Apparatus and method for surgical stereotactic procedures

• US 6,261,300 B1
• Filed: 04/20/2000
• Issued: 07/17/2001
• Est. Priority Date: 09/30/1994
• Status: Expired due to Term

• Current Assignee: Schaerer Medical USA Incorporated
• Original Assignee: Ohio Medical Instrument Co., Inc.
• Inventors: Day, James L., Riker, Robert J., Miller, Erik G., Carol, Mark
• Primary Examiner(s): Philogene, Pedro
• Application Number:
  US09/553,508
• Time in Patent Office: 453 Days
• Field of Search: 606/130, 606/1, 600/417, 600/429
• US Class Current: 606/130
• CPC Class Codes: A61B 2034/107 Visualisation of planned trajectories or target regions
• CPC Class Codes: A61B 2034/2059 Mechanical position encoders
• CPC Class Codes: A61B 2034/2068 using pointers, e.g. pointers having reference marks for determining coordinates of body points
• CPC Class Codes: A61B 2034/2072 Reference field transducer attached to an instrument or patient
• CPC Class Codes: A61B 2090/363 Use of fiducial points
• CPC Class Codes: A61B 2090/364 Correlation of different images or relation of image positions in respect to the body
• 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 90/10 for stereotaxic surgery, e.g. frame-based stereotaxis
• 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 90/36 Image-producing devices or illumination devices not otherwise provided for
• CPC Class Codes: A61B 90/50 Supports for surgical instruments, e.g. articulated arms

Abstract

An apparatus and method are disclosed for displaying a path between a selected target and selected points on a patient'"'"'s skull and for guiding surgical instruments along any selected path. The system is comprised of an image display system, an articulated arm and probe, and a stereotactic system. The sub-systems are coupled to one another so that the articulated probe may be used to select patient fiducial points that correspond to selected image fiducial points. Using these points, the image display system coregisters the external locations to the displayed images so that the probe condition may be displayed with the displayed images. The system further permits the identification of a selected target within a patient'"'"'s brain and to project a path from the external position to the target prior to the performance of a craniotomy. After evaluation of the path, a surgeon may lock the stereotactic system in place to preserve a selected surgical path and to guide instruments along that path. A method of utilizing the system to perform such surgical procedures is also described.

Claims

1. A tooling support for use during a stereotactic procedure performed on a patient supported by a patient support comprising:

a support apparatus adapted to connect to the patient support; and

a tool holder mounted to the support apparatus and movable to selected positions proximate the patient, the tool holder comprising

an alignment element rotatably mounted on the tool holder and adapted to receive a tool, the alignment element being selectively rotatable to change an orientation of the alignment element without changing its position with respect to the patient, thereby defining a path between the tool and a target point within the patient, and

a clamp operably mounted with respect to the alignment element for selectively locking the alignment element in the tool holder at an orientation directing the tool along the path.

2. The tooling support of claim 1 wherein the support apparatus comprises one end adapted to be connected to the patient support and an opposite end connected to the tool holder.

3. The tooling support of claim 2 wherein the patient support includes a skull clamp and the one end of the support apparatus is mounted to the skull clamp.

4. The tooling support of claim 2 wherein the patient support includes a table and the one end of the support apparatus is mounted to the table.

5. The tooling support of claim 1 wherein the tool that the alignment element is adapted to receive is a probe coupled to a spatial coordinate generator.

6. The tooling support of claim 1 wherein the support apparatus comprises an adjustable arm assembly.

7. The tooling support of claim 6 wherein the adjustable arm assembly comprises at least two arms.

8. The tooling support of claim 6 wherein the support apparatus further comprises:

a first shaft having one end adjustably coupled to the patient support; and

a second shaft having one end rotatably connected to an opposite end of the first shaft to permit the second shaft to be oriented at an angle with respect to the first shaft, whereby the tool holder is selectively moved to a desired position by adjusting the positions of the first and second shafts.

9. The tooling support of claim 8 further comprising a block adapted to be mounted to the patient support and coupled to the one end of the first shaft.

10. The tooling support of claim 9 wherein the block is rotatably coupled to the one end of the first shaft.

11. A tooling support for use during a stereotactic procedure performed on a patient supported by a patient support comprising:

an adjustable arm assembly having one end adapted to connect to the patient support; and

a tool holder mounted on an opposite end of the adjustable arm assembly and movable to selected positions proximate the patient, the tool holder comprising

a generally spherical alignment element rotatably mounted on the tool holder and adapted to receive a tool, the alignment element being pivotable with respect to the tool holder to define a path between the tool and a target point within the patient, and

a clamp operably mounted with respect to the alignment element for selectively locking the alignment element in the tool holder at an orientation directing the tool along the path.

12. A tooling support for use during a stereotactic procedure performed on a patient supported by a patient support comprising:

a mount adapted to connect to the patient support;

a first shaft having one end adjustably coupled to the mount;

a second shaft having one end adjustably coupled to an opposite end of the first shaft to permit the second shaft to be oriented at different angles with respect to the first shaft; and

a tool holder mounted at an opposite end of the second shaft and adapted to receive a tool, the tool holder including an alignment element rotatably mounted in the tool holder and adapted to receive a tool at a desired position with respect to the patient, the alignment element being selectively adjustable to move the tool to an orientation directing the tool along a path between a target point within the patient; and

a clamp operably connected to the alignment element for selectively locking the alignment element with respect to the tool holder at the orientation directing the tool along the path.

