JPH04500168A - Methods and devices especially for guiding neurosurgical procedures - Google Patents

Abstract

(57) [Summary] This bulletin contains application data before electronic filing, so abstract data is not recorded.

Description

[Detailed description of the invention] In particular, the technical field of methods and devices for guiding neurosurgery The present invention relates in particular to methods and devices for guiding neurosurgical procedures. .

Background technology As is known, neuroradiological diagnostic methods especially provide anatomical information to surgeons. CAT ( Introduction and use of equipment such as computerized X-ray axial tomography and MR (magnetic resonance) It has now made great progress.

These and other reasons make performing neuroradiological examinations in stereotaxic conditions less Accurate orientation regarding the method of surgical standards pre-sent to each element of the radiological image. Stereotactic neurosurgical techniques have developed significantly as they allow the infliction of injuries.

Such methods are primarily used, especially with regard to cerebral lesions; In the near future, with the development in the field of medical equipment for neurosurgery, such methods will become available. This does not mean that it cannot be used efficiently in any part of the human body.

Therefore, the use of the method according to the invention is not limited to only such surgeries. what to do In the following, reference will be made to neurosurgery.

In the case of cerebral lesions, the brain i from the time of performing radiological examinations to the time of surgical intervention Since it does not undergo significant deformation with respect to MM, the aforementioned collar can be applied to CAT or MR. According to the neuroanatomical information obtained from the Various possibilities of performing neurosurgery based on different stereotactic routes of approach It is possible to research and develop gender.

The use of CAT or MR is currently determined by radiological imaging of the lesion or plane. to determine the coordinates of the mi to define the preferred and best, sometimes longer, guidelines to be adopted during the actual surgery. This allows the angle to be determined.

Demarcation of the approach route regarding radiological images is currently performed using CAT or MR imaging. It is generally performed by a surgeon on an equipped diagnostic tool.

By examining various consecutive radiological images (for CAT, parallel By continuously observing the anatomical cross-sections of a compound leaflet with similar cross-sections, or with regard to MR, By examining the semi-axial anterior or sagittal plane), the surgeon Visualize the three-dimensional elongation of the anatomical elements shown in the image and therefore draw on your own experience. to determine the surgical route to be adopted during the surgery to avoid damaging the tissue near the lesion. You have to do it the same way.

This technique, currently in use, allows surgeons to guide or It is possible to explore and reach parts of the brain or spinal cord, but surgery cannot be performed with absolute certainty. We can never have the kind of information that would allow us to plan.

This disadvantage is that the surgical probe traverses various anatomical elements to reach the lesion. The axis of the path of is often defined by parallel sections of the CAT radiograph. Planar or semi-axial anterior or sagittal plane of MR in which anatomical images are displayed arises from the fact that it is not in line with one of the

This means that the three-dimensional reconstruction of the image is completely dependent on the visualization ability of the surgeon. This is the reason why.

Therefore, surgeons currently have to sequentially examine various sections given by CAT and MR. Select the ablation route to the tumor by examining the tumor, but do not examine the complete mass of the lesion. I can't.

The problem arises if, for example, the purpose of the intervention is to obtain a large amount of radiation isotopes for therapeutic treatment. /If the throat is to be inserted into the lesion, or if the lesion is to be taken care of. If so, -1 becomes stricter.

Particularly in cases where it is difficult or when a simple biopsy sampling must be performed. Current methods require that the surgeon examine the seeds that occur between the lesion and the surrounding healthy cerebral structures. It is difficult to know completely about their mutual connections.

Anatomical sections of various compound leaves from images produced by CAT or MR By successive examinations, the steps taken during surgery to reach the desired point of the lesion can be The difficulty in determining the theoretical path to follow can therefore be imagined.

In addition to the above, various determinations of anatomical data performed with different devices are displayed separately from each other on different consoles of the device that produced them, so a single This further emphasizes that it cannot be integrated into the image.

For example, known techniques do not allow three-dimensional visualization of cerebral blood vessels, so angiography , information provided by tests of extreme diagnostic significance to CA, T or MR. Does not allow you to evaluate at the same time as the picture given.

Therefore, it is practically impossible to test the surgical route for possible collisions with vascular structures. It is Noh.

Mitsuda p. The purpose of the present invention is to achieve stereolocation guided by anatomical reconstruction of images from CAT or MR. This method significantly reduces surgical trauma during removal of lesions, e.g. cerebral lesions. In particular, it provides a method and position for guiding neurosurgical procedures. By doing so, the disadvantages mentioned above can be eliminated.

