Cerebral surgery apparatus - Patent Review 5154723

Claims

What is claimed is:

1. A cerebral surgery endoscope apparatus comprising:

a stereotaxic instrument to be secured to the head of a patient to effect positioning of a treating instrument in an affected part;

treating instrument inserting means whose inserting direction is determined by said stereotaxic instrument, for inserting treating instruments into the head of the patient, a rear end of said inserting means extending to and operatively connecting with said stereotaxic instrument, and an overall length of said inserting means being hollow; and

a telescope detachably inserted into said inserting means having a channel into which a treating instrument can be inserted and further having an insertable part to be inserted into said inserting means,

said telescope and channel being removably inserted into said inserting means in a state that the longitudinal axis of the insertable part of said telescope and the longitudinal axis of said inserting means are substantially in parallel, and said treating instrument being removably insertable into said channel, and further

said telescope and channel being removably insertable into said inserting means allowing supplying or draining of liquid through a cavity of said inserting means while said telescope is removably inserted into said inserting means.

2. A cerebral surgery endoscope apparatus comprising:

a stereotaxic instrument to be secured to the head of a patient to effect positioning of a treating instrument in an affected part;

treating instrument inserting means whose inserting direction is determined by said stereotaxic instrument, for inserting treating instruments into the head of the patient;

a telescope detachably inserted into said inserting means having a channel into which a treating instrument can be inserted and further having an insertable part to be inserted into said inserting means,

said telescope and channel being removably inserted into said inserting means in a state that the longitudinal axis of the insertable part of said telescope and the longitudinal axis of said inserting means are substantially in parallel, and said treating instrument being removably insertable into said channel, and further

said telescope and channel being removably insertable into said inserting means allowing supplying or draining of liquid through a cavity of said inserting means while said telescope is removably inserted into said inserting means; and

a fixing device connected to said stereotaxic instrument to support and fix said inserting means and said telescope with respect to said stereotaxic instrument, a rear end of said inserting means extending to and operatively connecting with said fixing device, and an overall length of said inserting means being hollow.

3. A cerebral surgery endoscope apparatus comprising:

a stereotaxic instrument to be secured to the head of a patient to effect position of a treating instrument in an affected part;

an inserting means whose inserting direction is determined by said stereotaxic instrument, for inserting treating instruments into the head of the patient, a rear end of said inserting means extending to and operatively connecting with said stereotaxic instrument, and an overall length of said inserting means being hollow; and

a telescope detachably inserted into said inserting means having a channel into which a treating instrument can be inserted and further having an insertable part to be inserted into said inserting means,

said telescope and channel being removably inserted into said inserting means in a state that the longitudinal axis of the insertable part of said telescope and the longitudinal axis of said inserting means are substantially in parallel, and said telescope and channel being removably insertable into said inserting means allowing supplying or draining of liquid through a cavity of said inserting means while said telescope is removably inserted in said inserting means, and further

said treating instrument being removably insertable into said channel,

said treating instrument being insertable into said channel of said telescope and then into the head of the patient.

4. A cerebral surgery endoscope apparatus according to claim 3, further comprising:

an adapter for detachably connecting said treating instrument and said telescope.

5. A cerebral surgery endoscope apparatus according to claim 4, wherein said treating instrument is an ultrasonic suction instrument having a tubular probe, and said adapter includes a hollow portion into which said probe is inserted and an inlet and an outlet for a refrigerant for cooling said probe inserted into said hollow portion.

6. A cerebral surgery endoscope apparatus according to claim 4, wherein said treating instrument is an ultrasonic suction instrument having a tubular probe, and said adapter includes a cylindrical member into which said probe is inserted and a window allowing presence of said probe inserted in said cylindrical member to be confirmed.

7. A cerebral surgery endoscope apparatus according to claim 4: wherein

said treating instrument is removably insertable into said channel of said telescope and then into the head of the patient

wherein said adapter includes a telescope-side connecting portion detachably connectable to said telescope, a treating instrument-side connecting portion detachably connectable to said treating instrument, connecting means for connecting said telescope side connecting portion and said treating instrument-side connecting portion such as to allow the same to advance and retract, and fixing means which is capable of fixing positions of said telescope-side connecting portion and said treating instrument-side connecting portion at desired positions, a rear end of said inserting means extending to and operatively connecting with said adapter, and an overall length of said inserting means being hollow.

8. A cerebral surgery endoscope apparatus according to claim 7, further comprising a fixing device connected to said stereotaxic instrument and adapted to support and fix said inserting means, said telescope, said adapter, and said treating instrument.

