Target depth locators for trajectory guide for introducing an instrument

• US 20040167542A1
• Filed: 02/20/2003
• Published: 08/26/2004
• Est. Priority Date: 02/20/2003
• Status: Active Grant

• Current Assignee: Image Guided Neurologics, Inc. (Medtronic Plc)
• Original Assignee: Image Guided Neurologics, Inc. (Medtronic Plc)
• Inventors: Skakoon, James G., Solar, Matthew S., Lee, David, Miller, Thomas I., Bridges, Thomas L.
• Granted Patent: US 7,559,935 B2
• Time in Patent Office: Days
• US Class Current: 606/130
• CPC Class Codes: A61B 2017/3405 using mechanical guide means
• CPC Class Codes: A61B 90/11 with guides for needles or instruments, e.g. arcuate slides or ball joints
• CPC Class Codes: A61B 90/39 Markers, e.g. radio-opaque or breast lesions markers

Abstract

This document discusses, among other things, examples of a stereotactic apparatus that includes reticles or other imagable locators for confirming placement of an instrument introduced along a desired trajectory. In certain examples, the reticles are re-positionable with respect to the trajectory to permit placement confirmation along different views. In other examples, the reticles are positionable toward or away from a skull.

Claims

1. An apparatus including:

a mounting base, configured to be locally secured in or about an entry portal in a surface;

a trajectory guide assembly, adjustably coupled to the mounting base, the trajectory guide assembly including at least one adjustably orientable instrument guide structure to establish a trajectory for an instrument to be introduced through the entry portal in the surface; and

first and second imagable locators, coupled to the trajectory guide assembly at respective different first and second positions that are located away from the trajectory, the first and second imagable locators defining a first line therebetween that intersects the trajectory.

2. The apparatus of claim 1, in which the first line substantially orthogonally intersects the trajectory.

3. The apparatus of claim 1, in which the first and second imagable locators are adjustably coupled to the trajectory guide assembly to adjust the first line to intersect the trajectory at different points along the trajectory.

4. The apparatus of claim 1, in which the first line continues to intersect the trajectory as the trajectory guide assembly is adjusted with respect to the mounting base to orient the instrument guide structure.

5. The apparatus of claim 1, in which the first and second imagable locators are positioned away from the trajectory guide assembly such that, when the mounting base is affixed to a skull-shaped surface and the trajectory guide assembly is coupled to the mounting base, the first and second imagable locators are located on opposite sides of the skull-shaped surface.

6. The apparatus of claim 1, in which the first and second imagable locators are carried by at least one positioning assembly that is couplable to the trajectory guide assembly in different orientations to permit the first line to intersect the trajectory from different directions.

7. The apparatus of claim 6, in which the at least one positioning assembly includes at least one positioner configured to permit adjustment of locations of at least one of the first and second imagable locators to adjust the first line to intersect the trajectory at different points along the trajectory.

8. The apparatus of claim 1, in which the first and second imagable locators include alignment reticles.

9. An apparatus for use with a trajectory guide assembly that is adjustably coupled to a mounting base that is configured to be locally secured in or about an entry portal in a surface, the trajectory guide assembly defining a trajectory, through the entry portal, along which an instrument is introduced, the apparatus configured for confirming, using an imaging system, a depth to which the instrument is inserted along the trajectory, the apparatus including:

a positioning assembly that is adapted to be coupled to the trajectory guide assembly; and

first and second imagable locators, coupled to the positioning assembly at respective first and second locations away from the trajectory such that, when the positioning assembly is coupled to the trajectory guide assembly, a first line between the first and second locators intersects the trajectory.

10. The apparatus of claim 9, in which the first line substantially orthogonally intersects the trajectory.

11. The apparatus of claim 9, in which the positioning assembly is adapted to be adjustably coupled to the trajectory guide to adjust the first line to intersect the trajectory at different points along the trajectory.

12. The apparatus of claim 9, in which the first line continues to intersect the trajectory as the trajectory guide assembly is adjusted with respect to the mounting base.

13. The apparatus of claim 9, in which the first and second imagable locators are positioned away from the trajectory guide assembly such that, when the mounting base is affixed to a skull-shaped surface and the trajectory guide assembly is coupled to the mounting base and the positioning assembly is coupled to the trajectory guide assembly, the first and second imagable locators are located on opposite sides of the skull-shaped surface.

14. The apparatus of claim 9, in which the positioning assembly is couplable to the trajectory guide assembly in different orientations to permit the first line to intersect the trajectory from different directions.

15. The apparatus of claim 14, in which the positioning assembly includes at least one positioner configured to permit adjustment of locations of at least one of the first and second imagable locators to adjust the first line to intersect the trajectory at different points along the trajectory.

16. The apparatus of claim 9, in which the first and second imagable locators include alignment reticles.

17. An apparatus including:

an instrument guide structure, configured to be locally secured in or about an entry portal in a skull, the instrument guide structure configured to establish a trajectory for an instrument to be introduced through the entry portal in the surface; and

first and second imagable locators, coupled to the instrument guide structure such that the first and second imagable locators are located on opposing sides of the skull, the first and second imagable locators defining a first line therebetween that intersects the trajectory.

18. The apparatus of claim 17, in which the first line substantially orthogonally intersects the trajectory.

19. The apparatus of claim 17, further including at least one positioning assembly carrying the first and second locators, the at least one positioning assembly coupled to the instrument guide structure, the positioning assembly including a positioner configured to adjust the first line to intersect the trajectory at different points along the trajectory.