Within this aim, an important object of the invention is to treat lesions close to the cranial convexity. by passing through each scientific pathway, which is sometimes longer than what normally occurs. of the surgical approach, which prevents trauma to the healthy tissue surrounding the much deeper lesion. A method and method for guiding neurosurgical procedures in particular that allows for the adoption of The purpose is to provide equipment.

Another object of the present invention is to perform surgical treatment with lesions! Certain cerebral structures, especially the main blood vessels, Particularly in neurosurgical hands, allowing visualization of capsules and nuclei as well as cortical areas in three dimensions An object of the present invention is to provide a method and apparatus for guiding surgery.

A further object of the present invention is to provide information on the orientation of medical surgical instruments with respect to surgical standards. methods for guiding neurosurgical procedures, especially for guiding neurosurgical procedures. and providing the device with Il.

All of these objectives aim to detect the required neuroradial radiation by means of at least one stereotactic sensing device. Performing a physical examination on a part of the patient; computer X-ray body axis! lTl1i photography The radiological images from the device and/or the nuclear magnetic resonance device can be stored in a computer's storage device. loading the base created by the stereotaxic detection device onto the radiological image; Having the computer memorize the location of the quasi-point; the different anatomy of each cough image. detecting in the computer the contours of the different anatomical structures; storing the anatomy in the computer; identifying different anatomical structures in the image; A three-dimensional image of the contour of the stereotactic sensing device and the stereotactic plane defining the surgical instrument path. for displaying on a visual display together with a three-dimensional image of the lobe outline and on the computer; consists of processing all the data put into the computer by a specific program substantially achieved by a method particularly for guiding neurosurgical operations characterized by It will be done.

The method is coupled to a computerized X-ray axial tomography system or stereotaxic detection device. A device, in particular for guiding neurosurgical operations, comprising a magnetic resonance device, the device comprising: Two-dimensional radiation from a computer X-ray body axial sine imaging device or from the magnetic resonance device having means for transmitting the radiological image to a combinator with a visible display; The computer converts the two-dimensional radiological image into a three-dimensional image on the visual display. processing means for converting into a three-dimensional display of the stereotaxic detection device and a schematic three-dimensional display of the stereotaxic detection device; The surgery is performed using a surgical device characterized by having the following features:

Brief description of the drawing Other features and advantages of the present invention include the method and method particularly for neurosurgery according to the present invention. Illustrated by way of example and non-limiting example in the accompanying drawings of It will become clear from the description of preferred but non-limiting embodiments.

In the drawings, FIG. 1 is a schematic perspective view of an apparatus for guiding neurosurgical surgery according to the present invention. It is a diagram.

FIG. 2 is a block diagram of the apparatus illustrated in FIG.

FIG. 3 is an enlarged view of a three-dimensional image displayed on the display device of the device according to the present invention. Ru.

No. 41XI is a perspective view of the locator device according to the present invention.

Figure 5 shows the location of the locator on the stereoscopic projection obtained by digital angiography. FIG.

Figure 6 shows the stereotactic probe superimposed on two stereoscopic angiographic images. FIG.

Figure 7 shows an anatomical three-dimensional image in a unique positional relationship with the direction of one or more surgical instruments. 1 is a schematic diagram of an articulated arm suitable for storage; FIG.

Company made 'p eta 1 stage With reference to the above-described drawings, it can be seen that the method according to the invention comprises the following sequential steps. will be given.

Stereotaxic detection instruments, more precisely stereotaxic instruments (3), are used to detect fools (15) before surgery. ) to undergo a preliminary neuroradiological examination, Fuse (15) was first It will be done.

The localization reference has a locator element (16), whereby the localization Detects and detects the positioning of the image plane in relation to the surgical criteria formed by Lumenoto. can be determined. The a'J image was distorted by neuroradiological examination. Use a stereotactic helmet made of suitable material to be shown without advantageously - allows to determine the plurality of criteria logically and precisely, and The position of the plane of the radiological image can be determined by determining the position of the reference. .

Radiology thus obtained by MR or CA, T using a stereotaxic helmet The target image is sent to the computer (6) and later displayed on the computer's display. The data is loaded into the storage device as shown in the image.

Once the computer has mapped the tomographic plane of each radiological image from CAT or MR, Once the position has been captured, the operator, and more precisely the surgeon, can You can trace the contours of anatomical structures that are relevant to surgical planning in your view. Ru.

The extent of pathological tissue, location of cavities, main vessels and characteristic cerebral regions are approximately determined. It will be done.

This detection of the contours of the anatomical structures in each radiological image can, of course, also be performed on the CAT. is the shape of a stereotactic helmet used for neuroradiological examinations performed on MR. For example, after the details of the digitizing pad (43) have been provided to the computer, performed by the surgeon manually using a cursor driven by the

The procedure described above is to compare each radiograph of CAT or MR to radiological images by an outside f4 physician. Even if various organizations are interpenetrated, their distribution is Contours belonging to anatomical structures related to the same type of tissue to facilitate extraction. are assigned the same color.

