Method and apparatus for performing stereotactic surgery

• US 4,955,891 A
• Filed: 10/22/1987
• Issued: 09/11/1990
• Est. Priority Date: 07/02/1985
• Status: Expired due to Fees

• Current Assignee: Ohio Medical Instrument Co., Inc.
• Original Assignee: Ohio Medical Instrument Co., Inc.
• Inventors: Carol, Mark P.
• Primary Examiner(s): Yasko, John D.
• Assistant Examiner(s): LEWIS, WILLIAM W
• Application Number:
  US07/111,987
• Time in Patent Office: 1,055 Days
• Field of Search: 128/303 B, 128/395, 128/630, 33/515, 33/511, 604/116, 269/328, 403/90, 403/131, 403/115, 606/129, 606/130
• US Class Current: 606/130
• CPC Class Codes: A61B 90/11 with guides for needles or instruments, e.g. arcuate slides or ball joints
• CPC Class Codes: Y10T 403/32311 Ball and socket
• CPC Class Codes: Y10T 403/32319 including pivot stud
• CPC Class Codes: Y10T 403/32573 Ball stud passes through confining opening
• CPC Class Codes: Y10T 403/32704 Stud extends into ball

Abstract

A method and apparatus for performing stereotactic surgery upon a target within a skull establishes a first, predetermined geometric relationship between a positioning fixture mounted on the skull and a scanning table surface upon which the skull is supported; and that geometric relationship is duplicated in a phantom fixture. An arc device permits entry into the skull by a medical instrument from a plurality of locations upon the skull.

Claims

1. A method for performing stereotactic surgery with a medical instrument upon a target within a skull, comprising the steps of:

(a) establishing a first, predetermined geometric relationship between a positioning fixture attached to both the skull and to a support surface upon which the skull is disposed;

(b) scanning the skull to produce an image of the target within the skull with respect to the positioning fixture;

(c) transferring at least a portion of the positioning fixture to a phantom fixture and disposing the portion of the positioning fixture from the positioning fixture with respect to the phantom fixture to establish a second, predetermined geometric relationship therebetween, which is identical to the first, predetermined geometric relationship, whereby the slope of the skull where the positioning fixture is attached to the skull is duplicated within the phantom fixture;

(d) disposing a phantom target within the phantom fixture at a location which corresponds to the location of the target within the skull;

(e) determining the trajectory and distance of a medical instrument extending from the positioning fixture portion to the phantom target;

(f) attaching the portion of the positioning fixture upon the skull in the same location it was originally attached to the skull;

(g) attaching a carrier member, arc member, and instrument guide member to the positioning fixture; and

(h) inserting the medical instrument through the instrument guide member, whereby the medical instrument will intersect the target in the skull.

2. The method of claim 1, wherein the positioning fixture is attached to the support surface by an attachment member having first and second end portions, and the first, predetermined geometric relationship is the attachment member disposed coplanar with the support surface;

and the second, predetermined geometric relationship is the attachment member disposed coplanar with the phantom fixture.

3. The method of claim 2, including the steps of:

moveably associating the first end portion of the attachment member with respect to the positioning fixture; and

securing the attachment member with respect to the positioning fixture prior to scanning the skull.

4. The method of claim 3, including the steps of:

moveably associating the attachment member with respect to a portion of the positioning fixture by using a positioning ball secured to the first end portion of the attachment member; and

the positioning ball is rotatably received within the positioning fixture.

5. The method of claim 4, including the steps of using as the attachment member an elongate rod, which includes a means for identically orientating the second end portion of the attachment member with respect to both the support surface and the phantom fixture.

6. The method of claim 5, including the steps of:

using a mating tongue and groove connection as the means for identically orientating the second end portion of the attachment member; and

associating the mating tongue and groove connection with the second end of the attachment member and an end of an elongate rod disposed coplanar with the support surface and the phantom fixture.

7. The method of claim 1, including the steps of:

using an outer and inner gimbal in the phantom fixture; and

disposing the positioning fixture portion within the inner gimbal in the second geometric relationship.

8. The method of claim 7, wherein the positioning fixture is attached to the support surface by an attachment member having first and second end portions;

the first, predetermined geometric relationship is the attachment member disposed coplanar with the support surface;

the second geometric relationship is the attachment member disposed coplanar with the phantom fixture; and

, while the positioning fixture portion is fixed with respect to the attachment member, the outer and inner gimbals are adjusted to receive the positioning fixture portion.

9. The method of claim 8, including the steps of locking the inner and outer gimbal with respect to the phantom fixture;

securing the positioning fixture portion within the inner gimbal; and

determining the trajectory and distance of the medical instrument by;

inserting the medical instrument through the positioning fixture until it intersects the phantom target; and

locking the medical instrument with respect to the positioning fixture at the desired trajectory and distance.