9. A cerebral surgery endoscope apparatus according to claim 7 or 8, wherein said adapter includes at a front end portion thereof a substantially tubular adapter body having said telescope-side connecting portion and at a rear end portion thereof said treating instrument-side connecting portion, said adapter further including a sliding member fitted slidably at a rear end portion of said adapter body; a moving device having a cam ring fitted rotatably around the outer peripheral portions of said adapter body and said sliding member, cam grooves provided in said adapter body and said sliding member, and a cam pin which is secured to said cam ring, is engaged into said cam grooves, and is slidable along said cam grooves so as to make said sliding member longitudinally movable relative to said adapter body by the rotation of said cam ring; a scale indicating the position of said sliding member relative to said adapter body; and a setscrew capable of fixing said sliding member to said adapter body.

10. A cerebral surgery endoscope apparatus according to claim 7 or 8, wherein said adapter includes at a front end portion thereof a substantially tubular adapter body having said telescope-side connecting portion and at a rear end portion thereof said treating instrument-side connecting portion, said adapter further including a sliding member fitted slidably at a rear end portion of said adapter body, a scale for indicating the position of said sliding member relative to said adapter body, and a fixing member which is capable of fixing said sliding member to said adapter body when the outside diameter of outer periphery-side members of said adapter body and said sliding member is reduced.

11. A cerebral surgery endoscope apparatus according to claim 7 or 8, wherein said adapter includes at a front end portion thereof a substantially tubular adapter body having said telescope-side connecting portion and at a rear end portion thereof said treating instrument-side connecting portion, said adapter further including a sliding member fitted slidably at a rear end portion of said adapter body, a moving device having a rack provided on one of said adapter body and said sliding member and a pinion provided on the other and engaging with said rack, thereby making it possible to move said sliding member longitudinally relative to said adapter body as said pinion is rotated, and a setscrew capable of fixing said sliding member to said adapter body.

12. A cerebral surgery endoscope apparatus comprising:

a stereotaxic instrument to be secured to the head of a patient to effect positioning of a treating instrument in an affected part;

an inserting means whose inserting direction is determined by said stereotaxic instrument and which is inserted into the head of the patient;

a telescope detachably inserted into said inserting means having a channel into which a treating instrument can be inserted and further having an insertable part to be inserted into said inserting means;

said telescope and channel being removably inserted into said inserting means in a state that the longitudinal axis of the insertable part of said telescope and the longitudinal axis of said insert means are substantially in parallel, and

said telescope and channel being removably insertable into said inserting means allowing supplying or draining of liquid through a cavity of said inserting means while said telescope is removably inserted in said inserting means, and further

said treating instrument being removably insertable into said channel,

said treating instrument being inserted into said channel of said telescope and then into the head of the patient; and

a fixing device connected to said stereotaxic instrument to support and secure said inserting means, said telescope, and said treating instrument, a rear end of said inserting means extending to and operatively connecting with said fixing device, and an overall length of said inserting means being hollow.

13. A cerebral surgery endoscope apparatus according to claim 12,

wherein said inserting means can insert treating instruments into the head of the patient; wherein

said treating instrument is removably insertable into said channel of said telescope and then into the head of the patient; and wherein said apparatus further comprises:

an adapter for detachably connecting said treating instrument and said telescope.

14. A cerebral surgery endoscope apparatus according to any one of claims 1 to 13, wherein said telescope includes an elongated inserting portion which is adapted to be inserted into said inserting means, illumination means for making illumination light emergent from a distal end portion of said inserting portion; an image-forming optical system provided at said distal end portion of said inserting portion, an eyepiece section provided at a rear end portion of said inserting portion, and an image-transmitting optical system for transmitting an image formed by said image-forming optical system to said eyepiece section.

15. A cerebral surgery endoscope apparatus according to any one of claims 1 to 13, wherein said telescope includes a telescope body and a treating instrument installing section which is detachable from said telescope body.

16. A cerebral surgery endoscope apparatus according to claim 14, further comprising a television camera connected detachably to said eyepiece section and display means for displaying an image picked up by said television camera.

17. A cerebral surgery endoscope apparatus according to any one of claims 1 to 13, wherein said telescope includes an elongated inserting portion which is inserted into said inserting means, illumination means for making illumination light emergent from a distal end portion of said inserting portion, an image-forming optical system provided at a distal end portion of said inserting portion, and image pickup means using a solid-state image sensor for sensing an image formed by said image-forming optical system.

18. A cerebral surgery endoscope apparatus according to any one of claims 3 to 13, wherein said treating instrument is an ultrasonic suction instrument.

