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EP0406352A1 - Procede et appareil de guidage d'instruments chirurgicaux utilises notamment en neurochirurgie - Google Patents

Procede et appareil de guidage d'instruments chirurgicaux utilises notamment en neurochirurgie

Info

Publication number
EP0406352A1
EP0406352A1 EP89912445A EP89912445A EP0406352A1 EP 0406352 A1 EP0406352 A1 EP 0406352A1 EP 89912445 A EP89912445 A EP 89912445A EP 89912445 A EP89912445 A EP 89912445A EP 0406352 A1 EP0406352 A1 EP 0406352A1
Authority
EP
European Patent Office
Prior art keywords
stereotaxic
computer
process according
images
dimensional
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP89912445A
Other languages
German (de)
English (en)
Inventor
Cesare Giorgi
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
ISTITUTO NEUROLOGICO "CARLO BESTA"
Original Assignee
ISTITUTO NEUROLOGICO "CARLO BESTA"
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by ISTITUTO NEUROLOGICO "CARLO BESTA" filed Critical ISTITUTO NEUROLOGICO "CARLO BESTA"
Publication of EP0406352A1 publication Critical patent/EP0406352A1/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/103—Measuring devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
    • A61B5/107—Measuring physical dimensions, e.g. size of the entire body or parts thereof
    • A61B5/1077—Measuring of profiles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/10—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3954—Markers, e.g. radio-opaque or breast lesions markers magnetic, e.g. NMR or MRI
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers

