US 3223087 A
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Description (OCR text may contain errors)
Dec. 14, 1965 v. VLADYKA ETAL 3,223,087
STEREOTAXIC DEVICE Filed June 15, 1961 5 Sheets-Sheet 1 F|....\....,.. L f f n 7 o g e s A 1 |....|....\....1..l `.|....|....l..,.r..\ Il m a' g a Dec. 14, 1965 v. vLADYKA E'rAl. 3,223,087
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ATTORNEY Dec. 14, 1965 v. VLADYKA 4l-:TAL 3,223,087
sTEREoTAxIc DEVICE Filed June 15, 1961 5 Sheets-sheet s INVENToRs Inma/YA. vigna/2&5. zml.
@A fw United States Patent O 3,223,087 STEREOTAXIC DEVICE Vilibald Vladyka and Panel Jazek, both of Prague, Czechoslovakia, assignors to Chirana Praha, nrodni podnik, Prague, Czechoslovakia, a corporation of Czechoslovakia Filed June 15, 1961, Ser. No. 133,004 Claims priority, application Czechoslovakia, June 18, 1960, 3,937/60 2 Claims. (Cl. 12S-303.13)
This invention relates to a stereotaxic device enabling surgical operations on the human brain.
Surgical operation and treatment of the brain tissues inside the skull are always rather difficult due to the delicacy and complexity of the brain structure and to its inaccessibility. For certain treatments, the risk of the operation has been up to now so great that some areas of the brain have been practically inaccessible for any operation and consequently patients have remained without help and their cases have had to be given up as lost.
At present there are a number of known stereotaxic apparatus which should relieve this undesired state. These apparatuses are partly suitable in some cases and for areas of the brain. They are, however, very complicated and heavy and require very skillful manipulation.
It is, accordingly, an object of this invention to provide a stereotaxic apparatus which is easy to manipulate, which guarantees the required accuracy, and which enables the'r performance of different kinds of operations with the minimum discomfort to the patient, and the weight of which is sutiiciently light that it requ-ires no complicated supports and can Ibe directly atlixed to the patients head. The stereotaxic apparatus in accordance with this invention is directly aflixed to the patients skull by at least three threaded bolts, the pointed ends of which partly enter into the skull bones. The apparatus is aixed to the skull by means of a yoke supporting said threaded bolts, the threaded bolts entering the patients skull along a line corresponding to the central cerebral line, leaving said yoke beyond said line. A frame, whose angular position and distance from said yoke is adjustable, is supported by said yoke with an electrode holder, and extensions bearing X-ray reference marks are provided on said frame. The relative positions of different elements of said apparatus are determined on scales.
The invention is described in detail in the following specication in conjunction with the accompanying drawings which show by way of example different illustrative embodiments thereof. Y Y
In the drawings, FIG. l is a side View of the apparatus;
FIG. 2 is the corresponding front View;
FIG. 3 is a top View of a reference strip for X-ray examination;
FIG. 4 is a side elevation of another X-ray reference strip;
FIG. 5 is a side view of an apparatus with a plate provided with a network of lines -for X-ray examination and FIG. 6 is the corresponding front view.
FIG. 7 shows an electrode used for treatment of brain tissues; and
FIGS. 8 and 9 show a section and side view of a sidebar.
As shown in FIGS. 1 and 2, the fundamental frame of the apparatus which has to be atiixed to the patients skull is represented by a yoke 1 which is bent to the shape of, or part of, an open planar polygon member, such that the parts thereof which bear threaded bolts 4, 5 and 5 and have to be atlixed to the patients skull, are approximately parallel with that part of the skull where said bolts have to be aixed. The yoke 1 includes 3,223,087 Patented Dec. 14, 1965 ICC a first end portion a, a second end portion b, and an intermediate portion c. End portion a, which falls near the patients forehead, is provided with two lateral extensions 3 and 3 of approximately rectangular shape with cut threads for receiving the threaded bolt 4, which can be alternately selectively inserted into one of said extensions as determined by the place where the treatment has to be performed. As depicted, one extension projects from one side of the yoke and the other extension from the other side. The threaded bolt 4 is pointed on its end, such point being in line with the central cerebral line. The remaining part of the yoke 1 bears at least two sleeves 21 and 21 with set screws 5 which are equally displaced from the axis of symmetry of the yoke 1. Sleeve 21 is slidable along the intermediate portion c, and sleeve 21 along the second end portion b.
