KR970705947A - 신경외과적 입체 진단 절차를 위한 장치 및 방법(Apparatus and method for neurosurgical stereotactic procedures) - Google Patents

신경외과적 입체 진단 절차를 위한 장치 및 방법(Apparatus and method for neurosurgical stereotactic procedures)

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KR970705947A
KR970705947A KR1019970702160A KR19970702160A KR970705947A KR 970705947 A KR970705947 A KR 970705947A KR 1019970702160 A KR1019970702160 A KR 1019970702160A KR 19970702160 A KR19970702160 A KR 19970702160A KR 970705947 A KR970705947 A KR 970705947A
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로버트 제이 리커
마크 캐롤
제임스 엘. 데이
에릭 지. 밀러
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제임스 엘. 데이
오하이오 메디칼 인스트루먼트 캄파니 인코포레이티드
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    • 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
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • 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
    • 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
    • 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
    • A61B90/50—Supports for surgical instruments, e.g. articulated arms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G13/00—Operating tables; Auxiliary appliances therefor
    • A61G13/10—Parts, details or accessories
    • A61G13/12—Rests specially adapted therefor; Arrangements of patient-supporting surfaces
    • A61G13/1205—Rests specially adapted therefor; Arrangements of patient-supporting surfaces for specific parts of the body
    • A61G13/121—Head or neck
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/107—Visualisation of planned trajectories or target regions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A61B2034/2046—Tracking techniques
    • A61B2034/2059—Mechanical position encoders
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A61B2034/2068—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis using pointers, e.g. pointers having reference marks for determining coordinates of body points
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A61B2034/2072—Reference field transducer attached to an instrument or patient
    • 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
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B2090/363—Use of fiducial points
    • 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
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B2090/364—Correlation of different images or relation of image positions in respect to the body
    • 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
    • A61B90/14—Fixators for body parts, e.g. skull clamps; Constructional details of fixators, e.g. pins

Abstract

환자의 두뇌상에서의 선택된 타겟과 선택된 지점사이의 경로를 디스플레이하고, 임의의 선택된 경로를 따라 수술 기구를 안내하는 장치 및 방법에 개시된다. 본 발명의 시스템(10)은 화상 디스플레이 시스템(12), 관절있는 암 및 프로브(18) 및, 입체진단 시스템(16)으로 구성된다. 관절있는 프로브(18)가 선택된 화상 기준점에 대응하는 환자 기준점을 선택하는데 사용될 수 있도록 서브-시스템들은 서로 결합된다. 이들 기준점들을 사용함으로써, 화상 디스플레이 시스템(12)은 프로브의 상태가 디스플레이된 화상과 함께 디스플레이 될 수 있도록 디스플레이된 화상에 외부 위치를 동시 등록한다. 시스템(10)은 또한 환자 두뇌 내부의 선택된 타겟(T)의 식별을 허용하며, 개두술의 수행전에 외부 위치로부터 타겟까지의 경로를 투영할 수 있도록 한다. 경로 전개후, 외과 의사는 선택된 수술 경로를 유지하고 그 경로를 따라 기구를 안내하기 위해 입체진단 시스템(16)을 적소에 고정시킬 수 있다. 상기 시스템을 사용하여 수술 절차를 수행하는 방법이 또한 설명된다.

Description

신경외과적 입체 진단 절차를 위한 장치 및 방법(Apparatus and method for neurosurgical stereotactic procedures)
본 내용은 요부공개 건이므로 전문내용을 수록하지 않았음
제1도는 본 발명의 원리에 따른 시스템의 일 실시예의 성분들의 개략적인 사시도이다.