Definitions

  • stereotaxic neurosurgical technique has developed considerably, since the execution of neuroradiological examinations in stereotaxic conditions allows to give each element of the radiographic image a precise orientation with respect to a preset operative reference system-
  • Such systems are mainly used especially with regard to cerebral lesions, but this does not mean that in the near future, with the development in the field of neurosurgical armamentarium, such systems might not be used effectively on any part of the human body.
  • CAT or MR currently allows to determine the coordinates of a lesion or of a neoplasm identified on the planar radiological image and therefore to determine the angles which define the so-called approach path, i.e. the preferred and best, though sometimes longer, direction followed by the surgeon during the actual operation.
  • the definition of the approach path with regard to the radiological image is currently generally performed by the surgeon, at the diagnostic console with which the CAT or MR device is equipped.
  • the surgeon therefore currently chooses a path of approach to the neoplasm by examining in succession the various sections provided by CAT and MR, but is unable to examine the complete volume of the lesion.
  • the problem becomes more severe if, for example, the purpose of the intervention is to place a pellet of a radioactive isotope for a curative treatment inside the lesion or if said lesion is to be removed.
  • the known art does not allow to evaluate the information supplied by angiography, an examination of extreme diagnostic significance, simultaneously with the images provided by CAT or by MR, since the three-dimensional visualization of the cerebral vessels is not possible.
  • the aim of the present invention is to eliminate the above described disadvantages by providing a process and an apparatus particularly for guiding neurosurgical operations which allow to considerably reduce surgical traumatis during the removal of lesions, for example cerebral ones, using stereotaxic methods guided by th anatomical reconstruction of images arriving from CAT o MR.
  • an important object o the invention is to provide a process and apparatus particularly for guiding neurosurgical operations whicht allow to adopt surgical approach paths which avoid traumatism of the healthy tissue which surrounds even deep lesions by performing a surgical path which may sometimes be longer than what normally occurs for lesions proximate to the convexity of the braincase.
  • Another object of the present invention is to provide a process and apparatus particularly for guiding neurosurgical operations which allow to visualize in three dimensions, together with the lesion, the cerebral structures of surgical interest, especially the main vessels, the internal capsule and the nuclei, as well as the eloquent cortical regions.
  • Not least object of the present invention is to provide a process and apparatus particularly for guiding neurosurgical operations which allow to provide information on the orientation of the surgical instruments relative to the operative reference.
  • a process and apparatus particularly for guiding neurosurgical operations characterized in that it consists in: performing the required neuroradiological examinations, by means of at least one stereotaxic detection device, on a part of the patient; loading in the memory of a computer the radiological images arriving from a computerized axial tomography device or from a nuclear magnetic resonance device; storing in said computer the location of the reference points produced by said stereotaxic detection device on said radiological images; detecting in said computer the contour of the different anatomical structures of each of said images; storing in said computer said contour of said different anatomical structures; processing, by means of a specific program, all the data entered into said computer to represent on a visual display a schematic three-dimensional image of said contours of said different anatomical structures of said images together with a schematic three-dimensional image of said stereotaxic detection device and of a stereotaxic probe which defines a surgical path.
  • an apparatus particularly for guiding neurosurgical operations comprising a computerized axial tomography device or a magnetic resonance device connected to a stereotaxic detection device, characterized in that it comprises: means for transferring two-dimensional radiological images arriving from said computerized axial tomograph device or from said magnetic resonance device to a computer equipped with a visual display, said computer comprising processing means for converting said two-dimensional radiological images into three-dimensional images on said visual display simultaneously with the schematic three- dimensional representation of said stereotaxic detection device.
  • figure 1 is a schematic perspective view of the apparatus for guiding neurosurgical operations according to the invention
  • figure 2 is a block diagram of the apparatus illustrated in figure 1
  • figure 3 is an enlarged view of the three-dimensional image which is displayed o the visual display of the apparatus according to the invention
  • figure 4 is a perspective view of the locator device according to the invention
  • figure 5 is a schematic view of the projection of the reference points of the locator device on a stereoscopic projection obtained with a digital angiograph
  • ' figure 6 is a view of the stereotaxic probe superimposed on two stereoscopic angiographic images
  • figure 7 is a schematic view of the articulated arm adapted to place the anatomical three-dimensional images in a univocal spatial relationship with the orientation of one or more surgical instruments.
  • a stereotaxic detection device more precisely a stereotaxic helmet (3) , is initially fitted onto the patient (15) in order to subject him to the preparatory neuroradiological examinations before surgery.
  • the stereotaxic helmet -comprises a locator element (16) by means of which it is possible to detect and identify the arrangement of the plane of the image in relation to the operative reference constituted by said stereotaxic helmet.
  • stereotaxic helmets made of a material suitable for being shown by neuroradiological examinations without distorting or masking the image, conveniently allows to univocally and precisely determine a plurality of references, and it is possible to determine the position of the plane of the radiological image according to the positioning of said references.
  • radiographic images thus obtained by MR or CAT, by means of the use of the stereotaxic helmet, are fed into the computer (6) and loaded into memory to be then displayed on the display of said computer.
  • the operator can trace the contour of the anatomical structures (40) which occur on each section and are, in his opinion, relevant for the planning of the operation.
  • the limits of the pathological tissue, the position of the ventricles, the main vessels and the eloquent cerebral areas are generally determined. This detection of the contour of the anatomical structures occurring in each radiographic image is performed for example manually by the surgeon, using a cursor driven by a digitizer pad (43) , naturally after the specifications of the type of stereotaxic helmet used for the detection of the neuroradiological tests performed on CAT or on MR has been fed into the computer.
  • the computer When all the information has been acquired by the computer, the computer is capable, by means of a particular program, of displaying on the display a three- dimensional schematic image of the stereotaxic helmet and of a stereotaxic probe 21 which defines the surgical path chosen by the surgeon to perform the actual operation.
  • angle (42) and depth values which correspond, on the helmet used during surgery, to the path defined by the stereotaxic probe chosen by the surgeon on the visual display for the approach to the operation, are also indicated on the visual display.
  • an articulated arm indicated by 30, having at least six degrees of freedom and position detectors 31 associated with the regions 05494 - 10 -
  • the articulated arm is rota associated with an annular base plate 33 which, as al mentioned, is associated with the stereotaxic helmet means of the feet 32.
  • the first rod-like element 34 of the arm telescopingly extendable and rotatably supports a s rod-like element 35 which is also telescopingly exten and in turn articulately supports a third rod-like el 36 adapted to receive on its free end one or more sur
  • a locator device 16 is furthermore associated with the stereotaxic helmet and comprises a ring 20 from which three rods 17 extend perpendicular to the plane of said ring, each of said rods being tipped by a small steel sphere 18.
  • the three rods are conveniently spaced from one another on the perimeter of the ring and have a mutually different height from the plane of the helmet, so as to not mutually superimpose in the different angles and project images in different positions on the stereoscopic angiographic sequences illustrated in figures 5 and 6.
  • the images thus obtained are digitized by means of a TV camera and transferred to the surgical graphic computer.
  • the surgeon using the cursor of a digitizer pad, can identify in each image the exact position of the three spheres and therefore the angle of acquisition of the angiographic image.
  • the entire planning of the operation will be performed exclusively on the angiographic images.
  • the apparatus for guiding neurosurgical operations comprises a computerized axial tomography device or, as illustrated in figure 1, a magnetic resonance device 2 connected to a stereotaxic detection device, such as a known stereotaxic helmet 3 worn by a patient 15.
  • the apparatus 1 comprises means 4 for transferring the two-dimensional radiological images 5, arriving for example from the MR, to a computer 6 equipped with a visual display 7.
  • the computer 6 comprises in turn processing means, and more in detail software adapted to convert the two- dimensional images 5 into three-dimensional images 8 which are visible on a visual display 9 together with the three- dimensional schematic representation 10 of the stereotaxic helmet.
  • the apparatus for performing the three-dimensional processing of the cerebral angiographic images comprises a known digital angiograph, not illustrated in the drawings, in which the stereotaxic helmet 3 worn by the patient 15 is placed exactly at the isocenter of rotation of the cathode-ray tube.
  • a locator device 16 can furthermore be removably associated on the stereotaxic helmet and has three rods 17 tipped by small steel spheres 18 which are appropriately spaced and mounted at a different height from the plane of the helmet.
  • the materials employed, as well as the dimensions, may be any according to the requirements and to the state of the art.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Public Health (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Veterinary Medicine (AREA)
  • Pathology (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • General Health & Medical Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Physics & Mathematics (AREA)
  • Dentistry (AREA)
  • Biophysics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Magnetic Resonance Imaging Apparatus (AREA)
  • Apparatus For Radiation Diagnosis (AREA)