19. A cerebral surgery endoscope apparatus according to claim 18, wherein said ultrasonic suction instrument includes a vibrator section for generating ultrasonic vibrations, a tubular probe connected to said vibrator section and adapted to transmit the ultrasonic vibrations, and suction means for sucking an object to be sucked through a hollow portion of said probe.

20. A cerebral surgery endoscope apparatus according to any one of claims 1 to 13, wherein said stereotaxic instrument has an inner ring for fixing the head of a patient and an outer ring for fixing said inner ring such as to adjust the position of said inner ring.

21. A cerebral surgery endoscope apparatus comprising:

a stereotaxic instrument to be secured to the head of a patient to effect positioning of a treating instrument in an affected part;

an inserting means whose inserting direction is determined by said stereotaxic instrument, for inserting treating instruments into the head of the patient;

a telescope detachably inserted into said inserting means having a channel into which a treating instrument can be inserted and further having an insertable part to be inserted into said inserting means;

said telescope and channel being removably inserted into said inserting means in a state that the longitudinal axis of the insertable part of said telescope and the longitudinal axis of said inserting means are substantially in parallel, and

said telescope and channel being removably insertable into said inserting means allowing supplying or draining of liquid through a cavity of said inserting means while said telescope is removably inserted in said inserting means, and further

said treating instrument being removably insertable into said channel,

said treating instrument being insertable into said channel of said telescope and then into the head of the patient; and

a fixing device connected to said stereotaxic instrument to support and fix said inserting means, said telescope, and said treating instrument, said fixing device having moving means which is capable of allowing said inserting means, said telescope, and said treating instrument to be advanced and retracted in an inserting direction of said inserting means, a rear end of said inserting means extending to and operatively connecting with said fixing device, and an overall length of said inserting means being hollow.

22. A cerebral surgery endoscope apparatus according to claim 21, wherein said fixing device has means which allows said inserting means, said telescope, and said treating instrument to be rotated.

23. A cerebral surgery endoscope apparatus according to claim 21, further comprising an adapter for detachably connecting said treating instrument and said telescope.

24. A cerebral surgery endoscope apparatus according to claim 23, wherein said fixing device has a support for supporting said sheath, said telescope, and said treating instrument, and said moving means is fixed to at least one of said inserting means, said telescope, said treating instrument, and said adapter and has a slider which is longitudinally slidable relative to said support.

25. A cerebral surgery endoscope apparatus according to claim 24, wherein said slider includes a guide portion connected to said support, a sliding body which is longitudinally slidable along said guide portion, a support member which is secured to at least one of said inserting means, said telescope, said treating instrument, and said adapter and is longitudinally slidable relative to said sliding body, fixing means for fixing said sliding body relative to said guide portion, and fixing means for fixing said support member relative to said sliding body.

26. A cerebral surgery endoscope apparatus according to claim 25, wherein said slider includes a moving device having a rack which is provided one of either said sliding body and said support member and a pinion provided on the other and meshing with said rack, thereby allowing said support member to be longitudinally movable relative to said sliding body as said pinion is rotated.

27. A cerebral surgery endoscope apparatus according to claim 26, wherein a scale indicating the position of said support member relative to said sliding body is provided on one of said sliding body and said support member.

28. A cerebral surgery endoscope apparatus according to claim 26, wherein said support member has a clamping portion for clamping and fixing said adapter.

29. A cerebral surgery endoscope apparatus according to claim 26, wherein said support member has a belt wound around an outer peripheral portion of said adapter and adapted to fix said support member and said adapter.

30. A cerebral surgery endoscope apparatus according to claim 26, wherein said support member has an arm for fixing said support member and said adapter by pressing an outer peripheral portion of said adapter.

31. A cerebral surgery endoscope apparatus according to claim 24, wherein said slider has a guide portion and support member which is secured to at least one of said inserting means, said telescope, said treating instrument, and said adapter and is longitudinally movable along said guide portion.

32. A cerebral surgery endoscope apparatus according to claim 31, wherein said slider further has a rack provided on either one of said guide portion and said support member and a pinion provided on the other and meshing with said rack, thereby allowing said support member to be longitudinally movable relative to said guide portion as said pinion is rotated.

