Image-guided therapy of a tissue

• US 10,092,367 B2
• Filed: 08/16/2016
• Issued: 10/09/2018
• Est. Priority Date: 03/18/2014
• Status: Active Grant

• Current Assignee: Monteris Medical Incorporated (Monteris Medical US, Inc.)
• Original Assignee: Monteris Medical Incorporated (Monteris Medical US, Inc.)
• Inventors: Andrews, Eric, Grant, Mark, Ren, Brooke, Tyc, Richard
• Primary Examiner(s): TANNER, JOCELIN C
• Application Number:
  US15/237,785
• Publication Number:
  US 20160354175A1
• Time in Patent Office: 784 Days
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/1703 using imaging means, e.g. by X-rays
• CPC Class Codes: A61B 17/1739 specially adapted for particular parts of the body
• CPC Class Codes: A61B 17/3403 Needle locating or guiding means guides for suture needles A61B17/0482; guiding or tracking by nuclear magnetic resonance G01R33/285
• CPC Class Codes: A61B 18/04 by heating by applying electromagnetic radiation A61B18/18; hyperthermia using electric or magnetic fields, radiation or ultrasound A61N
• CPC Class Codes: A61B 18/1477 Needle-like probes
• CPC Class Codes: A61B 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 18/22 the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
• CPC Class Codes: A61B 2018/00011 with fluids
• CPC Class Codes: A61B 2018/00321 Head or parts thereof
• CPC Class Codes: A61B 2018/00446 Brain
• CPC Class Codes: A61B 2018/00791 Temperature
• CPC Class Codes: A61B 2018/0293 using an instrument interstitially inserted into the body, e.g. needle
• CPC Class Codes: A61B 2018/1869 with an instrument interstitially inserted into the body, e.g. needles
• CPC Class Codes: A61B 2018/20361 with redirecting based on sensed condition, e.g. tissue analysis or tissue movement
• CPC Class Codes: A61B 2034/107 Visualisation of planned trajectories or target regions
• CPC Class Codes: A61B 2034/2051 Electromagnetic tracking systems
• CPC Class Codes: A61B 2034/2065 Tracking using image or pattern recognition
• CPC Class Codes: A61B 2090/103 Cranial plugs for access to brain
• CPC Class Codes: A61B 2090/374 NMR or MRI
• CPC Class Codes: A61B 2090/3954 : magnetic, e.g. NMR or MRI
• CPC Class Codes: A61B 2576/026 : for the brain
• CPC Class Codes: A61B 34/10 : Computer-aided planning, simulation or modelling of surgical operations
• CPC Class Codes: A61B 34/20 : Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 5/0035 : adapted for acquisition of images from more than one imaging mode, e.g. combining MRI and optical tomography
• CPC Class Codes: A61B 5/0042 : for the brain
• CPC Class Codes: A61B 5/01 : Measuring temperature of body parts ; Diagnostic temperature sensing, e.g. for malignant or inflamed tissue clinical contact thermometers G01K13/20
• CPC Class Codes: A61B 5/015 : By temperature mapping of body part
• CPC Class Codes: A61B 5/055 : involving electronic [EMR] or nuclear [NMR] magnetic resonance, e.g. magnetic resonance imaging
• CPC Class Codes: A61B 5/4839 : combined with drug delivery
• CPC Class Codes: A61B 5/702 : Posture restraints
• CPC Class Codes: A61B 5/742 : using visual displays A61B5/339 takes precedence
• CPC Class Codes: A61B 5/748 : Selection of a region of interest, e.g. using a graphics tablet
• CPC Class Codes: A61B 6/032 : Transmission computed tomography [CT]
• CPC Class Codes: A61B 6/04 : Positioning of patients; Tiltable beds or the like operating tables A61G13/00; operating chairs A61G15/00
• CPC Class Codes: A61B 6/0421 : with immobilising means
• CPC Class Codes: A61B 6/0492 : using markers or indicia for aiding patient positioning
• CPC Class Codes: A61B 90/11 : with guides for needles or instruments, e.g. arcuate slides or ball joints
• CPC Class Codes: A61B 90/14 : Fixators for body parts, e.g. skull clamps; Constructional details of fixators, e.g. pins
• CPC Class Codes: A61B 90/37 : Surgical systems with images on a monitor during operation
• CPC Class Codes: A61B 90/50 : Supports for surgical instruments, e.g. articulated arms
• CPC Class Codes: A61F 5/37 : Restraining devices for the body or for body parts , e.g. slings; Restraining shirts handcuffs E05B75/00
• CPC Class Codes: A61F 5/3707 : for the head cervical supports A61F5/055; splints A61F5/05883
• CPC Class Codes: A61N 2005/1051 : using an active marker markers in general A61B90/39
• CPC Class Codes: A61N 2005/1055 : using magnetic resonance imaging [MRI]
• CPC Class Codes: A61N 2005/1097 : Means for immobilizing the patient
• CPC Class Codes: A61N 2007/003 : Destruction of nerve tissue
• CPC Class Codes: A61N 2007/0047 : interstitial
• CPC Class Codes: A61N 2007/025 : interstitial
• CPC Class Codes: A61N 5/062 : Photodynamic therapy, i.e. excitation of an agent
• CPC Class Codes: A61N 5/1048 : Monitoring, verifying, controlling systems and methods
• CPC Class Codes: A61N 7/02 : Localised ultrasound hyperthermia hyperthermia in general A61F7/00
• CPC Class Codes: A61N 7/022 : intracavitary
• CPC Class Codes: G16H 30/40 : for processing medical images, e.g. editing

