Patent Application
20060150984
The head of a patient is immobilized for surgery on or near the brain, skull, cervical spine and other neurological procedures. Such immobilization may be accomplished through a number of pins and screws that are attached to the skull and engaged to a table, support, wall or other stabilizing structure adjacent to and remote from the head of the patient. In order to engage such pins and screws, it is necessary to perforate the skin and engage the skull of the patient. This results in additional time being required during the surgery and also creates locations other than the surgery location on the patient that require post-operative treatment and healing.
According to one aspect, a surgical head fixation and positioning system includes a helmet member positionable about the head of the patient and selectively conformable to the head of the patient to provide a snug fit. The system can maintain the head in position during surgery, and also allow repositioning during surgery as may be desired for placement of surgical instruments and implants.
According to another aspect, a surgical head fixation and positioning system includes a helmet member positionable about the head of the patient having removable panel portions to provide access to the cranium of the patient through the helmet-like member.
According to another aspect, a surgical head fixation and positioning system includes a helmet member positionable about the head of the patient that includes an adjustable fixture for securing the helmet member and thus the head of the patient in a desired position relative to a stabilizing structure.
According to a further aspect, a surgical head fixation and positioning system includes a helmet member positionable about the head of the patient that includes mounting members extending therefrom for securing the helmet member and thus the head of the patient in a desired position relative to a stabilizing structure.
These and other aspects will be discussed further below.
For the purpose of promoting an understanding of the principles of the invention, reference will now be made to the embodiments illustrated in the drawings and specific language will be used to describe the same. It will nevertheless be understood that no limitation of the scope of the invention is thereby intended. Any alterations and further modifications in the described embodiments, and any further applications of the principles of the invention as described herein are contemplated as would normally occur to one skilled in the art to which the invention relates.
A surgical head positioning and fixation system includes a helmet member positionable about the head of a patient. The helmet member includes a rigid outer shell and an engagement member that is releasably and fixably engageable to the head of the patient. In one embodiment, the engagement member includes a series of columnar portions and row portions that form pockets therebetween. An enlargement member having portions in the pockets can be enlarged to fixedly engage the engagement member and thus the helmet member to the head of the patient.
In another embodiment, the helmet member includes an adjustment fixture rotatable about the helmet member and securable in any one of the rotated positions relative to the helmet member. The head of the patient can be manipulated in order to allow, for example, the cervical spine to be placed in flexion, extension, compression, traction, or rotated about the central axis of the spinal column. Such repositioning of the head and cervical spine may allow or facilitate the placement of implants, instruments and other devices in a desired position relative to the cervical portion of the spine. The rotatable adjustment fixture can be rotated to a position about the helmet member that allows engagement of the adjustment fixture to a surgical table, wall, frame or other fixture to maintain the manipulated position of the head and cervical spine of the patient.
In another embodiment, the helmet member includes one or more panels removably coupled thereto. The one ore more panels can be removed for selective access to portions of the cranium of the patient for surgical procedures and placement of instruments and implants relative to the skull or brain while the remaining portion of the helmet member is fixed to the head of the patient.
In a further embodiment, the helmet member includes at least one mounting member extending therefrom. The at least one mounting member can be engaged to a surgical table, wall, frame or other stabilizing structure to maintain a positioning of the head of the patient during the surgical procedure. The helmet member can be engaged to the head of the patient while the patient is conscious. Accordingly, in the standing position the desired neutral positioning of the head and cervical portion of the spine can be imaged pre-operatively with the helmet member fixed to the patient and recorded for replication in the operating room during the surgical procedure.
Referring to
Helmet member 12 includes a rigid outer shell 14 and an engagement member 16 therein that forms a lining for positioning against or adjacent the head of the patient. In the illustrated embodiment, outer shell 14 covers substantially the entire surface area of helmet member 12. Other embodiments contemplate an outer shell 14 that covers less than the entire surface area of helmet member 12. For example, outer shell 14 may comprise a series of rows and columns that align with rows and columns of the engagement member, as discussed further below.
In the illustrated embodiment, engagement member 16 can include a number of row portions 18 and a number of columnar portions 20 forming pockets 22 therebetween. At least a portion of enlargement member 34 is located in one or more of the pockets 22. In one embodiment, a portion of enlargement member 34 is located in each pocket 22. The respective portion of enlargement member 34 in a pocket 22 extends between adjacent ones of the row and columnar portions 18, 20 when enlarged to displace engagement member 16 toward the head of the patient and fixedly engage helmet member 12 thereto. In another embodiment, one or more of the pockets 22 do not include an enlargement member 34 or a portion of enlargement member 34 so that the adjacent portions of engagement member 16 are not placed in fixed engagement with the head of the patient. For example, if helmet member 12 were provided to cover the temples or eyes of the patient, then any portion of engagement member 16 in such areas would not be placed in fixed engagement with the head of the patient to avoid undue pressure on the temples or eyes.
As shown in
In the enlarged condition and in the illustrated embodiment, the respective portions of enlargement member 34 include arm portions 38, 39 that expand and project outwardly into adjacent receptacles 44 formed by the row and columnar portions 18, 20. The enlargement of arm portions 38, 39 into receptacles 44 moves engagement surface 46 of engagement member 16 outwardly and toward the head of the patient positioned in helmet member 12, as indicated by arrows 17 in
Other embodiments contemplate other shapes for the row and columnar portions 18, 20, including, for example, a T-shape, a C-shape, a V-shape, or any other suitable shape. The row and columnar portions 18, 20 may also include a cylindrical or other tubular shape with separate enlargement members or portions of an enlargement member housed therein. The enlargement member 34 can be shaped, for example, with outwardly extending arms and protrusions as shown, or a T-shape, spherical shape, cylindrical shape, oval shape, conical shape, frusto-conical shape, parallelepiped, star shape, diamond shape, pyramidal shape, and combinations thereof.