33. A cerebral surgery endoscope apparatus comprising:

a stereotaxic instrument to be secured to the head of a patient to effect positioning of a treating instrument in an affected part;

an inserting means whose inserting direction is determined by said stereotaxic instrument, for inserted treating instruments into the head of the patient;

a telescope detachably inserted into said inserting means having a channel into which a treating instrument can be inserted and further having an insertable part to be inserted into said inserting means;

said telescope and channel being removably inserted into said inserting means in a state that the longitudinal axis of the insertable part of said telescope and the longitudinal axis of said inserting means are substantially in parallel, and

said telescope and channel being removably insertable into said inserting means allowing supplying or draining of liquid through a cavity of said inserting means while said telescope is removably inserted in said inserting means, and further

said treating instrument being removably insertable into said channel,

said treating instrument being insertable into said channel of said telescope and then into the head of the patient; and

a fixing device connected to said stereotaxic instrument to support and fix said treating instrument, said fixing device having adjusting means allowing the position of said treating instrument to be adjusted, a rear end of said inserting means extending to and operatively connecting with said fixing device, and an overall length of said inserting means being hollow.

34. A cerebral surgery endoscope apparatus according to claim 33, further comprising an adapter for detachably connecting said treating instrument and said telescope.

35. A cerebral surgery endoscope apparatus according to claim 33 or 34, wherein said fixing device has a position adjusting mechanism fixed to said stereotaxic instrument, an arm connected to said position adjusting mechanism, and an inserting means holder provided at an end portion of said arm and adapted to hold said inserting means.

36. A cerebral surgery endoscope apparatus according to claim 33 or 34, wherein said fixing device has a support member which is fixed to said stereotaxic instrument and is flexible but rigid enough to support said inserting means, said telescope, and said treating instrument, as well as an inserting means holder connected to said support member and adapted to hold said inserting means.

37. A cerebral surgery endoscope apparatus according to claim 33 or 34, wherein said fixing device has a position adjusting mechanism fixed to said stereotaxic instrument, an inserting means holder for holding said inserting means, and an arm connecting said position adjusting mechanism and said inserting means holder and adapted to support said inserting means holder from below.

38. A cerebral surgery endoscope apparatus according to claim 33 or 34, wherein said fixing device has a position adjusting mechanism fixed to said stereotaxic instrument, an arm opposite end portions of which are respectively connected to said position adjusting mechanism, and an inserting means holder fixed at a desired position on said arm and adapted to hold said inserting means.

39. A cerebral surgery endoscope apparatus according to claim 33 or 34, wherein said stereotaxic instrument and said fixing device are made of material, such as a plastics, which does not produce an artifact for a CT image.

40. A cerebral surgery endoscope apparatus according to claim 12, further comprising:

an adapter for detachably connecting a telescope and said treating instrument inserted into said treating instrument channel to said telescope, said adapter comprising:

a telescope-side connecting portion detachably connectable to said telescope;

a treating instrument-side connecting portion detachably connectable to said treating instrument;

connecting means for connecting said telescope-side connecting portion and said treating instrument-side connecting portion such as to be capable of advancing and retracting the same; and

fixing means capable of fixing the positions of said telescope-side connecting portion and said treating instrument-side connecting portion at desired positions.

41. A cerebral surgery endoscope apparatus according to claim 4

wherein said adapter detachably connects said treating instrument and said telescope, said adapter including a telescope-side connecting portion detachably connectable to said telescope, a treating instrument-side connecting portion detachable connectable to said treating instrument, connecting means for connecting said telescope-side connecting portion such as to allow the same to advance and retract, and fixing means which is capable of fixing position of said telescope-side connecting portion and said treating instrument-side connecting portion at desired positions.

42. A cerebral surgery endoscope apparatus comprising:

a stereotaxic instrument to be secured to the head of a patient, including a support means and means for positionally orienting the support means with respect to an affected part;

treating instrument inserting means supported on the support means for receiving a treating instrument to be inserted into the affected part for treatment thereof, a rear end of said inserting means extending to and operatively connecting with the support means, and an overall length of said inserting means being hollow; and

a viewing instrument supported on the support means and operatively associated with said treating instrument inserting means so as to be insertable therewith into the affected part to provide real time observation of the treatment, and further having an insertable part to be inserted into said inserting means,

said viewing instrument being removably inserted into said treating instrument inserting means in a state such that the longitudinal axis of the insertable part of said viewing instrument and the longitudinal axis of said inserting means are substantially in parallel, and said treating instrument being removably insertable in said inserting in said inserting means with said viewing instrument, and further

said said viewing instrument and treating instrument being removably insertable into said inserting means allowing supplying or draining of liquid through a cavity of said inserting means while said viewing instrument is removably inserted in said inserting means.

43. Endoscope apparatus as recited in claim 42 wherein said viewing instrument is an endoscope.

44. An endoscope apparatus as recited in claim 43 wherein said endoscope includes illumination means, an image forming optical system, and a solid-state image sensing means.

