70 mounted on the holder base 69 at 0
The shaft portion 7 is formed to have an outer diameter substantially the same as that of a, and the pin portion 8 is formed to have the same axial center as the shaft portion 7 and a smaller diameter than the shaft portion 7. A circumferential groove 9 is formed at a position on the shaft portion 7 side of the pin portion 8, and a groove 10 extending in the axial direction is provided at a position closer to the tip end of the pin portion 8 than the circumferential groove 9.
As shown in FIG. 2, they are formed at positions facing each other. On the other hand, the first side 5 of the connecting member 2 has a shaft mounting hole 26 having a diameter slightly larger than the pin portion 8 of the fixed shaft 4.
Is formed, and the pin portion 8 is rotatably inserted therein. A screw hole is formed in the connecting member 2 at a position corresponding to the circumferential groove 9 of the pin portion 8, and a set screw 11 is screwed into the screw hole to prevent the fixed shaft 4 from coming off. Similarly, a screw hole is also formed at a position corresponding to the groove 10 in the axial direction, and an adjusting screw 12 including a knob portion 13 and a screw portion 14 is screwed therein as a rotational position adjusting means of the treatment needle. There is. Therefore, the fixed shaft 4 is reliably prevented from rotating at the groove 10 by the adjusting screw 12. A rack 6 which also serves as a guide rail for the arm 3 is mounted on the second side 15 of the connecting member 2, while the inside of the I-shaped arm 3 has a receiving groove for the guide rail as shown in FIG. 21 is formed, and the pinion 16 that meshes with the rack 6 is housed therein. The pinion 16 is mutually locked by two operating knobs 17 provided on the upper and lower sides of the arm 3 and a connecting shaft 27. Therefore, by rotating any one of the operating knobs 17, the pinion 16 also rotates at the same time. . Further, as shown in FIG. 1, a positioning screw 22 including a knob portion 23 and a screw portion 24 is screwed toward the rack 6 at a lateral position of the operation knob 17. Although not shown, since the rack is graduated, the arm 3 can be fixed at any position by rotating the positioning screw 22. Also, at the tip of this arm 3,
A threaded hole is formed toward the center of the mounting hole 25 of the therapeutic needle, and a fixing screw 18 of the therapeutic needle including a knob portion 19 and a screw portion 20 is screwed into the threaded hole. As described above, FIG. 4 shows the holder main body 1 mounted on the conventional holder base 69. Fixed shaft 4
Has an outer diameter that is the same as the outer diameter of the conventional holder body 70 (FIG. 6).
9 is securely fixed to the plate 9 with a set screw 72. By mounting the holder main body 1 on the holder base 69, the axis of the treatment needle (not shown) attached to the arm 3 with the fixing screw 18 is 3 with respect to the attachment center of the holder base 69.
Tilt at 0 °. Therefore, when the mounting center of the holder base 69 is set at a position inclined by, for example, 30 ° with respect to the central axis of the moving frame, the treatment needle itself is inclined by a total of 60 ° with respect to the central axis. When the holder base 69 is set on the center axis of the moving frame, the axis of the treatment needle is inclined by 30 ° with respect to the center axis, and the holder base is moved to move the treatment needle to the center axis. Since the needle can be positioned above, the therapeutic needle can be continuously adjusted from the central axis to a position inclined by 60 ° with respect to the central axis. FIG. 4 shows a state where the holder base 69 is moved to the right of the center of the holder guide 68. However, when the holder base 69 is moved to the left of the center of the holder guide 68, the adjustment screw 12 By operating the and rotating the connecting member 2 by 180 ° with respect to the fixed shaft 4 to fix the connecting member 2, the condition can be set symmetrically with FIG. 12
The 0 ° range is covered. When performing stereotactic brain surgery using the holder main body having the above-described configuration, the holder main body 1 is located closer to the center point than the holder guide 68, and therefore the position of the treatment needle is set to the maximum angle with respect to the moving frame. Even when inserting the treatment needle from the side of the head, the treatment needle may interfere with the gantry,
The operation is not difficult to perform. Also,
Since the treatment needle attached to the arm 3 is directed to the point O shown in FIG. 5, it is easy and accurate to insert the treatment needle toward the affected area measured by tomography.