The apparatus proper comprises a horizontal tube 6 on the ends of which there are mounted two graduated vertical sidebars 7, which, with tube 6, effectively provide a U-shaped frame for the apparatus. The tube 6 serves as the means connecting respective ends of the sidebars. The lower ends of the sidebars 7 are provided with pointed extensions 8 which can be utilized to provide reference marks for X-ray examination. The marks made by extensions 8 should 'be in line with the affected portion of the brain so that when the electrode is lowered, its active electrode portion will be at the aiected portion of the brain. Sleeves 9 supporting a horizontal sliding crossbar 10 are slidably supported by sleeves 17 on the vertical sidebars 7, the longitudinal disposition of crossbar 10 being laterally displaced -from the axes of the sidebars 7. The crossbar 10 is provided at a point displaced from its midpoint with a cylindrical portion which is coaxial with the axis of the crossbar and is engaged in a sleeve 11 which itself is in sliding engagement with yoke 1, to which it may beaixed by a set screw 31. The cylindrical portion 2 together with the bar 10 can be rotated in the support 11 to any position with an inclination of from zero to 360 and the required position can be fixed by the arresting means 12 which functions as a stop. The base of a threaded bolt 13 is pivotally engaged in the cylindrical portion 2 of the crossbar 10 and threaded portion passes through a nut 14 mounted on the horizontal tube 6. The thread of the screw 13 suitably has a large pitch and enables a quick relative displacement of the horizontal tube 6 upwards or downwards with respect to the horizontal crossbar 10. The longer part of the crossbar 10 is provided with a scale 20, the zero position ot which corresponds after adjustment of the yoke 1 to a position corresponding to the central cerebral line of the patient.
A holder 15 for electrodes 18 (FIGS. 3 and 4) can be shifted on the crossbar 10 to the right or left and is provided with a scale 16 thereon for determining the depth to which the electrode has to enter into the cerebral tissue. The holder is fixed in the proper position on the crossbar 10 by a set screw 23. Alternatively the holder can be arranged so as to allow an inclination with respect to the crossbar 10.
The electrode 18 is inserted into a bore 24 of the holder 15, the axis of said bore being in the same plane as the axis of the vertical bars 7 and parallel to these axes. Thus there is achieved the result that the electrode 18 can be exactly in line with the bars 7 and the electrode 18 can be thus introduced into the proper place of the cerebral tissue in accordance with the information resulting from previously taken X-ray pictures.
The depth for which the electrode 18 has to enter the cerebral tissue can be determined by the different scales provided on the apparatus.
The electrode 18, as shown in FIG. 5, has a stop member 25 which cooperates with the horizontal tube 6 so that when stop is in engagement with said tube, the tip of the electrode element is in the same plane as the extensions 8 with the marks for X-ray examination.
The proper adjustment of the apparatus is furthermore enabled by reference strips 19, 19a which are used for the determination of the central cerebral line. FIG. 5 shows a top View of one of these strips and FIG. 6 shows an elevation of another strip. The strips are .provided with a number of bores 27 therein, such as, for example, ten bores in 'like and a transverse Vcut '28 is provided in the axis of each Ibore 27 to enable the identification of the position of each bore in the course of X-ray examination. The strips 19, 19a lare further provided with two pins 26 to enable ytheir being aixed to the skull bones. The strip 19a as shown in FIG. 5 is straight and is fixed to the forehead of the patient. The strip 19 as shown in FIG. 6 is bent and is affixed-to the rear part of the skull. The pins 26 are exactly in line with the bores 27.
