• 专利附录
  • 专利说明
  • 权利要求
  • 类似技术
  • 同族专利
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  • 法律状态
  • 优先权
    • 专利摘要:
    A surgical microscope (1) according to the invention comprising a measuring device (50) for detecting optical properties of an operating field (7) serves for enlarged viewing of the surgical field (7) on a patient, wherein the surgical microscope (1) is equipped with an infrared stimulation device (10) , The invention also relates to a retrofit kit for a surgical microscope.
    公开号:CH712503A2
    申请号:CH00581/17
    申请日:2017-05-02
    公开日:2017-11-30
    发明作者:Panitz Gerald
    申请人:Zeiss Carl Meditec Ag；
    IPC主号:
    专利说明:

    Description: The invention relates to a surgical microscope for magnified viewing of the cortex of a patient and to a retrofit kit for a surgical microscope.
    [0002] Surgical microscopes are used in various fields of medicine to treat a patient surgically and / or therapeutically. They are used, among others, in ophthalmology and dentistry. In particular, surgical microscopes are used to magnify the cortex, that is, the exposed brain of a patient.
    An operating microscope has at least one, preferably two, binocular viewing beam paths in order to make it possible for a doctor to treat it by means of eyepieces, objectives, magnifying lenses and optionally further optical components in such a way that it enlarges a surgical field, in particular the cortex, on a patient to be treated can see. The enlarged view of the surgical field or the cortex allows him a precise treatment. In this case, the surgical microscope can be configured such that a partial light beam is coupled out of one or more observation beam paths via a beam splitter and fed to an image acquisition device in order to display an image of the surgical field externally on a monitor or a display in real time, for example for teaching purposes or for the attending physician. The surgical microscope can also be equipped with one or more observation beam paths for an assistant or a second attending physician. Finally, the surgical microscope can be equipped with one or more illumination devices in order to illuminate the surgical field in the desired manner, so that, for example, there are no shadowed areas in the surgical field.
    For example, from DE 10 2009 015 598 A1, which is based on the applicant, such a surgical microscope is known.
    From this document it is known that the optical properties of functionally active areas of the cortex differ in an external stimulation of the optical properties of passive areas of the cortex. These optical properties can be measured with suitable illuminations, in particular with appropriately selected wavelengths, corresponding imaging optics, image sensors and a correspondingly designed image processing software. For this purpose, a measuring device comprising a measuring device such as a thermal imaging camera is used. Such a stimulation of a functionally active area occurs, for example, in that a patient speaks in a guard operation. In doing so, the language center of the brain is activated and the corresponding functionally active areas in the cortex can be optically recorded and measured. Thus, the attending physician can recognize the functionally active area and, for example, in a tumor operation, only remove the non-active tissue around it so as not to cause permanent impairment in the patient.
    Another possibility for stimulation is that certain skeletal muscles, for example, the calves are electrically stimulated, which also leads to an activation of functionally active areas of the cortex.
    The measurement of the activation of the functionally active areas via the optical determination of the change in blood volume in the functionally active areas, as described for example in US 6,196,226 B1 or in US 5,215,095. Furthermore, it is known that functionally active areas are determined by electrophysiological detection. This is done by measuring the potential on the surface of the cortex by applying electrodes. However, there is the risk of contamination of the cortex by attached to the electrodes germs. On the other hand, the brain is burdened by the mechanical force of the applied electrodes and possibly by a current flowing through it.
    Finally, it is known from the article "Pulsed infrared light age neural activity in rat somatosensory cortex in vivo" by Jonathan M. Cayce et al., In Neuroimage 57, 2011, page 155-166, that in mouse brains by irradiation with Infrared light with a wavelength of about 1800 nm, a heat input to the cortex is effected, which causes a spatial and temporal variable stimulation of the cortex. It is assumed that this local heating is less stressful than the introduction of electrical current into the cortex. In particular, this is a non-contact stimulation of the cortex, so that the risk of contamination and mechanical stress on the cortex is minimized.
    Starting from this prior art, the skilled artisan is tasked with developing a surgical microscope known per se for examining the cortex in such a way that it is suitable for finding functional areas of the cortex without undue stress on it.
    According to the invention this object is achieved by a surgical microscope, which is formed according to the features of claim 1.
    The essence of the invention is that a surgical microscope known per se is additionally equipped with an infrared light source with which a desired area of the surgical field or the cortex can be irradiated. The surgical microscope is designed, for example, in accordance with the aforementioned DE 10 2009 015 598 A1, the disclosure content of which is expressly incorporated. This means that the surgical microscope has suitable optics for magnified representation of the surgical field or the cortex and is equipped with lighting devices to measure by means of a measuring illumination of at least one wavelength at which the stimulation in the functional tissue areas to a change in at least one optical property Measuring illumination compared to the original measurement illumination leads to localize these functional tissue areas. This can be done with suitable image processing software as described above.