45. An endoscope apparatus as recited in claim 42 further including fixing means for securing the stereotaxic instrument, support means, treating instrument inserting means, and viewing instrument in fixed position with respect to said affected part.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to an apparatus used in a surgical operation in cranial bones, and, more particularly, to a cerebral surgery apparatus for sucking and removing an affected part such as an intracerebral hematoma, a cerebral tumor, or the like.

2. Related Art Statement

Cerebral hemorrhage and subarachnoid hemorrhage can be cited as typical examples of cerebrovascular diseases. In recent years, stereotaxy using a CT (computer tomography) drainage method is conducted to remove an intracerebral hematoma or the like after the occurrence of an intracerebral hemorrhage, as shown in the "Journal of Brain Neurosurgery", Vol. 14, No. 2, pp. 123-133, published in February 1986.

In stereotaxy, a stereotaxic instrument is fixed to the head of a patient and is positioned in relation to an affected part in the brain by using a positioner provided in the instrument, and a treating instrument, such as a drainage tube, is inserted into the affected part, thereby allowing surgery to be conducted. In this type of sterotaxic surgery, the positioning accuracy has in recent years been improved by the use of CT in which an affected part is determined on the basis of a cross-sectional image of CT to allow positioning to be effected. Consequently, it has become possible to check at a microscopic level the intervention to which the patient is subjected.

Examples of surgical apparatuses that are used in this type of stereotaxy are disclosed in Japanese Patent Publication No. 25377/1986, Japanese Utility Model Publication No. 26088/1987, etc.

As a method of removing an intracerebral hematoma by stereotaxy, it is conventional for a method to be adopted in which a metal suction tube is inserted into the hematoma, and the hematoma is sucked and removed by a suction instrument such as a syringe. If the hematoma cannot be removed completely, a method is adopted in which an indwelling tube is left in a hematoma hole, a hematoma-resolving agent such as urokinase is injected, and the resolved hematoma is sucked and removed from the indwelling tube several hours later.

Another method has also come to be adopted in which a hematoma is broken down, sucked and removed by using an ultrasonic suction device.

Furthermore, biopsy of cerebral tumors, thermocautery, or the like using, for instance, Nd-YAG laser beams, is conducted by stereotaxy.

In the removal of a stereotaxic intracerebral hematoma using the CT drainage method, the state of suction of a hematoma cannot be observed on a real-time basis, so that a surgical operation is performed in a blind manner. Consequently, there is the risk of causing damage to a cerebral parenchyma. In addition, there are also cases where the intracerebral hematoma cannot be removed completely when undue efforts are made not to damage the cerebral parenchyma. Furthermore, since it is essential to proceed with the surgical operation while successively confirming the state in which the hematoma is being sucked so as not to cause damage to the cerebral parenchyma, the time of an operation tends to become extremely long. This means that the patient is subjected to a large scale invasion and the operator inevitably experiences considerable strain and fatigue.

In addition, the method of sucking and removing a hematoma by means of a sucking device such as a syringe involves problems in that the sucking pressure must be increased to a substantially high level due to the highly viscose nature of the hematoma, with the attendant danger of sucking the cerebral parenchyma as well due to the high sucking pressure, and in that the hematoma is liable to become clogged in the inner hole of the suction tube which can frequently cause the operation to be interrupted.

The diameter of the suction tube must be enlarged in order to render clogging with a hematoma less likely to occur, so that the degree of damage caused in the cerebral parenchyma increases by that margin.

In addition, in the hematoma resolving method, the resolution power of the hematoma resolvent is very small, and the situation is not such that this method can ever be clinically satisfactory. Hence, because of the retention of a catheter for a long period of time and the frequent administration of a resolvent, the possibility of a concurrent infectious disease is unavoidable, and the agony experienced by the patient is very great due to the retention of the catheter over a long period of time.

Furthermore, although the method that utilizes an ultrasonic suction device is very effective, there is a risk of causing damage to the cerebral parenchyma owing to the fact that the operation is conducted blind. In addition, since no device is available for fixing the ultrasonic suction device that would be capable of effecting an advancing and retracting operation, the advancing and retracting operation must be performed manually with the apparatus held by the operator's hand. Consequently, there is a danger that damage of the cerebral parenchyma will be caused inadvertently.

The above-mentioned drawbacks are not confined to the suction and removal of intracerebral hematomas, but are also commonly experienced in conventional stereotaxy, including operations on cerebral tumors.