When all the information has been acquired by a computer, the computer The stereotaxic probe 21 and the stereotaxic probe 21 and the actual A three-dimensional schematic that defines the surgical path chosen by the surgeon to perform the surgery. Images can be displayed on the display unit.

As mentioned above, the type of anatomical structure in the radiological image is predetermined by the surgeon. Each contour is 3-dimensionally identical within the figure defined by the schematic representation of the stereotaxic lumenote. area for controlling the rotation of the image and the direction of the stereotactic probe. area is displayed on the periphery of the display.

Finally, the helmet used during surgery, on the throat, is used by the surgeon to enter the surgery. Angle (42) corresponding to the path defined by the stereotaxic probe selected on the display The depth value is displayed on the arrow tension display.

In another scheme, a joint arch designated by the reference numeral 30 with at least six degrees of freedom is used. A position detector 31 linked to the position where the form changes is connected to the computer. can be used to give the orientation of the arm with respect to the stereotactic 3 . The stereotaxic reference point 3 and the cough control are linked in the manner B preset by the legs 32. has been done.

The articulated arm allows the 3D anatomical image 8 to be oriented by the surgeon during surgery. one or more known non-illustrated surgical instrument orientations and unique spaces that are determined; It is possible to arrange them in relation to each other.

More specifically, the articulated arm is rotatably linked to the annular base plate 33; This is connected to the positioning lever 3 by means of the legs 32 on the bridge already mentioned.

The tenth gutter-like element 34 of the arm can extend telescopically and is rotatable. The 20th No. 1'-shaped element 35 is supported on the top. 2nd Il:1. .

The dome-shaped element 35 can be extended telescopically and can be extended in an articulated manner. a 30th end-like element 36 suitable for receiving 3 one or more surgical instruments at its freer end; is supported.

Conversion of cerebral angiographic and radiological images into three-dimensional images is described in the present invention. The related method is performed by the following sequential steps.

A stereotaxic lumenometer placed at the same location where CAT and MR will be performed is an ordinary Initially, the positioning is It will be done.

In this way, a series of image captures is performed according to the defined stereoscopic projection. .

The locator device 16 is further coupled to the stereotaxic device and is located from the ring 20. It has become. Three rods 17 extend from the ring perpendicularly to the plane of the cough ring. Each rod has a small steel ball 18 at its tip.

The three rods are conveniently spaced from each other on the periphery of the ring and have different Stereoscopic blood shown in FIGS. 5 and 6 without overlapping each other at an angle of The images are projected at different positions in the angiography order, so that they are different from each other from the plane of Herrond. It has a certain height.

With suitable technical means, the images obtained in this way are recorded by a television camera. It is digitized and sent to the surgery's graphics computer.

At this point, the surgeon uses the digitizer bud's cursor to Accurate position of two balls! , thus the angle of capture of the angiographic image can be determined. .

From the above, the distance and brightness between the focal point and the stereo position of the cathode ray tube and the image plane are determined. Stereotactic positioning in the rotating plane of the cathode ray tube for digital angiography is constant and known, the acquisition angle of each angiographic projection can be uniquely determined. It is possible to determine

At this stage, the computer determines the stereotactic path for each acquisition angle of each angiographic projection. and thus on top of each stereotaxically obtained angiographic image. It is possible to overlap them.

In this regard, surgeons can use the information detected with CAT or MR to Determine the appropriate surgical route and visualize the selected route on stereotactically obtained angiographic images. A projection of B21 can be obtained.

From what has been said so far, it is possible to simultaneously observe two stereoscopic images using suitable glasses. enables three-dimensional perception of the interrelationship between vascular structures and surgical probes Make it.

Obviously, if the surgical target is a vascular structure, the overall surgical plan is It will be performed on angiographic images.

In order to guide the neurosurgical procedure, indicated generally by the reference numeral 1, in the aforementioned camphor The device is a computed tomography device or a computerized tomography device, as illustrated in FIG. A magnetic field coupled to the powerful stereotactic sensing device of the known stereotactic helmet 3 worn by It has an air reservoir.

The device 1 displays a two-dimensional radiological image 5 from MR, for example, with a visible display section 7. It has means 4 for sending to a computer 6.

The computer 6 uses a processing method suitable for converting the two-dimensional image 5 into a three-dimensional image. In particular, it has software, and the three-dimensional images are It can be viewed on the visual display section 9 together with the three-dimensional schematic representation 10 of the notes.