Claims (28)

  1. 화상을 표시하기 위한 화상 디스플레이 시스템; 상기 화상 시스템에 결합되어 상기 디스플레이 시스템상에 디스플레이된 화상에 대한 기준을 선택하는 화상 기준 선택기; 상기 화상 시스템에 결합되어 상기 디스플레이 시스템상에 디스플레이된 화상에 대한 타겟을 선택하는 타겟 선택기; 상기 프로브에 관련된 위치가 상기디스플레이된 화상에 표시되도록 상기 화상 시스템에 관하여 프로브에 대한 공간 좌표를 제공하는, 상기 화상 시스템에 결합된 관절있는 암 및 프로브; 상기 화상 시스템 및 상기 관절있는 암에 결합되어 상기 화상 기준 선택기에 의해 선택된 상기 기준에 대응하는 환자에 대한 기준을 선택하는 환자 기준 선택기; 상기 관절있는 암에 의해 제공된 상기 좌표가 상기 디스플레이된 화상과 매치됨으로써 상기 디스플레이된 프로브 위치로부터 상기 선택된 타겟까지의 경로가 상기 디스플레이된 화상 위에 디스플레이될 수 있도록 상기 선택된 화상 기준에 대해 상기 선택된 환자 기준을 동시 등록하기 위한 동시 등록 처리기 및; 상기 관절있는 암의 상기 프로브를 상기 환자의 머리에 근접하게 유지시키고, 상기 환자의 두개골에 근접한 위치를 유지하도록 선택적으로 고정함으로써 외과의사가 상기 프로브 위치와, 상기 선택된 타겟 사이의 상기 디스플레이된 화상상에 디스플레이된 상기 경로를 평가하여 기구 홀더에 삽입된 임의의 기구가 상기 디스플레이된 경로를 따른다는 확신을 갖도록 하는 프로브 홀더를 포함하는 신경외과적 입체진단 시스템.
  2. 제1항에 있어서, 상기 화상 기준 선택기가 오퍼레이터에게 상기 디스플레이된 화상에 대한 상기 기준을 선택할 수 있게 하는 시스템.
  3. 제2항에 있어서, 상기 화상 기준 선택기는, 소정의 수의 화상 기준점 식별기를 제공하는 메뉴 및; 선택된 화상 기준점을 선택적으로 활성화시키기 위한 활성화 아이콘을 추가로 포함하는 시스템.
  4. 제1항에 있어서, 상기 환자 기준 선택기는, 상기 화상 디스플레이 시스템이 상기 관절있는 암 및 프로브로부터 좌표 데이터를 수용하여 환자 기준을 식별할 수 있도록하는 환자 기준을 식별하는 오퍼레이터 활성화된 선택기를 추가로 포함하는 시스템.
  5. 제1항에 있어서, 상기 프로브 홀더는 환자 두개골에 대해 상기 홀더내의 상기 프로브의 배향을 변화시키도록 조절될 수 있는 시스템.
  6. 제5항에 있어서, 상기 배향이 조절될 수 있는 상기 프로브 홀더는 볼 및 소켓 메카니즘을 포함하는 시스템.
  7. 제1항에 있어서, 상기 프로브 홀더는, 환자의 머리에 설치하기 위한 두개골 고리 및; 상기 프로브를 수용하기 위해 위치한 용기를 갖는 이식 플레이트를 추가로 포함하는 시스템.
  8. 제7항에 있어서, 상기 프로브 홀더는, 상기 용기(94)내에 부합되고 상기 용기 내에 고정될 수 있는 볼 및 소켓 메카니즘을 추가로 포함하는 시스템.
  9. 제1항에 있어서, 상기 화상 디스플레이 시스템은, 상기 관절있는 암 및 프로브의 동작을 확인할 수 있도록 위치하는 상기 프로브 및 관절있는 암의 디스플레이를 추가로 포함하는 시스템.
  10. 제1항에 있어서, 상기 동시 등록 처리기는 상기 디스플레이된 방사선 화상을 생성하기 위해 사용된 방사선 데이타와 상기 선택된 환자 기준을 동시 등록하기 위한 반복 알고리즘을 수행하는 시스템.
  11. 제1항에 있어서, 수술 기구를 환자의 머리근처에 선택적으로 위치시키는 입체진단 시스템을 추가로 포함하는 시스템.