SUMMARY OF THE INVENTION:

Accordingly, an object of the present invention is to provide a cerebral surgery endoscope apparatus which is capable of performing treatment of an affected part, such as a hematoma and a tumor, safely and positively within a short period of time, while orthoptically observing the state of treatment of the affected part on a real-time basis.

Another object of the present invention is to provide a cerebral surgery endoscope apparatus which is capable of accurately effecting the positioning of a surgical instrument and of positively holding and fixing the surgical instrument.

Still another object of the present invention is to provide a cerebral surgery endoscope apparatus which is capable of positively effecting the positioning and holding of a surgical instrument and of accurately and positively adjusting the position of the surgical instrument relative to the head of a patient.

A further object of the present invention is to provide a cerebral surgery endoscope apparatus which is capable of performing an advancing and retracting operation of a treating instrument, as desired, and is capable of fixing the same at a desired position.

To these ends, in accordance with the present invention, there is provided a cerebral surgery endoscope apparatus comprising: a stereotaxic instrument secured to the head of a patient and adapted to effect positioning of a treating instrument in an affected part; a sheath or treating instrument inserting means whose inserting direction is determined by the stereotaxic instrument and which is inserted into the head; a telescope or other viewing instrument detachably inserted into the sheath and having a channel into which a treating instrument can be treating the inserting instrument being adapted to be inserted into a channel of the telescope and then into the head of the patient; an adapter for detachably connecting the treating instrument and the telescope; and a fixing device connected to the stereotaxic instrument and adapted to support and fix the sheath, the telescope, the adapter, and the treating instrument.

Other objects, features and advantages of the present invention will become apparent from the following detailed description of the invention when read in conjunction with the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1 to 20 relate to a first embodiment of the present invention, in which

FIG. 1 is a perspective view illustrating an overall cerebral surgery apparatus;

FIG. 2 is a side-elevational view of a state in which a sheath, a telescope, an adapter, an ultrasonic suction instrument, and a fixing device are assembled;

FIG. 3 is a cross-sectional view of the sheath;

FIG. 4 is a side-elevational view of a mandrel;

FIG. 5 is a perspective view of the fixing device;

FIG. 6 is a cross-sectional view illustrating a mechanism for adjusting the fixing device;

FIG. 7 is a cross-sectional view taken along the line B--B' of FIG. 6;

FIG. 8 is a side-elevational view of a sheath holder;

FIG. 9 is a cross-sectional view taken along the line C--C' of FIG. 8;

FIG. 10 is a cross-sectional view illustrating a connecting portion for connecting the sheath holder and a support;

FIG. 11 is a cross-sectional view of the telescope;

FIG. 12 is a front-elevational view of a tip portion of an inserting portion of the telescope;

FIG. 13 is a cross-sectional view taken along the line D--D' of FIG. 12;

FIG. 14 is a cross-sectional view illustrating a slider of the support;

FIG. 15 is a cross-sectional view taken along the line E--E' of FIG. 14;

FIG. 16 is a cross-sectional view taken along the line A--A' of FIG. 2 and illustrating a fixing portion for fixing the slider and an adapter;

FIG. 17 is a cross-sectional view of the adapter;

FIG. 18 is a cross-sectional view illustrating the positional relationship between a probe and a sheath-inserting portion with a sliding member of the adapter disposed at its forward limit;

FIG. 19 is a side-elevational view of the adapter;

FIG. 20 is a cross-sectional view illustrating the positional relationship bettween the probe and the sheath-inserting portion with the sliding member of the adapter disposed at its rearward limit;

FIG. 21 is a cross-sectional view illustrating the slider of the support in accordance with a second embodiment of the present invention;

FIG. 22 is a cross-sectional view illustrating the slider of the support in accordance with a third embodiment of the present invention;

FIGS. 23 and 24 relate to a fourth embodiment of the present invention; in which

FIG. 23 is a cross-sectional view of the adapter;

FIG. 24 is a cross-sectional view of a cross-sectional view taken along the line F--F' of FIG. 23;

FIG. 25 is a cross-sectional view illustrating a connecting portion for connecting an adapter body and the sliding member of the adapter in accordance with a fifth embodiment of the present invention;

FIG. 26 is a cross-sectional view illustrating a connecting portion for connecting an adapter body and the sliding member of the adapter to the main body of the adapter in accordance with a sixth embodiment of the present invention;

FIG. 27 is a cross-sectional view of the adapter in accordance with a seventh embodiment of the present invention;

FIG. 28 is a cross-sectional view of the adapter in accordance with an eighth embodiment of the present invention;