20. The apparatus of claim 17, further including at least one positioning assembly carrying the first and second locators, in which the positioning assembly is adapted to be couplable to the instrument guide structure in different orientations to permit the first line to intersect the trajectory from different directions.

21. The apparatus of claim 17, further including at least one positioning assembly carrying the first and second locators, the at least one positioning assembly coupled to the instrument guide structure, the at least one positioning assembly including at least one positioner configured to permit adjustment of locations of at least one of the first and second imagable locators to adjust the first line to intersect the trajectory at different points along the trajectory.

22. The apparatus of claim 17, in which the first and second imagable locators include alignment reticles.

23. An apparatus including:

a mounting base, configured to be locally secured in or about an entry portal in a surface of a skull;

a trajectory guide assembly, adjustably coupled to the mounting base, the trajectory guide assembly including;

an instrument guide structure that is configured to establish a trajectory for an instrument to be introduced through the entry portal in the surface;

a rotational joint, that permits the instrument guide structure to rotate about a first axis concentric to the entry portal and orthogonal to the surface; and

an arc-shaped joint, that permits instrument guide to tilt to adjust an angle between the trajectory and the first axis concentric to the entry portal; and

a positioning assembly, including first and second imagable reticles including respective first and second centers, the positioning assembly adjustably coupled to the instrument guide structure such that a first line between the centers of the first and second imagable reticles intersects the trajectory statically and while the instrument guide is being positioned using the rotational and arc-shaped joints.

24. The apparatus of claim 23, in which the positioning assembly carries the first and second reticles such that they are positioned on opposing sides of the skull.

25. The apparatus of claim 24, in which the first and second reticles are adjustably coupled to the positioning assembly to permit the first and second reticles to be moved toward or away from the skull.

26. The apparatus of claim 24, in which the positioning assembly is rotatably coupled to the instrument guide structure to permit at least some rotation of the first and second reticles about the skull such that the first line intersects the trajectory in a plurality of different directions.

27. The apparatus of claim 24, in which the positioning assembly includes at least one positioner configured to permit adjustment of locations of the first and second reticles to adjust the first line to intersect the trajectory at different points along the trajectory.

28. A method including:

locally mounting a base in or about an entry portal in a surface of a skull;

obtaining a desired trajectory through the entry portal toward a target within the skull;

inserting an instrument along the trajectory;

positioning first and second imagable locators on opposing sides of the skull; and

determining a depth of the instrument along the trajectory to ensure that the instrument has reached the target, in which the determining includes obtaining an image of the first and second imagable locators and the instrument.

29. The method of claim 28, in which the locally mounting the base includes securing a trajectory guide in or about a burr hole in the skull.

30. The method of claim 28, in which the obtaining the desired trajectory includes adjusting an instrument guide with respect to the base.

31. The method of claim 30, in which the obtaining the desired trajectory includes custom-fabricating an instrument guide, to point the trajectory toward the target, using images of the skull and the target.

32. The method of claim 28, in which the obtaining the desired trajectory includes at least one of:

rotating an instrument guide about an axis concentric to the burr hole and orthogonal to the skull surface; and

tilting the instrument guide to adjust an angle between the trajectory and the axis.

33. The method of claim 28, in which the positioning the first and second imagable locators includes coupling a positioning assembly to an instrument guide in one of a plurality of possible orientations in which a first line between the first and second imagable locators intersects the trajectory.

34. The method of claim 28, in which the positioning the first and second imagable locators includes coupling at least a portion of a positioning assembly to an instrument guide in one of a plurality of possible positions such that a first line between the first and second imagable locators intersects the trajectory in a desired one of a plurality of different points along the trajectory, the desired one of the plurality of different points'"'"' along the trajectory corresponding to a location of the target on the trajectory.

35. A method including:

locally mounting a base in or about an entry portal in a surface of a skull;

adjusting an orientation of an instrument guide structure, with respect to the base, to obtain a desired trajectory through the entry portal toward a target within the skull;

inserting an instrument along the trajectory using the instrument guide structure to guide the instrument along the trajectory;

coupling first and second imagable locators to the instrument guide structure such that a first line between the first and second imagable locators intersects the trajectory; and

determining a depth of the instrument along the trajectory to ensure that the instrument has reached the target, in which the determining includes obtaining an image of the first and second imagable locators and the instrument.

36. The method of claim 35, in which the locally mounting the base includes securing a trajectory guide in or around a burr hole in the skull.

37. The method of claim 35, in which the adjusting the orientation of the instrument guide structure includes at least one of:

rotating a portion of the instrument guide structure about an axis concentric to the burr hole and orthogonal to the skull surface; and

tilting a portion of the instrument guide structure to adjust an angle between the trajectory and the axis.

38. The method of claim 35, in which the positioning the first and second imagable locators includes coupling a positioning assembly to the instrument guide in one of a plurality of possible orientations in which a first line between the first and second imagable locators intersects the trajectory.

39. The method of claim 35, in which the positioning the first and second imagable locators includes coupling at least a portion of a positioning assembly to the instrument guide in one of a plurality of possible positions such that a first line between the first and second imagable locators intersects the trajectory in a desired one of a plurality of different points along the trajectory, the desired one of the plurality of different points along the trajectory corresponding to a location of the target on the trajectory.

40. The method of claim 35, in which the positioning the first and second imagable locators includes moving at least one of the imagable locators toward or away from the skull to obtain a desired position, and securing the at least one of the imagable locators at the desired position.