  12. 제11항에 있어서, 상기 입체진단 시스템은, 막대가 환자의 머리에서 선택된 타겟을 지시하도록 상기 프로브 홀더 내에 설치될 수 있는 아크 운반 막대; 상기 아크 운반 막대 둘레에 회전 가능하게 설치된 지지체암 및; 아크가 상기 환자의 머리 내의 상기 선태괸 타겟 주위에 중심에 있는 서클을 규정하도록 상기 지지체암에 미끌어지게 설치될 수 있는 아크를 추가로 포함하는 시스템.
  13. 선택된 타겟까지의 수술 경로를 평가하여 확보하는 방법에 있어서, 스캐너 화상 데이터로부터 발생된 화상을 디스플레이하는 단계; 디스플레이된 화상에 대한 기준을 선택하는 단계; 상기 디스플레이된 화상으로부터 외부 지점에 대한 공간 좌표를 제공하는 단계; 상기 제공된 공간 좌표에 의해 한세트의 외부 지점을 선택하는 단계; 상기 선택된 목표와 상기 외부 위치중 한 위치사이의 상기 디스플레이 화상에 경로가 디스플레이될 수 있도록 상기 선택된 화상 기준과 상기 선택된 외부 지점을 동시 등록하는 단계 및; 외과 의사가 상기 외부 지점중 한 지점과 상기 선택된 타겟사이의 상기 디스플레이 화상에 표시된 상기 경로를 평가하고 이 평가를 통해 상기 디스플레이된 경로를 따라 기구를 주입할 수 있도록 환자의 머리주위에 프로브를 선택적으로 확보하는 단계를 포함하는 방법.
  14. 제13항에 있어서, 상기 프로브 위치설정 단계는, 환자의 두개골에 대한 상기 프로브의 배향을 변화시키는 단계 및; 선택된 배향으로 상기 프로브를 선택적으로 고정시키는 단계를 포함하는 방법.
  15. 제13항에 있어서, 관절있는 암 및 프로브의 동작이 입중되도록 관절있는 암 및 프로브를 디스플레이하는 단계를 추가로 포함하는 방법.
  16. 제13항에 있어서, 상기 동시 등록 단계는, 화상 지점의 제1세트를 선택하는 단계; 외부 지점의 제2세트를 선택하는 단계; 각 지점의 세트에 의해 규정된 기하학적 도형의 중심을 산정하는 단계; 상기 제1중심의 상기 제2중심으로의 변화에 대응하는 좌표값으로 상기 지점의 제1세트를 이동시키는 단계; 상기 지점의 제1세트의 변환에 근거하여 장점값을 산정하는 단계; 증가량에 의해 한방향으로 상기 지점의 제1세트를 이동시키는 단계; 상기 지점의 제1세트가 상기 이동되지 않은 지점보다 더 잘 맞는지 평가하는 단계 및; 상기 화상내에 디스플레이된 모든 방향에서의 상기 평가가 상기 장점값보다 작을 경우 상기 지점의 제2세트로 상기 지점의 제1세트를 변환하는 단계를 추가로 포함하는 방법.
  17. 환자의 머리를 보유하는 두개골 클램프; 프로브에 접속된 한쪽 단부와 상기 두개골 클램프에 접속될 수 있는 반대쪽 단부를 갖는 관절있는 암 및; 상기 선택된 위치에서 프로브를 보유하도록 환자의 머리 근처의 선택된 위치에 위치한 프로브 홀더로서, 상기 선택된 위치에서 선택된 배향으로 상기 프로브를 유지시킴으로써 상기 선택된 위치와 환자 머리의 목표점 사이의 경로를 규정하여 상기 경로를 따른 평가 및 수술을 용이하게 하는 프로브 홀더를 포함하는 신경외과적 입체진단 시스템.
  18. 제17항에 있어서, 상기 프로브 홀더가 선택된 위치에 위치하는 제1부재; 프로브를 수용하고 보유하도록 상기 제1부재에 의해 지지되고 상기 제1부재에 대해 이동될 수 있는 제2부재 및; 상기 제1부재에 대한 선택된 배향으로 제2부재 및 프로브를 고정시키기 위한 제1 및 제2부재에 대하여 배치된 클램프를 포함하는 시스템.
  19. 제17항에 있어서, 관절있는 암의 반대쪽 단부와 두개골 클램프 사이에 결합된 베이스를 추가로 포함하는 시스템.
  20. 제19항에 있어서, 상기 두개골 클램프는 상기 두개골 클램프의 암에 접속된 제1접속기를 포함하고, 상기 베이스는 상기 두개골 클램프상의 제1접속기와 접속될 수 있는 제2접속기에 부착된 시스템.
  21. 제20항에 있어서, 상기 베이스는 관절있는 암의 다른쪽 단부에 접속된 샤프트를 수용하고 보유하기 위한 방출 가능한 클램프를 추가로 포함하는 시스템.
