Surgery – Truss – Pad
Patent
1987-07-13
1989-05-30
Yasko, John D.
Surgery
Truss
Pad
604175, A61B 1700
Patent
active
048340898
DESCRIPTION:
BRIEF SUMMARY
The invention relates to a neurosurgical auxiliary apparatus for use in brain operations, i.e. a brain surgery or brain imaging adapter intended for surgical procedures performed through a craniotomy opening, for imaging and/or tumor resection; the adapter comprising an ultrasonic transducer, means for supporting the transducer, and means for introducing medium into the craniotomy opening. By means of the adapter the operating neurosurgeon obtains a three-dimensional determination of the shape and position of a tumor to be removed, for instance. Imaging is carried out by means of the ultrasonic transducer. The adapter according to the invention is the first stereotactic apparatus for tumor resection which is attached to the skullbone and which at the same time functions as an imaging apparatus, being provided with the ultrasonic transducer. Surgical instruments may also be attached to the adapter.
Known methods for the determination of a tissue object to be removed include x-ray CT imaging and NMR imaging, which can be used preoperatively and under certain conditions even intraoperatively (Lunsford, L. D., R. Parrish and L. Albright (1984) Intraoperative imaging with a therapeutic computed tomographic scanner, Neurosurgery 15: 559-561). Intraoperative ultrasound determination can be carried out either with a sector or a linear transducer, the imaging being performed through a craniotomy opening into which medium has been introduced (Koivukangas J. (1984) Ultrasound imaging in operative neurosurgery: An experimental and clinical study with special reference to ultrasound holographic B (UBH) imaging, Academic dissertation, Acta Universitatis Ouluensis, Series D, Medica No. 115, Neurologica et Neurochirurgica No. 10). When a known apparatus is used, the operating surgeon performs the imaging from a desired direction, supporting the detector manually or by means of a separate supporting apparatus (Tsutsumi Y., Y. Andoh and N. Inoue (1982) Ultrasound-guided biopsy for deep-seated brain tumors, J. Neurosurg. 57: 164-167). In this way it is possible to roughly determine the position and shape of a tumor located e.g. under intact tissue. On the basis of this information the surgeon can decide the position and direction of the tissue incision. After the incision, the removal of the tumor can be carried out by means of some known method.
One problem with known apparatuses is that the operating neurosurgeon has to support manually the ultrasonic transducer; that the precise location and shape of the object cannot be determined; and that the imaging cannot be accurately repeated. The distance of the tumor from the surface of the brain can be determined accurately from a high-quality ultrasound image, whereas the transfer of the information from the image to the object is difficult, because there is no accurate data on the place and orientation of the imaging plane. Further, the precise border of the tumor to intact tissue cannot necessarily be visually determined in the incised tissue, even though it may be visible in an ultrasound image. Since all tumors are not accurately visualized in an x-ray CT image, either, intraoperative ultrasound imaging is of great importance. After resection of the tumor or a part thereof, the tissue adapts itself and changes shape so that the imaging has to be repeated for the determination of the new location and shape. The problems are repeated, too, and the images are not comparable with each other. Tissue spatulas or hollow tubes generally used in operations have to be supported on the edge of the patient's craniotomy opening, a stereotactic frame or some other separate support by means of flexible arms which can be locked in position. The position and massiveness of the tissue supports hampers the intraoperative ultrasound imaging, because the shadow regions and reflections created thereby are difficult to avoid.
For imaging, the ultrasonic transducer requires contact with the brain tissue, either directly or through a medium, such as saline solution, which transmits the acoustic wav
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Koivukangas John P.
Noponen Seppo V.
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