    In addition, the surgical microscope is equipped with an infrared light source, which is designed so that the infrared light can be directed in a desired time course with a desired intensity to a desired area of the surgical field or the cortex. In particular, this infrared light source is integrated into the actual surgical microscope, for example, incorporated in the housing of the surgical microscope, wherein the infrared light source relative to the or the observation beam paths arranged and aligned so that the desired area can be illuminated. Due to the coatings of the optical elements as well as other refractive indices, it is apparent that infrared light must be passed through a different optical path than the visible light for illumination and observation or evaluation of the surgical microscope.
    It can be seen that the illumination intensity of the infrared light is selected such that the exiting infrared light is below a safe limit to damage the examined brain tissue. For example, the beam cross section of the infrared light can already be selected at the exit from the infrared light source so that the energy density of the infrared light is below this limit. Thus, the risk of the impact of the infrared light beam on a reflective surface a risk to the attending physician and other personnel can be avoided. Therefore, they do not necessarily have to wear infrared goggles.
    If the cortex tissue is irradiated with infrared light, the function-bearing areas are activated as described in the above-mentioned article, that is, more blood circulation. This can then be determined in known manner via known optical measurement methods. It is not necessarily required that this measuring device is an integral part of the surgical microscope for optically determining the functional areas. This optical measuring device can also be spatially separated from the surgical microscope, wherein it is adjusted that all components are networked with each other to coordinate observation, irradiation with infrared light and the corresponding evaluation. Furthermore, it is apparent that all functionalities of the surgical microscope can be controlled by a treating physician and / or another person in a manner known per se, that is, for example via voice commands, by means of a manually operated external control, for example by means of a joystick and / or a suitably trained foot pedal. Furthermore, the surgical microscope can have a second observation beam path for a wizard as well as external image display devices and / or image recording devices.
    The advantage of the invention is that in a surgical microscope, which is equipped with an additional infrared light source, all components and functionalities of the surgical microscope can be controlled and controlled together. Thus, it is possible, in particular, that only the attending physician alone can carry out a corresponding examination without requiring additional technical support staff.
    Advantageous embodiments of the invention are the subject of dependent claims.
    Preferably, the light emitted by the infrared light source with respect to its intensity and / or its timing and / or the size of the generated light spot is changeable. Due to the variable intensity, the degree of stimulation of the cortex tissue can be selected as desired, of course avoiding excessive irradiation in order to avoid damage to the cortex tissue by overheating. Due to the time course, for example, the pulse-pause ratio, successive stimulation of the same area can be done. For example, a stimulation every 30 seconds, so that the examined tissue after stimulation has sufficient time to return to normal, ie normal circulation. By repeated optical detection of the irradiated area, the functionally active areas can then be precisely located. By a variable size of the examined area, that is, for example, the diameter, the intensity or the location of the infrared light spot which is irradiated to the cortex tissue, the attending physician can, for example, only examine a small area or capture a large area. A corresponding embodiment of an infrared optics of the infrared light source is known to the person skilled in the art. These functions are controlled by the attending physician or by an external operator with controls such as joystick, keyboard and / or foot pedal. In this case, for example, the size and positioning of the stimulation spot by a mechanical displacement of the entire infrared light source relative to the other components of the surgical microscope or by adjustment of appropriate optical elements such as mirrors, lenses and the like, which are associated with the infrared light source.
    Furthermore, it is preferred that the surgical microscope is equipped with a pilot light. Since infrared light is not visible to the human eye, the attending physician does not know which spot or which area of the exposed cortex the infrared light source of the surgical microscope is actually aligned with. For this purpose, an additional pilot light generating device is provided on the surgical microscope, which emits visible light to the human eye and projects with a pilot light source, for example, a light symbol such as crosshair, circle or stain on the cortex. For example, this pilot mark indicates the center and diameter of the area stimulated by infrared light. For this purpose, this additional pilot light generating device for the pilot mark is so coupled to the infrared light source, that in a change, for example, the diameter of the infrared light beam, the pilot light is driven accordingly to illustrate the changed diameter, for example, by a larger or smaller circle on the illuminated areal. Likewise, a coupling occurs when the location of the infrared stimulation is changed, that is, the infrared light source is aligned to another area of the exposed cortex. Likewise, an intensity of the infrared light can be represented by the brightness of the pilot light. The pilot physician can see this pilot light directly through the observation beam paths of the surgical microscope when the pilot light is projected onto the exposed area of the cortex. In the same way, it is possible for a corresponding virtual overlay to take place on an external monitor image. In this case, a corresponding coupling of the pilot light, which is virtually superimposed on the monitor, takes place through the control of the surgical microscope. Preferably, the additional light source for generating the pilot light is integrated into the surgical microscope or its housing. In principle, however, it is also possible that this is an external device which is controlled via corresponding data lines in order to project a pilot light corresponding to the infrared light.