[Brief description of drawings]

1 to 3 show a holder main body of a therapeutic needle holder used in a stereotactic brain surgery apparatus according to the present invention. FIG. 1 is a partially cutaway plan view, and FIG. 2 is II- of FIG. II sectional view,
FIG. 3 is a sectional view taken along the line III-III of FIG. 2, FIG. 4 is a plan view of the therapeutic needle holder mounted on an arc-shaped holder guide, and FIG. 5 is an exploded perspective view of a conventional stereotactic brain surgery device. Figure, 6th
FIG. 1 is a plan view of a conventional stereotactic brain surgery device in which a treatment needle holder is attached to a holder guide. 1 ... Holder body, 2, 7 ... Main body part (2 ... Connection part (connection member), 7 ... Shaft part), 3 ... Holding part (arm), 4 ... Mounting part (fixed shaft), 5: First side, 6, 1
6, 17 ... Axial position adjusting means (6 ... rack, 16
...... Pinion, 17 …… Operation knob), 8 …… Pin part,
9 ... circumferential groove, 10 ... axial groove, 11 ... set screw,
12 ... Rotational position adjusting means (adjustment screw), 13 ... Knob part, 14 ... Screw part, 15 ... Second side, 18 ... Fixing screw, 19 ... Knob part, 20 ... Screw part, 21 ...... Guide rail receiving groove, 22 …… Set screw, 23 …… Knob part, 24 …… Screw part, 25 …… Treatment needle mounting hole, 26
...... Shaft mounting hole, 27 ...... Connection shaft, 50 ...... Fixed frame, 53
…… Movement frame, 54 …… Treatment needle holder, 68 …… Holder guide, 69 …… Holder base

Claims (4)

[Claims] 1. A fixing frame (50) for fixing the position of a patient's head.
And a moving frame (53) configured to be positionable with respect to the fixed frame (50). The moving frame (53) moves the treatment needle holder (54) to a predetermined center point (O). The treatment needle holder (54) has a holder guide (68) that rotates and moves, and the treatment needle holder (54) has a holder base (69) that moves in an arc shape on the holder guide (68), and the holder base (69).
A stereotactic brain surgery device comprising: a holder body (1) attached to a holder for holding a treatment needle, wherein the holder body (1) is a body portion (2, 7) attached to the holder base (69). And the holder base (6) on the side of the center point (O) with respect to the main body (2, 7).
9) Holding to hold the treatment needle so as to be displaced from the straight line connecting the center point (O) and the movement direction of the holder base and to direct the insertion tip of the treatment needle toward the center point (O). Axial position adjusting means (6, 16, 1) for moving the holding part (3) relative to the body part (2, 7) in the axial direction of the part (3) and the held therapeutic needle.
A stereotactic brain surgery device comprising: 7). 2. The main body (2, 7) is rotatably mounted on the holder base (69) about a rotational axis (b) passing through the central point (O) as a central axis. ,
Rotational position adjusting means (12) for positioning the rotational position
The stereotactic brain surgery device according to claim 1, further comprising: 3. The axial position adjusting means comprises a rack (6) arranged on the main body (2, 7) in parallel with the axis of the therapeutic needle held by the holding portion (3), and The pinion (16) is rotatably supported by the holding portion (3) so as to mesh with the rack (6), and the operation knob (17) is rotated integrally with the pinion (16). The stereotactic brain surgery device according to claim 1, wherein 4. The fixed shaft (7) fixed to the holder base (69) about the rotary shaft center (b) as a central axis, and the fixed shaft (7). The rotation position adjusting means (12) has a connecting part (2) that connects the holding part (3) and is rotatable about the rotation axis (b) with respect to the fixed shaft (7). 3.) The stereotactic brain surgery device according to claim 2, wherein the means (3) is a means for positioning the rotational position of the connecting portion (2) with respect to the fixed shaft (7).