Abstract

Image-guided therapy of a tissue can utilize magnetic resonance imaging (MRI) or another medical imaging device to guide an instrument within the tissue. A workstation can actuate movement of the instrument, and can actuate energy emission and/or cooling of the instrument to effect treatment to the tissue. The workstation and/or an user of the workstation can be located outside a vicinity of an MRI device or other medical imaging device, and drive means for positioning the instrument can be located within the vicinity of the MRI device or the other medical imaging device. The instrument can be an MRI compatible laser or high-intensity focused ultrasound probe that provides thermal therapy to, e.g., a tissue in a brain of a patient.

Claims

1. A system for introducing neurosurgical instruments into a skull of a patient, comprising:

a low profile skull anchor device comprising attachment means to attach to an area of a skull of a patient, wherein

the low profile skull anchor device comprises a central opening for providing access to an entry formed in the skull of the patient, and

the attachment means provides a mounting height of the low profile skull anchor device of 30 millimeters or less from a surface of the skull of the patient;

a removable guide stem comprising a locking means for detachably connecting the guide stem to the low profile skull anchor device;

a guide sheath for inserting a neurosurgical instrument, wherein the guide sheath comprises a proximal opening and at least one distal opening and is configured to extend beyond the low profile skull anchor device and into the entry formed in the skull of the patient; and

a pre-shaped probe for delivery of thermal therapy to a three-dimensional region of tissue in the skull of the patient, the pre-shaped probe having a pre-determined angle of curvature such that the pre-shaped probe is configured to exit the at least one distal opening of the guide sheath following a predetermined curved trajectory path.

2. The system of claim 1, further comprising:

a height locking means for locking a height of the guide sheath.

3. The system of claim 2, wherein the guide sheath comprises a plurality of connection points for mating with the height locking means.

4. The system of claim 3, wherein each consecutive pair of connection points of the plurality of connection points is separated by a precise distance to enable selection of a particular height of a plurality of heights.

5. The system of claim 2, further comprising a second guide sheath for introduction of another neurosurgical instrument, wherein a diameter of the distal opening of the second guide sheath is smaller than the diameter of the distal opening of the guide sheath.

6. The system of claim 5, wherein the second guide sheath is configured for insertion within the guide sheath.

7. The system of claim 1, further comprising a second guide sheath having a smaller diameter opening than the guide sheath, wherein the guide sheath and the second guide sheath are configured to be interchangeably connected to the low profile skull anchor device.

8. The system of claim 7, wherein a shape of the opening of the second guide sheath is different from a shape of an opening of the guide sheath.

9. The system of claim 1, wherein the pre-shaped probe is a laser probe having a diameter of between one-tenth of a millimeter to three millimeters.

10. The system of claim 1, wherein a portion of the pre-shaped probe having the predetermined angle of curvature is between one millimeter to two centimeters in length.

11. The system of claim 1, wherein the pre-determined angle of curvature is maintained by a flexible encasement.

12. The system of claim 11, wherein the flexible encasement comprises a polymer tubing surrounding a laser fiber.

13. The system of claim 1, wherein the guide sheath comprises at least two lumens, wherein the pre-shaped probe is configured for introduction via a first lumen of the at least two lumens, and an additional instrument is configured for contemporaneous introduction via a second lumen of the at least two lumens.

14. The system of claim 1, wherein the pre-shaped probe comprises at least one fiducial marker for validating an angle of deployment during image-guided therapy.

15. The system of claim 1, wherein at least a portion of an interior portion of a central cylindrical portion of the removable guide stem is deformable so as to cover an outer surface of the probe.

16. The system of claim 15, wherein at least a portion of the interior portion of the central cylindrical guide stem is comprised of a shape memory alloy material having a transition temperature that exceeds a maximum temperature associated with a specified thermal therapy.