In still another embodiment, engagement member 16 extends completely about the inner surface of helmet member 12 and forms an inner lining that covers enlargement member 34. When enlargement member 16 is enlarged, it pushes outwardly on the engagement member 16 and places it into contact with the head of the patient. This embodiment of engagement member 16 may include row and column portions 18, 20 beneath the outer lining portion, or such row and column portions 18, 20 may be omitted.
Enlargement member 34 may include one or more portions in each of or a subset of the pockets 22. Enlargement member 34 may further include two or more separate enlargement members in respective ones of one or more pockets 22. The portions may be in the form of a bag, bladder, swellable device, or other device capable of being collapsed, deflated, un-enlarged, shrunk or otherwise assume a reduced profile configuration for positioning helmet member 12 on and off the head of the patient. The portions of enlargement member 34 may be expanded, inflated, enlarged, swelled or otherwise configured to assume an increased profile or size to fixedly engage engagement member 16 and thus helmet member 12 to the head of the patient. The portions enlargement member 34 may be enlarged, inflated and/or expanded with air, liquid, gas or other fluid or substance. The portions of enlargement member 34 may be interconnected by a network of tubes, passages or parts of adjacent enlargement member portions to allow simultaneous insertion and removal of the fluid from all the enlargement member portions. Alternatively, any one or sub-combination of enlargement member portions may be networked with one another or isolated to allow for selective enlargement of various portions of enlargement member 34. One or more leads 29 may be provided in fluid communication with one or more portions of enlargement member 34 and coupled to a fluid source (not shown) for delivery and removal of fluid to enlarge and reduce enlargement member 34.
Engagement member 16 can be in the form of a liner of shell 14 that provides a high friction engagement surface 46 positionable in fixed engagement with the skin of the head of the patient. The cross-sectional properties and/or material properties of the engagement member 16 allows portions of the engagement member 16 to move or translate toward and away from shell 14 for selective fixed engagement and release of the head of the patient. Engagement member 16 may be comprised of pads or other forms. Engagement member 16 may be comprised of a foam material made from plastic, elastomer, or other suitable material with sufficient elasticity to fixedly engage the head of the patient in response to enlargement of enlargement member 34 and allow removal of helmet member 12 when enlargement member 34 is in a reduced profile configuration. Engaging surfaces 46 can be coated with a sticky substance or other friction enhancing substance, material or surface treatment, including surface irregularities, to facilitate fixed engagement with the head of the patient and prevent or resist movement of helmet member 12 when positioned thereon.
Shell 14 can be made from any suitable material, such as plastics and polymers, metals and metal alloys, ceramics, elastomer, or composite materials, for example. Shell 14 can be made from a radiolucent material to facilitate radiographic and other imaging of the patient's head pre-operatively and during surgery. In one embodiment, shell 14 is provided with sufficient rigidity to allow rigid and fixed engagement of the helmet 12 to a surgical table, wall, frame or other stabilizing structure to prevent movement of the patient's head during surgery. Shell 14 provides a protective covering for the patient's head while allowing permanent attachment of fixation hardware that substitutes for pin fixation directly to the patient's skull.
Referring back to
One example of an application for head positioning and fixation system 10 is shown in
Prior to surgery, the patient can be fitted with helmet member 12. The neutral positioning of the head and neck of the patient can be pre-operatively registered in a standing, supine, prone or other positioning. The registered position can be transferred into the operating room and replicated on the operating table. Helmet member 12 can be fixedly engaged to a stabilizing structure 66 with one or more mounting members 70 in the operating room while the patient remains conscious. Stabilizing structure 66 can be the operating table, wall, frame or other device which, when coupled with helmet member 12, maintains the positioning of the head of the patient relative to the surgical table.
The head of the patient can be positioned on the surgical table with helmet member 12 fixedly secured thereto. Adjustment fixture 26 can be rotated into positioned and releasably secured in the desired position with locking member 28. One or more mounting members 70 can be coupled to adjustment fixture 26 and/or directly into bores or onto bolts or hardware extending from outer shell 14 to maintain the positioning of the head of the patient on the surgical table. Mounting members 70 maintain the positioning of the head of the patient during the surgical procedure, while adjustment fixture 26 can be rotated or otherwise moved about helmet member 12 to allow repositioning of the head and neck of the patient during the procedure. Since the one or more mounting members 70 engage adjustment fixture 26 and/or rigid shell 14 rather than the patient's skull, such repositioning is facilitated as an option during the surgical procedure.
Helmet member 12 may also include one or more removable portions 50 to provide access to the skull of the patient through a window or recess in helmet member 12. Removable portion 50 may be removably coupled to helmet member 12 with screws, pins, flaps, ball-detent mechanisms, friction fit, dovetail/groove interface, snap fit, or other engaging device or means. Removable portion 50 can allow access to the skull, brain or other portion of the patient's head for performing a surgical procedure, evaluation or observation. For example, in the illustrated embodiment, removable portion 50 provides access to the occiput. Other embodiments contemplate removable portions that allow access to other portions of the skull of the patient.
While the invention has been illustrated and described in detail in the drawings and foregoing description, the same is to be considered as illustrative and not restrictive in character. All changes, modifications and equivalents that come within the spirit of the invention as defined by the following claims are desired to be protected.
