Apparatus and methods for performing brain surgery
Less invasive surgical techniques for performing brain surgery are disclosed in which a dilating obturator and cannula assembly is inserted into brain tissue until the obturator tip and cannula are adjacent to the target tissue. The obturator is removed and surgery is performed through the cannula. In preferred embodiments the obturator and cannula are placed using image guidance techniques and systems to coordinate placement with pre-operative surgical planning. A stylet with associated image guidance may be inserted prior to insertion of the obturator and cannula assembly to guide insertion of the obturator and cannula assembly. Surgery preferably is performed using an endoscope partially inserted into the cannula with an image of the target tissue projected onto a monitor. Dilating obturator structures having a rounded or semi-spherical tip and/or an optical window for visualizing brain tissue during expansion are contemplated.
1. A surgical access device for brain surgery, the surgical access device comprising:
an obturator having a proximal obturator end, a distal obturator end and an obturator shaft extending between the proximal obturator end and the distal obturator end, the distal obturator end comprising a transparent window forming an atraumatic blunt dilating tip;
a cannula having a proximal cannula end and a distal cannula end and a longitudinal access channel extending from the proximal cannula end to the distal cannula end, the cannula being configured and dimensioned to removably mount over the obturator shaft with the proximal cannula end adjacent the proximal obturator end, and the distal obturator end extending outside the distal cannula end; and
an image guidance identification device comprising image guidance reflectors attached to and located outside the obturator and configured to indicate the position of the surgical access device to an image guidance system to allow insertion of the surgical access device in tissue under guidance without requiring insertion of a stylet in advance of the surgical access device.
2. The surgical access device of claim 1 , wherein the distal cannula end comprises a chamfered leading edge.
3. The surgical access device of claim 1 , wherein the cannula comprises a transparent material.
4. The surgical access device of claim 1 , wherein the cannula is cylindrical.
5. The surgical access device of claim 1 , wherein the proximal obturator end comprises a handle portion.
6. The surgical access device of claim 5 , wherein the handle portion is larger than the longitudinal access channel to prevent the cannula from sliding over the proximal obturator end.
7. The surgical access device of claim 6 , wherein the image guidance identification device is mounted to the handle portion.
8. The surgical access device of claim 1 , wherein the atraumatic blunt dilating tip comprises a rounded surface.
9. The surgical access device of claim 1 , wherein the atraumatic blunt dilating tip comprises a semi-spherical surface.
10. The surgical access device of claim 1 , wherein the obturator comprises a longitudinal obturator channel extending to the atraumatic blunt dilating tip.
11. The surgical access device of claim 1 , wherein the longitudinal obturator channel is configured and dimensioned to receive an endoscope.
12. The surgical access device of claim 1 , wherein the obturator does not include an access channel through the atraumatic blunt dilating tip.
13. The surgical access device of claim 1 , wherein the obturator further comprises a longitudinal stylet channel that is configured and dimensioned to receive a stylet.
14. The surgical access device of claim 1 , wherein the obturator shaft is cylindrical.
15. The surgical access device of claim 1 , wherein the image guidance identification device is mounted directly to the obturator.
16. The surgical access device of claim 1 , wherein the image guidance identification device is mounted to the proximal obturator end.
17. The surgical access device of claim 1 , wherein the image guidance reflectors comprise infrared reflectors.
18. The surgical access device of claim 17 , wherein the infrared reflectors comprise three infrared reflectors.
19. The surgical access device of claim 1 , wherein the obturator is pre-calibrated to an image guidance system.
20. The surgical access device of claim 1 , wherein the image guidance identification device is removable from the cannula with the obturator.