13. An apparatus for use during a stereotactic procedure comprising:

a skull clamp for holding a patient'"'"'s head in a desired position;

an arm having a first end connected to the skull clamp; and

a probe holder mounted on the arm and adapted to hold a probe, the arm being movable to locate the probe holder in proximity to a patient at a desired position, the probe holder being pivotable at the desired position with respect to the patient to allow a surgeon to evaluate and establish a desired path between the desired position and a target located in the head of the patient, the probe holder being lockable to fix the probe holder supporting the probe at a desired orientation directing the probe along the desired path.

14. The apparatus of claim 13 wherein the probe holder comprises a ball and socket mechanism, the ball being lockable within the socket.

15. The apparatus of claim 13 wherein the arm further comprises at least two adjustable arms adjustably supporting the probe holder with respect to the skull clamp.

16. The apparatus of claim 13 wherein the probe holder is also adapted to receive an instrument in a manner so as to align the instrument with the target along the desired path.

17. A stereotactic guide device for use with a neurosurgical headclamp comprising an arm having a proximal end and a distal end, an attachment device carried by the proximal end for securing the arm to the headclamp in a spacial position close to a patient'"'"'s head, a chuck device secured to the distal end of the arm, the chuck including an external body and a ball freely rotatable about its center in the external body, the ball capable of axially guiding an elongated surgical instrument therethrough, and a locking device to releasably lock the ball in a selected orientation relative to the external body.

18. An apparatus for use during a stereotactic surgical procedure, the apparatus comprising:

a probe holder having a swivel socket,

an alignment ball moveably inserted into the swivel socket, the alignment ball having a bore adapted to receive a surgical tool, and

a screw extending through the swivel socket for locking the alignment ball within the swivel socket; and

an arm assembly having a first end adapted to mount the apparatus to a skull clamp fixed to the head of a patient,

a second end terminating into the probe holder, and adjustable arms and joints for adjusting the probe holder at a desired position with respect to the head of the patient.

19. The apparatus of claim 18 wherein the arm assembly comprises a sunburst connector connectable to the skull clamp.

22. The apparatus of claim 18 wherein the adjustable arms comprise

a first adjustable arm extending from a joint connected to the skull clamp; and

a second adjustable arm extending from a joint on the first adjustable arm.

23. The apparatus of one of the claims 22 wherein the second adjustable arm terminates in the probe holder.

20. The apparatus of 19 wherein the adjustable arms comprise a rigid offset arm having one end extending from the starburst connector.

21. The apparatus of claim 20 wherein an opposite end of the rigid offset arm is rotatable connected to another adjustable arm.

24. A tooling support for use during with an imaging system during a stereotactic procedure being performed on a patient comprising:

a tool holder locatable at a desired position with respect to the patient, the tool holder comprising

an alignment element rotatably mounted on the tool holder and being selectively rotatable to change an orientation of the alignment element without changing its position with respect to the patient, and

a clamp operably mounted with respect to the alignment element for selectively locking the alignment element,

the alignment element adapted to support a probe and being pivotable at its position with respect to the patient to allow a surgeon to evaluate and establish a desired path as displayed on the imaging system between the probe and a selected target point, the alignment element being lockable with the clamp to fix the alignment element supporting the probe at a desired orientation directing the probe along the desired path, and thereafter, upon removing the probe, the alignment element adapted to receive an instrument, and the alignment element providing independent of the imaging system, support and guidance for the instrument so that the instrument follows the desired path.

25. The tooling support of claim 24 wherein the tool holder is attached to the patient.

26. The tooling support of claim 24 wherein the tool holder is attached to a patient support.

27. The tooling support of claim 26 wherein the tool holder is mounted to a patient support.

28. A tooling support for use with an imaging system during a stereotactic procedure performed on a patient comprising a tool holder adapted to be mounted at a desired position on a patient, the tool holder comprising a lockable, rotatable alignment element adapted to support a probe connected to the imaging system and being pivotable at the desired position with respect to the patient to allow a surgeon to evaluate and establish a desired path as displayed on the imaging system between the probe and a selected target point, the tool holder being lockable to fix the tool holder supporting the probe at a desired orientation directing the probe along the desired path, and thereafter, upon removing the probe, the tool holder adapted to receive an instrument, and the tool holder providing independent of the imaging system, support and guidance for the instrument so that the instrument follows the desired path.

29. A tooling support for use with an imaging system during a stereotactic procedure performed on a patient comprising a tool holder adapted to be mounted at a desired position with respect to a patient, the tool holder comprising a lockable, rotatable alignment element adapted to support a probe connected to the imaging system and being pivotable at the desired position with respect to the patient to allow a surgeon to evaluate and establish a desired path as displayed on the imaging system between the probe and a selected target point, the tool holder being lockable to fix the tool holder supporting the probe at a desired orientation directing the probe along the desired path, and thereafter, upon removing the probe, the tool holder adapted to receive an instrument, the tool holder providing independent of the imaging system, support and guidance for the instrument so that the instrument follows the desired path.

30. A method for using a tool holder and an imaging system for evaluating and securing a surgical path to a target point within a patient comprising:

releasably securing a tool holder with respect to a patient;

supporting a probe in the holder;

displaying a path on the imaging system extending from the probe;

rotating an alignment element on the tool holder to a desired orientation causing the path being displayed on the imaging system to extend from the probe to the target point;

releasably locking the alignment element at the desired orientation; and

removing the probe and inserting an instrument, the tool holder providing independent of the imaging system, support and guidance for the instrument so that the instrument follows the desired path.

31. The method of claim 30 further comprising releasably securing the tool holder to the patient.

32. The method of claim 30 further comprising releasably securing the tool holder to a patient support.