Neurosurgical punch embolization of tumors

 

The invention relates to medical instruments and can be used, for example, removing an ornate krovosnabjaemah of brain tumors using direct interstitial introduction of embolizing material. Neurosurgical punch embolization of tumors contains the handle and the main tubular body with end point. The punch is provided with an additional tubular housing special design, which has on the outside end of the connector element for connection with a source of negative pressure. The main tubular body has an outside end of the connector element for connection with means for introduction of embolizing material and mounted in the cavity of the rod, the working face of which is made flush with the end point. The handle has a flattened shape and is located in the plane of the longitudinal axes of the housings or oriented to the plane of the longitudinal axes of the housings at an angle of 60-120. As a result, the device provides an exception massive intraoperative blood loss when removing, in particular, is richly supplied with blood brain tumors with the exception of possible embolism vascular corpus embolizing material in contact with the blood of the patient. 4 C.p. f-crystals, 5 Il.

The invention relates to medical instruments and can be used for removal (surgical treatment) richly krovosnabjenia (vascularized) of brain tumors using direct interstitial doing embolizing material.

Famous punch containing an elongated hollow body with a handle and a tool for dissecting the tissue (see the description of the A. C. of the USSR №280761, class. And 61 In the 17/24, 1969). The disadvantage of this drill is its invasiveness, excluding the application of such a tool in operations which may cause massive blood loss.

Massive intraoperative blood loss is possible, in particular, when removing richly krovosnabjaemah of brain tumors, is still a complex and not resolved before the end of the problem. Massive blood loss is not only significantly affects the results of surgical intervention (less radical removal of the tumor), but may pose a direct threat to the life and health of the operated patient.

Modern methods of prevention operative blood loss, reduce blood flow in the tumor,ako this method has certain disadvantages: technically superselective embolization is not always possible, it requires filigree endovascular technique of catheterization of cerebral vessels, despite the use of preventive measures remains some risk of ischemic complications [2, 3] and hemorrhagic complications [4]. An alternative approach in this direction is the technique of direct intraoperative embolization richly krovosnabjaemah of brain tumors, when embolizing material (cyanacrylat) is injected directly into the stroma of the tumor by using a conventional syringe and injection needle [5 - 7]. Compared with preoperative embolization this method is technically much easier. The only, but very serious complication of the technique of direct intraoperative embolization is the risk of embolizing material into the lumen of the large vessel with its subsequent migration through the blood and embolism of blood vessels in healthy brain tissue. Clear the cause of this complication is the fact that the surgeon conducting the direct interstitial embolization can't control the safe position of the tip of the injection needle (i.e., to understand whether it is in the lumen of the large vessel or not). The only possibility to diagnose such a dangerous position of the needle tip is sozdaniya embolizing material such, that when in contact with any of saline fluid (in particular, in contact with the blood of the patient), he gives an immediate polymerization with formation of insoluble conglomerate, occluding the lumen of the needle and requiring its replacement.

Thus, as in the medical literature are not described neurosurgical instruments, specially designed for tumor embolization, as the closest analogue of the invention is selected “Device for sealing vessels” description of the A. C. of the USSR №1482674, class. And 61 In 17/12, 1989, containing the handle and the main tubular body with end point.

The objective of the invention is to create a specialized neurosurgical drills for tumor embolization.

Medico-technical result of the proposed device is that it provides an exception massive intraoperative blood loss when removing, in particular, is richly supplied with blood brain tumors with the exception of possible embolism of cerebral vessels and subsequent ischemic stroke, and also in the exclusion of obliteration of the working tubular housing embolizing material in contact with the blood of the patient.

The invention is E end-point, unlike the closest equivalent, equipped with an additional tubular housing having at the outside end of the connector element for connection with a source of negative pressure, with the main tubular body has an outside end of the connector element for connection with means for introduction of embolizing material and mounted in the cavity of the rod, the working face of which is made flush with the end point, and the handle has a flattened shape and is located in the plane of the longitudinal axes of the housings or oriented to the plane of the longitudinal axes of the housings at an angle of 60-120. Given a set of essential features sufficient to achieve a technical result, in all cases to which the requested amount of legal protection.

In some cases, of its execution or use of the punch may have a non-working end of the additional tubular casing made curved; the main tubular body and an additional tubular body made in a single tube, which is divided by a longitudinal partition, the end point can have a dagger or spear sharpening, with the longitudinal axis osnovna can be located coaxially.

The causal link listed signs with the technical result of the invention is that additional tubular body having at the outside end of the connector element for connection with a source of negative pressure, allows you to monitor the introduction of punch in the tumor tissue, the performance of the main tubular body with accommodation on the outside end of the connector element for connection with means for introduction of embolizing material allows you to enter the desired polimerizuet material, eliminating premature contact with the environment; placed in the cavity of the rod, the working face of which is made flush with the end point, allows gentle perforation, and the location of the rigid arm in the plane of the longitudinal axes of the housings or oriented to the plane of the longitudinal axes of the housings at an angle of 60-120makes it convenient for you to hold the drill in position. Numeric range 60-120set in the study of the possible positions of the punch during operations. Studies have shown that the location of the arm at different angles to pleskot>/p>Curved outside end of the additional tubular housing increases the area of the handle is flattened shape allows you to increase the convenience of connecting a source of negative pressure, and means for introducing an embolizing substance; the performance of the main tubular body and an additional tubular housing in the form of a single tube, which is divided by a longitudinal partition, simplifies the design of the punch and execution end of taper with a dagger or spear sharpening facilitates perforation of the tumor.