A known device (not shown) for three-dimensional processing of cerebral angiography images is used. A digital angiogram, in which the stereotaxic head worn by patient 15 Lumet 3 is placed exactly at the isometric point of rotation of the Blaue tube.

The locator device 16 is further removably linked on the stereotaxic device. and can be mounted at different heights from the plane of the helmet, appropriately spaced. It has three rods 17 with small angled steel balls 18 at their ends.

The present invention thus constructed is capable of many modifications and variations, all of which are are within the scope of the inventive concept, and all details are further provided with technical equivalents. It can be replaced by other elements.

In practice, the materials and dimensions used can be any according to the needs and state of the art. .

international search report international search report EP 8901362 SA　32234

Claims (1)

[Claims] 1. Perform the required neuroradiological examination with at least one stereotaxic sensing device (3). computerized X-ray axial tomography equipment and/or or radiological images (5) from a nuclear magnetic resonance apparatus to the memory of a computer (6). loading the base created by the stereotaxic detection device onto the radiological image; storing the positions of the quasi-points (18) in the computer; detecting in the computer the contours of the different anatomical structures (40); storing contours of anatomical structures in the computer; A three-dimensional image (8) of the outline of the anatomical structure is used to define the surgical instrument path. The visual display unit ( 9) All data entered into the computer and displayed on the Especially for neurosurgical operations, characterized in that they consist of processing by means of a program. A method for guiding. 2. The computer is housed in close proximity to an operating room where a surgical procedure is performed on the patient. The method according to claim 1, characterized in that: 3. The stereotactic sensing device (3) detects the radiological image of at least one surgical instrument. characterized in that it has a locator element (16) for detecting a position relative to The method according to claim 1. 4. The locator element has an articulated arm (30), the arm (30) is a leg (32) for linking with the stereotaxic detection device (3) in a preset manner. ) is rotatably linked to an annular substrate (33) having The method according to claim 3. 5. The articulated arm is rotatably associated with a second rod-like element (35). It has a first rod-like element (34) which is attached to the , rotatably supporting a third rod-like element (36) for supporting a surgical instrument; and the arm has a position detection device linked to the part whose shape changes. 5. A method according to claim 4, characterized in that it comprises a step (31). 6. at least one of the first and second rod-like elements extends telescopingly; 6. The method according to claim 5, wherein: 7. Different data from computerized X-ray axial tomography and/or nuclear magnetic resonance The computer memorizes the contours of the anatomical structures created using the digitizer pad (44 ) by moving the cursor (43). The method described in Box 1. 8. The contours of different anatomical structures in the radiological image are shown for each type of tissue. 2. A method according to claim 1, characterized in that they have the same coloring. 9. the visual display for rotating the first three-dimensional image and the surgical path; characterized in that it comprises control means (41) for orienting the , the method according to claim 1. 10. The visual display shows the angular value (42) and the equivalent angular value of the surgical guide device. The method according to claim 1 has an indication of the depth of the surgical path corresponding to the How to put it on. 11. connected to a computerized X-ray body axial tomography device or a stereotaxic detection device (3); A device, in particular for guiding neurosurgical operations, comprising a magnetic resonance device (2) , from the computerized X-ray axial tomography device or from the magnetic resonance device. To send the original radiological image (5) to a computer (6) with a visual display. means (4) for converting the two-dimensional radiological image into the visible for converting to a three-dimensional image (8) on the display unit (9) and for the stereotaxic detection device. A surgical device characterized in that it has a processing means for a three-dimensional representation of an outline. 12. Digitizer pad for interaction with the 3D image on the operator side ( 12. The device according to claim 11, characterized in that it has: 43). 13. Have the patient wear a stereotactic helmet (3); a digital angiographically defined digital angiography device; Performing a series of stereotactic acquisitions with stereoscopic projections; placing the locator on each stereoscopic projection; Projecting a plurality of reference points (18) of the device; memorizing the acquisition; determining the reference point in each stereoscopic angiographic image; Uniquely determining the angle of capture of each angiographic projection; calculating a projection of the path of the position; and superimposing the projection on the angiographic image; A method in particular for inducing neurosurgical operations, characterized in that it consists of: 14. The helmet and locator device are connected to a cathode ray tube circuit for digital angiography. 14. A method according to claim 13, characterized in that it is arranged at an equiangular point of rotation. 15. The locator device comprises an annular element (20) and at least three rods. (17) extend perpendicularly from the element, each rod having a ball (18) at its end. 14. The method according to claim 13, characterized in that: 16. The rods are spaced apart from each other along the periphery of the ring and are connected to each other. 14. A method according to claim 13, characterized in that it has different heights. 17. characterized by having one or more of the features described and illustrated in detail , especially methods and devices for guiding neurosurgical procedures.