Abstract

Le procédé décrit, qui sert au guidage d'un instrument utilisé lors d'une intervention de neurochirurgie, permet de réduire considérablement les traumatismes chirurgicaux lors de l'enlèvement de lésions cérébrales grâce à la possibilité de convertir en images tridimensionnelles à la fois les contours des structures anatomiques et la représentation du dispositif pour la détection stéréotaxique de la région affectée, avec une sonde stéréotaxique qui définit une trajectoire chirurgicale. L'appareil de réalisation du procédé mentionné ci-dessus comprend un organe (4) servant à transférer les images radiologiques bidimensionnelles (5) provenant d'un dispositif de tomographie axiale informatisé ou à résonance magnétique à un ordinateur (6), lequel est équipé d'un écran de visualisation et comporte un organe processeur permettant de convertir les images bidimensionnelles en images tridimensionnelles (8) avec représentation tridimensionnelle schématique du dispositif de détection stéréotaxique (3).
EP89912445A 1988-11-18 1989-11-14 Procede et appareil de guidage d'instruments chirurgicaux utilises notamment en neurochirurgie Withdrawn EP0406352A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
IT226598 1988-11-18
IT8822659A IT1227365B (it) 1988-11-18 1988-11-18 Procedimento ed apparecchiatura particolarmente per la guida di opera zioni neurochirurgiche

Publications (1)

Publication Number Publication Date
EP0406352A1 true EP0406352A1 (fr) 1991-01-09

Family

ID=11198964

Family Applications (1)

Application Number Title Priority Date Filing Date
EP89912445A Withdrawn EP0406352A1 (fr) 1988-11-18 1989-11-14 Procede et appareil de guidage d'instruments chirurgicaux utilises notamment en neurochirurgie

Country Status (5)

Country Link
EP (1) EP0406352A1 (fr)
JP (1) JPH04500168A (fr)
BR (1) BR8907179A (fr)
IT (1) IT1227365B (fr)
WO (1) WO1990005494A1 (fr)

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Also Published As

Publication number Publication date
IT1227365B (it) 1991-04-08
IT8822659A0 (it) 1988-11-18
JPH04500168A (ja) 1992-01-16
WO1990005494A1 (fr) 1990-05-31
BR8907179A (pt) 1991-03-05

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