FIG. 29 is a cross-sectional view illustrating an adapter-fixing portion of the support in accordance with a ninth embodiment of the present invention;

FIG. 30 is a cross-sectional view illustrating the adapter-fixing portion of the support in accordance with a tenth embodiment of the present invention;

FIG. 31 is a perspective view illustrating the overall cerebral surgery apparatus in accordance with an eleventh embodiment of the present invention;

FIG. 32 is a cross-sectional view illustrating the telescope in accordance with a twelfth embodiment of the present invention;

FIGS. 33 and 34 relate to a thirteenth embodiment of the present invention; in which

FIG. 33 is a perspective view illustrating the overall cerebral surgery apparatus;

FIG. 34 is a cross-sectional view illustrating a connecting portion for connecting a tube and the support of the fixing device ;

FIGS. 35 and 36 relate to a fourteenth embodiment of the present invention;

FIG. 35 is a perspective view illustrating the overall cerebral surgery apparatus;

FIG. 36 is a top plan view illustrating a stage of the fixing device;

FIG. 37 is a perspective view illustrating the overall cerebral surgery apparatus in accordance with a fifteenth embodiment of the present invention;

FIGS. 38 to 41 relate to a sixteenth embodiment of the present invention, in which

FIG. 38 is a perspective view illustrating the overall cerebral surgery apparatus;

FIG. 39 is a cross-sectional view of an example of a fixing portion of an arm of a stereotaxic apparatus;

FIG. 40 is a cross-sectional view illustrating another example of the fixing portion of the arm of the stereotaxic apparatus; and

FIG. 41 is a perspective view illustrating the cerebral surgery apparatus with an inner ring installed in a ring of the stereotaxic apparatus.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

FIGS. 1 to 20 illustrate a first embodiment of the present invention.

As shown in FIG. 1, a cerebral surgery apparatus in accordance with this embodiment comprises: a stereotaxic instrument 1 which is fixed to the head of a patient and adapted to effect the positioning of an affected part; a sheath or treating instrument inserting means 2 whose inserting direction is determined by this stereotaxic instrument and which is inserted into the affected part; a telescope 3 which is detachably inserted into this sheath 2; an ultrasonic suction device 5 which is a treating instrument inserted retractably into a treatment instrument channel of the telescope 3; an adapter 4 which detachably connects the ultrasonic suction device 5 and the telescope 3; and a fixing device 6 which is connected to the sterotaxic instrument 1 and integrally supports the sheath 2, the telescope 3, the adapter 4, and the ultrasonic suction device 5.

The stereotaxic instrument 1 has a ring 12 secured on an operating table 11, and the head 10 of the patient is inserted into the ring 12 and is adapted to be secured to the stereotaxic instrument 1 by means of, say, four head-securing screws 13 disposed on the ring 12. An arm 15 is connected via a positioner 14 to one side portion of the ring 12. A sheath holder 16 for holding the sheath 2 is provided on this arm 15. The sheath 2 is adapted to be set at an optimum piercing position when the sheath 2 is adjusted in the X, Y and Z directions by means of the positioner 14 and in the .alpha. and .beta. directions by means of the arm 15 and the sheath holder 16 such as to be aligned with the position of the affected part in the brain.

As shown in FIG. 3, the aforementioned sheath 2 has a hollow, elongated sheath-inserting portion 21 and a main body 22 connected to a rear end of the sheath-inserting portion 21. A connecting member 23, to which the telescope 3 or a mandrel 30, which will be described later, can be connected detachably, is provided at a rear end of the main body 22. In addition, a liquid feeding port 25, which communicates with a hollow portion in the sheath-inserting portion 21 and has a cock 24, is provided on a side portion of the main body 22. Incidentally, two liquid feeding ports 25 may be provided to allow both the supply and discharge of the liquid.

At the time of inserting the sheath 2 into the brain, the sheath 2 is inserted into the brain with the mandrel 30 installed in the sheath 2, as shown in FIG. 4. The mandrel 30 comprises a shaft 31 which is inserted into the sheath-inserting portion 21, a tip portion 32 disposed at a tip of this shaft 31 and having a conical tip, a connecting portion 33 which is connected to a rear end of the shaft 31 and is detachably connectable to the main body 22 of the sheath 2 via a connecting member 23, and a grip 34 connected to a rear end of the connecting portion 33.

The sheath 2 is fixed by the sheath holder 16 disposed on the arm 15. In addition, the positions of the sheath 2 and the sheath holder 16 are fixed by the fixing device 6. As shown in FIG. 1, this fixing device has a support 17 for integrally supporting the sheath 2, the telescope 3, the adapter 4, and the ultrasonic suction device 5. This support 17 and the sheath holder 16 are adapted to be secured by a setscrew 19.