The invention is illustrated by drawings, where Fig. 1 shows a General view of neurosurgical punch embolization of tumors with compacted handle located in the plane of the longitudinal axes of the housings of Fig. 2 - cross section a-a shown in Fig. 1; Fig. 3 - location of buildings punch in the section a-a shown in Fig. 1, in the case of orientation of the flattened arm to the plane of the longitudinal axes of the housings at an angle of 90Fig. 4 and 5 - section a-a shown in Fig. 1, the orientation of the arm corresponding to Fig. 2 and 3 in the case of performing buildings in a single tube, divided by a longitudinal septum.

Neurosurgical and additional tubular housing 4, with the non-working end of the connecting element 5 for connection with a source of negative pressure. The main tubular body 2 has on the outside end of the connector element 6 for connection with means for introducing an embolizing substance. In the cavity of the main tubular body 2 has a rod 7, the working face of which is made flush with the end point 3. The handle 1 has a flattened shape and is located in the plane of the longitudinal axes of the housings 2 and 4 or oriented to the plane of the longitudinal axes of the housings 2 and 4 at an angle of 60-120. Outside of the additional end of the tubular body may be made curved, and the main tubular body 2 and an additional tubular housing 4 is designed as a tube, which is divided by a longitudinal septum. End point 3 can have a dagger or spear sharpening.

Work neurosurgical punch in the following way. The surgeon, holding the hammer by the handle 1, introduces the main tubular body 2 and an additional tubular housing 4 in the tumor tissue to a depth of 0.5-1.0 see As the working face of the mandrel 7 is made flush with the end point 3 of the main tubular body is th taper 3 with a dagger or spear sharpening, used, generally, in the injection needle. Then the source of negative pressure (e.g., syringe), costacabana with the connecting element 5, create a vacuum in additional tubular housing 4. The absence of receipt of the blood in the syringe indicates the correct position of the end taper 3 main tubular body 2. i.e. the position of the end taper 3 out of the vessel. From the cavity of the main tubular body 2 remove the rod 7 and join the connecting element 6 together with the introduction of an embolizing substance, such as cyanacrylate. As a means of introduction of the embolizing material may also be used with a syringe. Carry out the introduction of an embolizing substance in the tumor tissue in the right quantity, is inserted into the cavity of the main tubular body 1 of the rod 7, clearing it from embolizing material, and remove the punch from the cloth.

Thus, thanks to the developed design neurosurgical drills, it becomes possible to perform simple diagnosis correct position its end taper 3 (not in the lumen of the vessel) followed by immediate introduction of an embolizing substance without risk of premature polymerization cavity of the main tubular body 2.

Sources of information

1. Halbach V, Hieshima G, Higashida T, et al. //Endovascular therapy of head and neck tumors. In Vinuela F, Halbach VV, Dion JE (eds): Interventional Neuroradiology. Endovascular Therapy of the Central Nervous System. New York, Raven Press, 1992. - pp.17-28.

2. Metson R, Hanson DG //Bilateral facial nerve paralysis following arterial embolization for epistaxis. Otolaryngol. Head Neck Surg. - 1983. - Vol. 91. - pp.299-303.

3. Chan RC, Thompson GB //Ischemic necrosis of the scalp after preoperative embolization of meningeal tumors. Of Neurosurgery. - 1984. - Vol. 15. - pp.76-81.

4. Suyama T, Tamaki N, Fujiwara K, et al. //Peritumoral and intratumoral hemorrhage after gelatin sponge embolization of malignant meningioma: Case report. Of Neurosurgery. - 1987. - Vol. 21. - pp.944-946.

5. Hilal SK, Michelsen JW //Therapeutic percutaneous embolization for extra-axial vascular lesions of the head, neck and spine. J Neurosurgery.- 1975. - Vol. 43. - pp.275-279.

6. Casasco A, Herberteau D, Houdart E, et al. //Devascularization of craniofacial tumor by percutaneus tumor puncture. AJNR. - 1994. - Vol. 15. - pp.1233-1239.

7. George B, Casasco A, Deffrennes D, et al. //Intratumoral Embolization of Intracranial and Extracranial Tumors: Technical Note. J Neurosurgery. 1994 - Vol. 35 (4). - pp.771-774.

8. USSR author's certificate No. 280761, class. And 61 In the 17/24, 1969.

9. USSR author's certificate No. 1482674, class. And 61 In 17/12, 1989.

Claims

1. Punch embolization of tumors containing the handle and the main tubular body with end point, wherein the provided additional tubular housing having at the outside end of the connector element for connection with a source of the negative is zaimosvyazi with means for introduction of embolizing material and mounted in the cavity of the rod, the working face of which is made flush with the end point, and the handle has a flattened shape and is located in the plane of the longitudinal axes of the housings or oriented to the plane of the longitudinal axes of the housings at an angle of 60-120.

2. Punch under item 1, characterized in that the non-working end of the additional tubular body is curved.

3. Punch under item 1 or 2, characterized in that the main tubular body and an additional tubular casing as a single tube, which is divided by a longitudinal septum.

4. Punch under item 1, or 2, or 3, characterized in that the end point has a dagger or spear sharpening.

5. Punch under item 1 or 2 or 3 or 4, characterized in that the longitudinal axis of the main tubular body aligned with the longitudinal axis of the additional tubular housing.

 

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