    Furthermore, it is proposed that the surgical microscope and in particular the infrared light source is equipped with a distance meter, which determines the distance of the infrared light source to the cortex, for example via a transit time measurement of a light beam from the distance meter to the exposed tissue of the cortex. On the basis of the distance thus determined, in particular the intensity of the infrared light beam can be chosen such that it always lies below a safety limit when hitting the cortex, in order to avoid overheating of the cortex tissue. The distance thus determined is then automatically taken into account even at selected different intensities, which are desired by the attending physician.
    In a further embodiment, the irradiation location of the infrared light beam on the cortex tissue is variable relative to the optical axis of the observation beam path or the observation microscope of the surgical microscope. This means that the attending physician can view a large surgical field, such as an exposed cortex, and direct the spot of infrared illumination to various locations in this large area. Thus, he can successively examine the entire area optically on functionally active areas. In this case, the change in the irradiation location of the infrared light either takes place such that the entire infrared light source is mechanically displaced and / or rotated and / or tilted relative to the surgical microscope or the observation beam path or by means of suitable optical components such as mirrors or lenses for infrared wavelength infrared, the associated with a fixed infrared light source.
    In the context of the invention it is included in that the infrared light source is either integrated into the surgical microscope, for example, is installed in a housing of the surgical microscope, or that the additional infrared light source is designed as an external probe. Such a probe is held by the attending physician or an assistant by hand and has optics from which emits suitable infrared light. A pilot light can then be used to show the treating physician which area is being stimulated. In this case, the pilot light can also be integrated in the hand-held probe.
    If the irradiation location of the infrared light is variable, the infrared light can be scanned over the area to be stimulated. This means that the beam of infrared light is guided, for example, in rows or rasters over the area to be stimulated in the manner of a scanning operation. It should be noted that, for example, at high scan speed only a short stimulation occurs over a lower scan speed at which a certain location of the stimulated area remains exposed to the infrared light for a longer time. This has the advantage that the intensity of the infrared light beam can be chosen lower because an entire area to be stimulated is successively swept by the infrared light beam. It can also be chosen arbitrarily size and shape of the area to be irradiated. Also during this scanning process, the intensity of the stimulation, ie the intensity of the infrared light, can be varied locally. For example, in areas already recognized as being activatable, they are irradiated more strongly than areas that can not be activated. Compared to a static irradiation of a large area with a correspondingly higher intensity, a desired area can thus be stimulated with less intensity in a shorter time.
    It is also possible that, for example, a movement of the treated patient or his brain and / or the surgical microscope can be detected and compensated automatically to obtain constant conditions over the entire irradiation period.
    To use an already existing surgical microscope in the same way as described above can serve a retrofit kit, which essentially comprises an infrared stimulation device with an infrared light source and optionally a pilot light generating device and / or a measuring device for detecting the stimulated areas. This can for example be attached to a housing of an existing surgical microscope, so that a fixed relationship between the actual surgical microscope and the infrared light source is obtained. The infrared light source is then designed so that infrared light is also conducted to the surgical field, wherein the location where the infrared light impinges on the surgical field is preferably marked with a pilot light. If not already part of the surgical microscope, a measuring device can also be integrated in this retrofit kit in order to be able to detect the stimulated areas, for example with a thermal imaging camera.
    In the following an embodiment of the invention will be explained in more detail with reference to a drawing. The individual figures of the drawing show:
    Fig. 1 is a surgical microscope in a schematic representation and Fig. 2 shows an infrared light source in a schematic representation.
    The surgical microscope 1 shown schematically in Fig. 1 is used to magnify a surgical field 7, in particular the exposed cortex 6 of a patient to be treated. The surgical microscope 1 comprises, inter alia, a housing 2 in or on which an eyepiece 3 as well as an objective 4 and an enlargement changer 8 are arranged for enlargement. As a result, an observation beam path 5 is obtained, via which a treating physician can see the surgical field 7 enlarged. It can be seen that the surgical microscope 1 is designed to be rotatable and / or pivotable and / or tiltable via a corresponding mount in all spatial directions and solid angles in order to be able to see the surgical field enlarged from a desired direction with the desired spacing. Furthermore, the surgical microscope 1 can have a visible light illumination device in order to evenly illuminate the surgical field 7. For example, the surgical microscope 1 is designed in accordance with DE 102009 018633 A1. It has an additional thermal imaging camera 9 with which the stimulated, ie better perfused, areas in the surgical field 7 can be detected, evaluated and measured. To simplify the illustration, only one observation beam path 5 is depicted here, but preferably the surgical microscope 1 is designed as a stereoscopic or binocular surgical microscope. Likewise, additional beam splitters can be provided in the housing 2 in order to decouple an observation image in a manner known per se and to represent it, for example, on an external monitor. Furthermore, image recording devices and other measuring devices may be provided, for example for optical coherence tomography. Likewise, data can be superimposed on the observation beam (s). Furthermore, it can be seen that all functions of the surgical microscope 1 are controlled in a manner known per se by a central control unit and actuated by the attending physician, for example via a joystick and / or a foot pedal.