The mandrel 30 is adapted to be withdrawn after the sheath 2 has been inserted into a target point. With the telescope 3, the adapter 4, and the ultrasonic suction device 5 assembled together, as shown in FIG. 2, this assembly, instead of the mandrel 30, is adapted to be inserted into the sheath 2 and connected thereto.

A liquid supply tube 27 which is connected to a liquid feeding device (not shown) is connected to the liquid feeding port 15 of the sheath 2. A light guide 29 which is connected to a light source device (not shown) is connected to a light guide connector 28 of the telescope 3. In addition, an electric cord 41 of the ultrasonic suction device 5 is connected to a generator 40 for driving the ultrasonic suction device 5, and a drainage tube 42 is connected to a collection bottle 43 which is attached to the generator 40 and adapted to collect a discharged liquid. A tube 44 extends from the collection bottle 43, and is connected to a discharged liquid container (not shown) via a pump 45.

The fixing device 6 has an arrangement which is illustrated in FIGS. 5 to 10.

As shown in FIG. 5, a fixing table 51 of the fixing device 6 is disposed on top of the ring 12 of the stereotaxic instrument 1. This fixing table 51 is formed to extend in the direction of X shown in FIG. 5, and is mounted on the ring 12 to be parallel with the operating table 11 of the stereotaxic instrument 1. The fixing table 51 is fixed to the ring 12 by means of a setscrew 52 screwed in from a side portion of the fixing table 51. Flanges 51a are formed on top of the fixing table 51 in the direction of X. A sliding table 53 is installed on the fixing table 51 and is formed to extend in the direction of Z shown in the drawing, to engage with the flanges 51a, and to be slidable in the direction of X. After adjustment of the sliding table 53 in the direction of X is carried out by sliding the same, the sliding table 53 is fixed to the fixing table 51 by a setscrew 54 which is screwed in from a top portion of the fixing table 51. A projection 53a is formed on top of the sliding table 53 along the direction of Z. A support table 55, which engages with the projection 53a and is slidable in the direction of Z, is mounted on the sliding table 53. After adjustment is made of this support table 55 in the direction of Z by sliding the same, this support table 55 is secured to the sliding table 53 by means of a setscrew 56 which is screwed in from the top of the support table 55.

As shown in FIGS. 6 and 7, a cylindrical column 57 projects from the top of the support table 55. A rotational cylinder 58 having a cylindrical hole, into which the column 57 is engaged, is fitted around the lower side of this column 57. This rotational cylinder 58 is rotatable on the column 57, and can be adjusted in the direction of .theta. shown in FIG. 5. This rotational cylinder 58 is fixed to the support cylinder 57 by means of a setscrew 59 which is screwed in from a side portion of the rotational cylinder 58. In addition, an upper side of the rotational cylinder 58 is provided with a groove 60, which is open to side surfaces and an upper surface of the rotational cylinder 58. An arm-holding plate 62 provided with a slit 61 is inserted into this groove 60, and an arm 63 is clamped in the slit 61. A shaft 64 having a knob 64a at an end portion thereof penetrates the rotational cylinder 58 and the arm-holding plate 62. An external thread 64b is formed at a tip portion of the shaft 64, on which a knob 65 is screwed onto this external thread 64b. The arm 63 is slidable in the slit 61 in the direction of .gamma. shown in FIG. 5. Furthermore, the arm-holding plate 62 is rotatable around the shaft 64, as shown in FIG. 7, thereby making it possible to adjust a rotational angle .epsilon. of the arm 63, as shown in FIG. 5. In addition, the arm 63 is arranged to be tightened and fixed by the slit 61 when the rotational cylinder 58 and the arm-holding plate 62 are tightened by the shaft 64 and the knob 65.

As shown in FIGS. 8 and 9, two auxiliary arms 66 are secured to a tip portion of the arm 63 by means of a bolt 67a and a nut 67b. A rotational member 74 of the sheath holder 16 is clamped between the two auxiliary arms 66, and this rotational member 74 is fixed by setscrews 68 which respectively pass through 67 formed in the auxiliary arms 66 and are screwed into the rotational member 74.

As shown in FIG. 10, the sheath holder 16 has a substantially cylindrical carrier 71 into which the sheath-inserting portion 21 of the sheath 2 is inserted. A holding cylinder 72 is fitted around this carrier 71. A support member 73 is threadingly engaged with an ou