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 method for performing brain surgery, the method comprising:
providing 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;
positioning image guidance position indicators outside the obturator;
providing 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;
assembling the cannula 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;
accessing tissue within a skull;
advancing the assembled cannula and obturator into the tissue; and
using the image guidance position indicators to monitor the placement of the assembled cannula and obturator while the assembled obturator and cannula is located in the tissue.
2. The method of claim 1 , wherein the image guidance position indicators comprise three reflectors.
3. The method of claim 1 , wherein the image guidance position indicators comprise infrared reflectors.
4. The method of claim 1 , further comprising pre-calibrating the obturator to an image guidance system.
5. The method of claim 1 , further comprising advancing the assembled cannula and obturator to an operative site in the tissue, and subsequently removing the obturator and the image guidance position indicators.
6. The method of claim 1 , further comprising providing the image guidance position indicators on a stylet, and positioning the stylet in an access channel extending through the obturator.
7. The method of claim 6 , further comprising advancing the assembled cannula and obturator to an operative site in the tissue, and subsequently removing the stylet and image guidance position indicators.
8. The method of claim 6 , wherein the access channel extends through an entire length of the obturator.
9. The method of claim 1 , further comprising superimposing an image of the assembled cannula and obturator over an image of the skull.
10. The method of claim 9 , wherein the image is a pre-operative image.
11. The method of claim 9 , wherein the image comprises a real-time image of the tissue.
12. The method of claim 1 , further comprising advancing the assembled cannula and obturator to an operative site within a brain, and subsequently removing the obturator from the cannula and removing tissue through the cannula.
13. The method of claim 1 , further comprising advancing the assembled cannula and obturator to an operative site within a brain, and subsequently removing the obturator from the cannula and visualizing a region of a brain tissue through a transparent wall of the cannula.
14. The method of claim 1 , further comprising visualizing the tissue through the transparent window.
15. The method of claim 14 , wherein visualizing the tissue through the transparent window comprises placing an endoscope into a channel extending through the obturator and using the endoscope to visually observe brain tissue through the transparent window.
16. The method of claim 15 , wherein the channel ends at the transparent window.
17. The method of claim 14 , wherein visualizing brain tissue through the transparent window is done while using the image guidance position indicators to monitor the placement of the assembled cannula and obturator while the assembled obturator and cannula is located in the brain tissue.
18. The method of claim 1 , wherein using the image guidance position indicators to monitor the placement of the assembled cannula and obturator while the assembled obturator and cannula is located in the tissue comprises using the image guidance position indicators to monitor the placement of the assembled cannula and obturator while the assembled obturator and cannula is advanced into the tissue.
19. The method of claim 1 , wherein the cannula comprises an outwardly-extending flange at the proximal cannula end.
20. The method of claim 1 , wherein the tissue comprises brain tissue.
21. The method of claim 1 , further wherein accessing tissue within the skull comprises accessing tissue thorough an opening through the skull.
22. The method of claim 21 , further comprising forming the opening through the skull.