RU202913U1 - DEVICE FOR MINI-INVASIVE ACCESS FOR LOW-INVASIVE INTRACRANIAL NEUROSURGICAL SURGERY - Google Patents

Abstract

The utility model relates to medicine and medical technology, namely to instruments for surgical treatment in neurosurgery. The device contains a blunt six-toothed Jansen retractor (1), on the working part of which two rectangular metal plates (4) with a mirror surface are attached, in the center of each plate there is a through slot for fixing the limiter (3), and one of the plates is equipped with a ruler graduated from in 5 mm increments. The use of the useful model provides a decrease in the time of surgical intervention, a decrease in traumatization of brain structures, and an improvement in the visualization of the operating field. 2 ill., 1 ex.

Description

The utility model relates to medicine and medical technology, namely to instruments for surgical treatment in neurosurgery.

Recently, methods of surgical treatment in neurosurgery have been improved. Minimally invasive treatment methods are replacing the existing methods. One of these methods is operations performed using the key-hole technology, translated from English as “keyhole”. This technique belongs to minimally invasive intracranial interventions. The essence of this method is to perform an operation in the presence of pathological formations in the brain using small trepanation approaches of about 3 cm in size. When performing such operations, after performing a corticotomy, it is necessary to push back the brain matter for better visualization of the surgical field.

The prototype of the utility model is a blunt six-toothed (according to the 3 × 3 scheme) Jansen retractor with a screw mechanism for branching the jaws, which is designed to expand the surgical wound by expanding the soft tissues of the cranial vault [[Electronic resource] Medtekhnika 111. Catalog. Access mode: https://www.111.su/101/101_977.html. Access date 05.10.2020].

The task of the utility model is to develop a device for displacing the brain matter when performing operations using the "keyhole" technology.

The technical result when using the useful model is to reduce the time of surgery, reduce traumatization of brain structures, improve visualization of the operating field.

The essence of the utility model is illustrated by Figures 1-2, which show the proposed device, a general view, where: 1 - Jansen retractor, 2 - nut for fixing the limiter, 3 - limiters, 4 - plates with a mirror surface.

The proposed device contains a blunt six-toothed Jansen retractor 1, on the working part of which two rectangular plates 4 with a mirror surface are fixedly attached, made of medical steel, dimensions L * W * T 75 * 15 * 1.5 mm. In the center of each plate there is a through-cut 60 * 5 mm for fixing the limiter 3 with a nut 2. The use of a movable limiter on the plates allows you to adjust the depth of insertion of mirrors into the cranial cavity. To accurately determine the depth of insertion of the mirrors into the cranial cavity, one of the plates 4 is equipped with a ruler, graduated with a step of 5 mm.

The use of this device provides the performance of minimally invasive operations on the brain. When using this device, the duration of the operation is reduced, which reduces intraoperative blood loss, the toxic effect of anesthesia. Improving the view of the surgical wound contributes to better detailing of the formations in the wound during the operation, which allows minimizing the surgical trauma.

The proposed device is used as follows: after preparation of the operating field, access to the cranial cavity is obtained by craniotomy. The access site is selected taking into account the localization of the pathological formation (intracerebral hematoma, brain formation, cyst, etc.). After gaining access, the dura mater is dissected. Further, by means of corticotomy, access to the object of surgical intervention is obtained. The proposed device with closed branches is installed in the formed channel. By tightening the nuts 2 on the tool plates, the depth of the tool is adjusted. To determine the depth of insertion of the working part, a ruler with a step of 0.5 mm is applied to them. After the introduction of the mirrors into the operating wound, the jaws of the device are pushed apart to obtain a good view of the bottom of the wound. Due to the mirror surface, the instrument plates facilitate better visualization of the surgical wound.

The use of this device allows:

1. Perform minimally invasive surgical interventions through mini-accesses.

2. To improve the visibility of the bottom of the surgical wound.

3. Reduce intraoperative blood loss.

4. Reduce the invasiveness of the operation.

5. Install the working part of the tool at a strictly specified depth.

Here is an example of the clinical use of the proposed device.

Patient T., born in 1946, was admitted on an emergency basis with complaints of headache, dizziness, weakness in the left extremities.

From the anamnesis: According to the daughter's words, headaches appeared in the morning, after dinner she fell down on the background of dizziness and weakness in her left leg, the daughter discovered at 17:00. after working on the floor, she was urgently taken to the hospital.

From the past diseases: Diabetes mellitus type 2, Hypertension Art. 2, Art. 3, risk 4.

Objective status: The patient's condition is serious. Respiration is spontaneous, in all pulmonary fields. BH 14 beats in min. Hemodynamics Hell 160/90 mm Hg The abdomen is soft and painless.

Neurological status: consciousness - stupor. Pupils: D = C vivid photoreaction. Corneal reflexes are depressed. Does not follow commands, reacts to painful stimuli. Tendon reflexes on the left are revitalized. Left-sided hemiparesis. Meningeal signs are positive.

Survey carried out:

CT of the brain: subcortical intracerebral hematoma in the right parietal-temporal region with a volume of 50 ml.

CT Bolus: no vascular pathology (aneurysm, AVM) was identified. Taking into account the age, concomitant diseases, neurological status and localization of the hematoma, it was decided to conduct surgical treatment with a new minimally invasive technique using the "key-hol" method.

The course of the operation: after 2-fold treatment of the operating field with chlorhexidine solution, with the patient in the supine position with the head turned to the left, a 5 cm long skin incision was made in the parietal-temporal region, the wound edges were moved apart with the help of a retractor, a milling hole was placed with the help of nippers a 3 × 3 cm window was formed, the dura mater was opened crosswise, corkotonia was performed, after which the proposed mini-invasive device was installed, and the plate retainers were fixed at 3 cm, the branches were divorced, a dark hemorrhagic hematoma was revealed, which with the help of suction and microinstrumentation removed, the bed of the hematoma is lined with hemostatic cotton wool, the cavity of the hematoma is washed with control warm saline, layer-by-layer sutures on the wound.

The next morning, the patient underwent CT control of the brain: total removal of the hematoma.

Neurological status: consciousness - stunning 1. Pupils: D = C vivid photoreaction. Live tendon reflexes D = C. Muscle strength of the left arm 4 points, legs 3.5 points. Meningeal signs are weakly positive. The patient was discharged on the 10th day from the hospital, without rehabilitation.

Claims (2)

1. A device for minimally invasive access in neurosurgical minimally invasive operations, containing a blunt six-toothed Jansen retractor, characterized in that two rectangular metal plates with a mirror surface are fixedly attached to its working part, in the center of each plate there is a through slot for fixing the restraints, and one of the plates is equipped with a ruler graduated in 5 mm increments. 2. The device according to claim 1, characterized in that the plates are 75 * 15 * 1.5 mm in size, and the slot is 60 * 5 mm in size.

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