EA-053302-B1 - Tube for endoscopic biopsy and removal of intracerebral tumors of the brain

Abstract

The invention relates to neurosurgery and is intended for endoscopic brain surgery, including biopsy and removal of deep-seated intracerebral tumors. The sheath is a transparent tube with channels for an endoscope, aspiration, a magnetic sensor for a neuronavigation system, fiber-optic light guides, and electrodes for neuromonitoring. The design enables the simultaneous use of fluorescent illumination with 5-aminolevulinic acid, magnetic neuronavigation, and neuromonitoring while maintaining a clear working channel for instruments. This enables operations to be performed in real time, increasing positioning accuracy and surgical safety. The device improves tumor tissue visualization, provides control over the location of functionally significant brain structures, and reduces surgical time.

Inventors

• Дубчев Дамир Ильдусович
• Дюсембеков Ермек Кавтаевич

Assignees

• АКЦИОНЕРНОЕ ОБЩЕСТВО "КАЗАХСКИЙ НАУЧНО-ИССЛЕДОВАТЕЛЬСКИЙ ИНСТИТУТ ОНКОЛОГИИ И РАДИОЛОГИИ"

Dates

Publication Date

20260504

Application Date

20251028

Priority Date

20251024

Claims (1)

1. endoscope, suturing of the dura mater, installation and fixation of a bone flap, layer-by-layer sutures on the wound and an aseptic dressing. Thus, the proposed device: provides integration of three key technologies in one tool; allows for biopsy and cytoreduction of deep-seated tumors with minimal tissue trauma; increases the accuracy of positioning of the tube and instruments; provides continuous monitoring of the location of functionally significant nerve pathways; improves visualization of the surgical field during bleeding due to the built-in aspiration channel; allows the simultaneous use of white and violet lighting; Convenience for the surgeon and reduction of surgical time due to the elimination of frequent instrument changes and manual fixation of the endoscope in the lumen of the tube along two axes. The invention improves the accuracy, safety and effectiveness of endoscopic interventions in the removal of deep brain tumors and has advantages over known analogues and the prototype. CLAUSES OF THE INVENTION A tube for endoscopic biopsy and removal of intracerebral tumors of the brain, including a housing in the form of a transparent tube with internal channels for placing an endoscope and surgical instruments, characterized in that the tube additionally contains a channel for aspiration, a channel for installing a magnetic sensor connected to a neuronavigation system for tracking the position of the distal end of the tube in the cranial cavity in real time, four channels for fiber optic light guides designed to supply violet light with the possibility of combined use of white light from the endoscope, two electrodes placed in the distal section of the tube and connected to a neuromonitoring system with the possibility of operating in bipolar and monopolar modes, and an obturator with an additional channel for installing a magnetic sensor of the neuronavigation system. -

Description

The invention relates to medicine, specifically to surgical instruments in neurosurgery, and is intended for endoscopic brain surgery, including biopsy and removal (cytoreduction) of deep-seated intracerebral tumors. The device enables the integrated use of intraoperative fluorescence contrast with 5-aminolevulinic acid (5-ALA), magnetic neuronavigation, and neuromonitoring. The treatment of deep-seated brain tumors remains one of the most significant challenges in neurosurgery today. Surgical interventions to remove deep-seated brain tumors, especially in functionally significant areas, carry a high risk of damaging neural pathways during surgery, leading to loss of neurological function and patient disability. The primary goal of brain tumor surgery is to establish the histological structure of the tumor and remove as much of it as possible (cytoreduction) while preserving healthy brain tissue. A method is known in which endoscopic biopsy is performed under fluorescence control using 5-ALA and a violet-emitting diode flashlight for malignant glioma. (Yoshida M, Yamaguchi S, Iwasaki K, Iwanaga M. 5-aminolevulinic acid-guided endoscopic biopsy with violet light-emitting diode flashlight in malignant glioma: Technical note //SurgNeurol Int. - 2023.-Vol. 14:397. doi: 10.25259/SNI_204_2023. PMID: 38053712; PMCID: PMC10695459.) A tube in the form of a transparent tube with a diameter of 10 mm and an endoscope with a diameter of 4 mm are used for biopsy. Tumor tissue is contrasted by administering 5-ALA to the patient before surgery. This causes the fluorescent substance protoporphyrin IX (PpIX) to accumulate in tumor cells. Protoporphyrin IX emits red fluorescence when exposed to violet light with a wavelength of 440-460 nm. Violet light is delivered to the surgical site using a flashlight through the endoscope's light guide. Neuronavigation is performed using optical spheres, with the neuronavigation probe inserted along the inner cylinder of a transparent 10 mm diameter tube. Aspiration is performed using an aspiration tube through the working channel. The disadvantages of this method are: the tube serves only as a retractor; there is no possibility of integrating magnetic neuronavigation and neuromonitoring; only one light source is used to illuminate the surgical field through the endoscope's light guide, and there is no possibility of simultaneously using white and fluorescent lighting; aspiration of blood and other fluids from the surgical field is performed only through an aspiration tube through the lumen of the tube; fixation of the endoscope in the lumen of the tube along two axes and at the insertion depth is required. A device for neurosurgical aspiration with spectroscopic and electrophysiological control is known (RU 183278 U1 A61B 5/489 (2006.01); G01N 21/47 (2006.01); G01N 21/64 (2006.01); A61B 17/32 (2006.01) (54). Device for neurosurgical aspiration with spectroscopic and electrophysiological control. Published: 17.09.2018 Bulletin No. 26). This device combines an aspiration tube in which light guides for fluorescence excitation, spectrometric light guides and a monopolar electrode for neuromonitoring are installed. The device allows for simultaneous aspiration, optical diagnostics of tissues in the surgical field and monopolar neuromonitoring. The disadvantages of this device include: it is designed for operations under an operating microscope, which complicates its use in endoscopic surgical interventions; neuromonitoring is only possible in monopolar mode; and a separate narrowband light source is required to excite fluorescence and a broadband light source to record reflectance spectra. A method for endoscopic removal of deep-seated pilocytic astrocytoma under fluorescence guidance using 5-ALA is also known (Mori R., Akasaki Y., Fukasawa N., Kawamura D., Karagiozov K., Murayama Y. Fully-Endoscopic Resection of Deep-Seated Pilocytic Astrocytoma Under 5-Aminolevulinic Acid Fluorescence Guidance: A Technical Note // Turk Neurosurg. 2022; 32(5): 872876). The described method uses a port-tube in the form of a round transparent tube-tubular retractor (View Site, Vycor Medical Inc, New York, USA), into which an endoscope equipped for photodynamic diagnostics (D-Light C system, KARL STORZ GmbH&Co., Germany) with switching between white and violet light is installed. The disadvantages of this method are: the tube serves only as a tubular retractor; there is no possibility of integrating magnetic neuronavigation and neuromonitoring; two light sources are used alternately through the endoscope's light guide, switching between white and violet light; there is no possibility of using two light sources simultaneously; aspiration of blood and other fluids from the surgical field is carried out only through the aspiration tube through the lumen of the tube; separate fixation of the endoscope in the lumen of the tube is required along two axes and at the insertion depth. The closest in technical essence to