Prior to applying ythe apparatus, the central cerebral line of the patient is determined. First the reference strips 19, 19a are respectively afiixed to the forehead and -to the rear part of the skull of the patient and an X-ray picture is taken of the cerebrurn and the bores 27 marked on the strips Y19, 19a which are in line with the central cerebral line. These marked -places on thel skull are bored to a certain depth and the yoke 1 of the apparatus fixed to the skull by inserting the pointed ends of the threaded bolts 4 and Sinto these bores. The whole yoke, supporting the ltube -6 ofthe apparatus, with the electrode holder, is thus affixed to the skull by means of these pointed ends of the bolts 4 and 5. The support 11 is thereafter shifted together with thesidebars 7 lto a place in which the extensions 8 ofthe bars 7 are in line with the place of the brain which is to be treated. The correct place is determined by X-ray examination. .Subsequently atrephine hole is made atthe proper place and the electrode is inserted/in the desired position through this hole, and the respective Vtreatment of the cerebral tissue is'started.
The elect-rode 18has a chosendiameter and length and beyond -its active parts it is covered with a special insulating lacquer such as thetype used for high frequency electric current equipment.
In order to -enable to determine .more accurately and with the minimum of X-ray pictures the correct place where the'electrode has vto be applied, a plate V29 -is affixed by means of bolts 30 and nuts 32 to the yoke 1 (see FIGS. 7 and 8). Plate 29 is provided with a network of lines 33, which contribute to the exact localization and adjustment of the electrode holder to the vrespective place already indicated by the first X-ray picture. This plate 29 is advantageously constructed of a transparent material in order Yto enable also the visual control, together with the -network of lines `33 applied by means of a material which is distinct when X-rayed. It should be advantageously in close proximity to one ofthe X-ra-y mark-s 8. In this embodiment the end -portion b of the yoke 1 is shown provided-with scale-divisions 35.
It is further advantageous 'for all of the threaded bolts 4 and 5 and all adjustable sleeves and `holders or their counterparts v respectively to be provided with scales thereonin order to enable the reproduction of the position of the apparatus in case a second operation or treatment is required.
While one -specic embodiment of my invention has been shown and described in detail, to illustrate the application of the principles of my invention, it will be understood that the same may be differently embodied without departing from such principles.
What I claim as my invention is:
1. A stereotaxic apparatus for surgical treatment of the human brain, comprising:
(a) an open partially polygonal planar yoke having respective first and second end portions ,and an intermediate portion;
(b) a first vpointed bolt-engaging :said first end portion near its end for application to thefront of the skull;
(c) a second pointed bolt engaging said second end portion near its end for application to the rear of the skull;
(d) at leastone sleeveslidably mounted on said yoke and adapted to be adjustably moved along said intermediate portion of the yoke;
(e) a third pointed bolt engaging said sleeve for application to the top of the skull;
(f) a support slidably mounted on said intermediate portion of the yoke;
(g) a crossbar held by said support and rotatable therein;
(h) a U-shaped planar frame comprising a pair of vertical sidebars and a horizontal base connected to each of said sidebars, said sidebars constituting a vertical frame of reference, and the ends of said sidebars being pointed for application to the skull lto serve as reference points, each of said sidebars being slidably mounted on the crossbar, said base being substantially parallel to said crossbar;
(i) arresting means connecting said yoke and said frame for fixing the v.disposition of said frame relative to said yoke;
(j) an electrode holder slidably mounted on vsaid `horizontal crossbar; and
(k) an electrode slidably mounted in said holder so as to be displaceable vertically in the vertical plane defined by said sidebars.
, 2. Astereotaxic apparatus asdefined in claim 1 wherein thelongitudinal axes of said first and second bolts 'are located in aicommon plane.
References Cited by the Examiner UNITED STATES PATENTS 3,053,256 9/1962 Cooper et al 12S-303 3,061,936 11/1962 De Dobbeleer 128--303 3,073,310 -1/1963 MOCarSki `128--303 3,115,140 12/1963 Volkman- 12S-T410 3,135,263 6/1964 Connelley 128--303 FOREIGN PATENTS 63.4,460 3/1950 Great Britain.
OTHER REFERENCES Verne et al. Journal de Chiruagie ,1946, vol. 6,2, No. 5 (28 pages, only page 198 relied upon).
Cooper (Neurological Alleviation of Parkinsonism), published by C. C. Thomas, Springfield, 1956 (13 pages, only pages 72, 74, 75, 77, 79, 80, and 83 relied upon).
RICHARD A. GAUDET, Primary Examiner.
JORDAN FRANKLIN, H. R. GOLDBERG, SIMON BRODBR, Assistant Examiners.