  22. 제21항에 있어서, 상기 베이스는 프로브 초기화 공정을 촉진시키기 위해 프로브를 수용 및 보유하는 공극을 추가로 포함하는 시스템.
  23. 제22항에 있어서, 제1비멸균 베이스, 관절있는 암 및 프로브, 제2멸균베이스, 관절있는 암 및 프로브를 추가로 포함하는 시스템.
  24. 제23항에 있어서, 상기 제1 및 제2베이스와 상기 제1접속기 각각은 상기 제1 및 제2베이스가 소정의 배향으로 제1접속기에 접속되도록 중요한 시스템을 갖는 시스템.
  25. 제17항에 있어서, 상기 프로브 홀더는, 선택된 위치에서, 선택된 배향으로 상기 프로브 홀더에 접속가능한 한쪽 단부를 갖는 막대 및; 상기 막대의 반대쪽 단부에 접속가능하며 상기 막대와 다른 위치 및 배향으로 이동가능하고, 상기 프로브를 수용하여 타겟점을 가로지르는 선택된 제2배향에서 상기 프로브를 보유하는 용기를 추가로 포함하는 시스템.
  26. 제17항에 있어서, 상기 프로브 홀더는, 막대; 선택된 배향의 선택된 위치에서 상기 막대를 보유하는 막대 홀더; 상기 막대의 길이 방향의 다른 위치에서 상기 막대에 접속가능한 지지체 암 및; 다른 위치에서 아크 부재에 접속가능하며, 선택된 제2위치에서 상기 타겟점을 가로지르는 선택된 제2배향으로 상기 프로브를 수용하여 보유하는 칼라를 추가로 포함하는 시스템.
  27. 환자를 지지하는 소자; 프로브에 접속된 한쪽 단부와 상기 환자를 지지하는 소자에 접속될 수 있는 다른쪽 단부를 갖는 관절있는 암 및; 환자근처의 선택된 위치에 위치되어 상기 선택된 위치에서 프로브를 보유하며, 상기 선택딘 위치의 제2배향으로 상기 프로브를 유지시킴으로써 상기 선택된 환자내부의 타겟 지점사이에 경로를 규정하여 상기 경로에 따른 평가 및 수술을 용이하게 하는 외과적 입체진단 시스템.
  28. 환자를 지지하는 소자; 이동가능한 단부와 상기 환자를 지지하는 소자에 접속가능한 고정 단부를 갖는 관절있는 암 및; 환자근처의 선택된 위치에 위치되어 상기 선택된 위치에서 상기 관절있는 암의 이동가능한 단부를 보유하며, 상기 선택된 위치의 제2배향으로 상기 관절있는 암의 단부를 유지시킴으로써 상기 선택된 위치와 환자내부의 타겟 지점사이에 경로를 규정하여 상기 경로에 따른 평가 및 수술을 용이하게 하는 외과적 입체 진단 시스템.
    ※ 참고사항 : 최초출원 내용에 의하여 공개하는 것임.
KR1019970702160A 1994-09-30 1995-09-28 신경외과적입체진단절차를위한장치및방법 KR100370302B1 (ko)

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US6071288A (en) 2000-06-06
KR100370302B1 (ko) 2003-05-12
US6423077B2 (en) 2002-07-23
EP0783279B1 (en) 2001-12-05
WO1996010368A2 (en) 1996-04-11
US20010039422A1 (en) 2001-11-08
DE69524434T2 (de) 2002-08-08
BR9509214A (pt) 1997-10-28
DE69524434D1 (de) 2002-01-17
US6261300B1 (en) 2001-07-17
AU3760895A (en) 1996-04-26
WO1996010368A3 (en) 1996-05-30
EP0783279A1 (en) 1997-07-16
US5695501A (en) 1997-12-09

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