10. The method of claim 9, wherein the medical instrument is locked with respect to the positioning fixture portion by:

associating an arc-trajectory ball with the positioning fixture portion;

inserting the medical instrument through the arc-trajectory ball until it intersects the phantom target; and

locking the arc-trajectory ball with respect to the positioning fixture portion.

11. The method of claim 10, including the step of indicating the distance from the positioning fixture to the phantom target when the medical instrument has intersected the phantom target.

12. The method of claim 11, wherein the distance is indicated by associating a depth stop member with the medical instrument after the arc-trajectory ball has been locked.

13. The method of claim 11, including the step of removing the medical instrument from the arc-trajectory ball, and the carrier member is attached to the positioning fixture by attaching the carrier member to the locked arc-trajectory ball.

14. The method of claim 1, including the step of locating the instrument guide member upon the arc member, whereby the medical instrument may enter the skull at a desired location upon the skull.

15. The method of claim 14, further including the step of rotating the arc member about the carrier member, whereby the medical instrument may enter the skull at a desired location upon the skull.

16. A system for performing stereotactic surgery with a medical instrument upon a target within a skull, comprising:

(a) a positioning fixture, having associated therewith, a means for attaching the positioning fixture to both the skull and to a support surface upon which the skull is disposed;

the positioning fixture including means for establishing a first, predetermined geometric relationship between the positioning fixture and the support surface;

(b) a phantom fixture, including;

means for receiving at least a portion of the positioning fixture;

means for establishing a second predetermined geometric relationship between the positioning fixture portion and the phantom fixture, wherein the second geometric relationship is identical to the first geometric relationship, whereby the slope of the skull where the positioning fixture is attached to the skull may be duplicated within the phantom fixture;

(d) the means for attaching the positioning fixture including an attachment member having first and second end portions;

in the first, predetermined geometric relationship, the attachment member is disposed coplanar with the support surface; and

in the second, predetermined geometric relationship, the attachment member is disposed coplanar with the phantom fixture; and

(d) a carrier member adapted for attachment to the positioning fixture, an arc member, adapted for attachment to the carrier member, and an instrument guide member, adapted to be attached to the arc member, whereby the medical instrument may be passed through the instrument guide member to intersect the target by entering the skull at a plurality of locations upon the skull.

17. The system of claim 16, wherein the means for establishing the first, predetermined geometric relationship, includes the first end portion of the attachment member being moveably associated with respect to the positioning fixture;

and the positioning fixture includes means for locking the attachment member with respect to at least a portion of the positioning fixture.

18. The system of claim 17, wherein the first end portion of the attachment member has a positioning ball associated therewith;

and a portion of the positioning fixture includes means for rotatably receiving the positioning ball therein.

19. The system of claim 18, wherein the rotatable receiving means comprise a ball socket member which permits the first positioning ball to rotate therein;

the ball socket member being rotatably mounted with respect to at least a portion of the positioning fixture and includes means for locking the ball socket member with respect to at least a portion of the positioning fixture.

20. The system of claim 19, wherein the ball socket member has an arc-trajectory ball disposed therein, upon the removal of the positioning ball.

21. The system of claim 20, wherein the arc-trajectory ball has a passageway therethrough adapted to permit a medical instrument to pass through the arc-trajectory ball.

22. The system of claim 21, wherein the arc-trajectory ball includes means for attaching the carries member to the positioning fixture.

23. The system of claim 16, wherein the instrument guide member includes means for guiding the medical instrument to predetermined locations within the skull which locations are offset from the target in the skull.

24. An apparatus, useful for performing stereotactic surgery, comprising:

(a) a skull plate member, adapted to be secured to a skull;

(b) a secondary plate member, adapted to overlie the skull plate member;

(c) a ball socket member rotatably received within the secondary plate member;

(d) means for aligning the skull plate member and secondary plate member with respect to one another;

(e) means for locking the ball socket member with respect to the secondary plate member;

(f) an arc-trajectory ball disposed within the ball socket member;

(g) a carrier member attached to the arc-trajectory ball;

(h) an arc member mounted on the carrier member, the arc member being curved substantially along the entire length of the arc member and having a predetermined radius of curvature; and

(i) means for guiding an instrument away from the arc-trajectory ball, the guiding means being mounted on the arc member, and moveable along the arc member.

25. The apparatus of claim 24, including means for locking the arc-trajectory ball within the ball socket member.

26. The apparatus of claim 24, wherein the arc member is adjustably mounted on the carrier member.

27. The apparatus of claim 24, wherein the instrument guide member is adjustably mounted on the arc member.

28. The apparatus of claim 24, wherein the instrument