    In Fig. 2, an infrared stimulation device 10 is also shown schematically. In this case, the infrared irradiation unit 12 is arranged in a housing 18. This essentially comprises the actual infrared light source 13, which is designed to generate infrared light, for example in the range of 1700-1900 nm wavelength. Via mirrors 14, which are designed to reflect infrared light, an infrared light beam 16 is directed to a desired location of the surgical field 7. There, on the spot on which the infrared light impinges on the surgical field 7, the tissue of the cortex 6 is heated, whereby the functional areas of the cortex 6, for example the speech center, are more perfused, which in a manner known per se by means of the abovementioned Thermal imaging camera 9 can be detected and evaluated.
    For this purpose, the mirrors 14 can be pivoted and / or tilted in a desired manner so that the infrared light beam 16 can be guided, for example, in the form of a line or a grid over the operating field 7. For the desired widening of the infrared light beam 16 is an irradiation optical system 15, which is shown here schematically as a lens. Furthermore, the infrared light source 13 is adapted to generate infrared light of desired wavelength, intensity and desired time change, the so-called pulse-pause ratio.
    Furthermore, the infrared stimulation device 10 has a pilot light generating device 20 for visible light. The visible to the human light of the pilot light source 21 is also directed to the operating field 7 with mirrors 22 and a pilot light optics 23, which is also shown here only schematically as a lens. Again, the mirrors 22 are mechanically movable to project the pilot light beam 24 to the same location of the surgical field 7 as the infrared light beam 16, especially when the infrared light beam 16 travels across the surgical field 7. For this purpose, a common control 11, which is connected via data lines 25 with the infrared light source 12 and the pilot light generating device 20 in connection. The control unit 11 in turn communicates via an interface 19 with the central control device of the entire surgical microscope 1. The pilot light source 21 can be used, for example, to generate a crosshair and / or a ring in order to indicate the location, size and / or diameter of the infrared light beam 16 on the cortex 6 , A corresponding pilot light beam 24 can also be displayed virtually in an external image of the surgical field 7 and / or in an observation beam path 5.
    Also shown here is the measuring device 50, which is arranged in a housing 56. The measuring device 50 essentially comprises a measuring device 52, for example a thermal imaging camera 9, wherein the observation field of the measuring device 52 is shown by the dotted lines and preferably the entire operating field 7 is detected. The measuring device 52 is associated with a measuring optics 51, which is also indicated here only schematically as a lens to detect the surgical field 7. The measured values of the measuring device 52 are detected by a controller 53, which is likewise connected to the other components of the surgical microscope 1 via data lines 25, in particular via an interface 54 with a central control device of the surgical microscope 1.
    It is understood that the surgical field 7 can still be viewed through the surgical microscope 1 with its observation beam path 5, so that the attending physician in particular the pilot light beam 24 can observe and control to the various areas of the cortex in the desired manner stimulate.
    In a treatment to be performed, the attending physician looks through the eyepiece 3 and sees the surgical field 7 enlarged. It can now control an infrared light beam 16, for example via its foot pedal via the surgical field 7 and thereby adjust its intensity and / or diameter in the desired manner. Also, for example, he can adjust the pulse rate in the desired manner to produce a stimulation of the cortex 7. In order to always know where the infrared light beam 16 impinges on the cortex 7 serves a pilot light generating device 20 in synchronism with the infrared light beam 16 to direct a pilot light beam 24 to the surgical field 7 and the cortex 6, for example in the form of a circle and / or a crosshair.
    If a functional area of the cortex 6 was activated, this results in a strong blood flow, which can be detected, for example, with a measuring device 50 with a measuring device 52 in the form of a thermal imaging camera 9 and evaluated in a manner known per se. Thus, the attending physician immediately receives information about where healthy tissue is. The tumor tissue around a functional area can then be selectively removed without damaging the functional area.
    It is understood that all components of the surgical microscope 1 are preferably controlled via a common control device and that, for example, the functional areas can then be displayed highlighted in color, for example, on an external monitor.
    In particular, the surgical microscope 1 is designed in such a way that the infrared stimulation device 10, the pilot light generating device 20 and the measuring device 50 are integrated into the surgical microscope 1, for example in the housing 2. In principle, however, it would also be possible for the infrared stimulation device 10 with the pilot light generating device 20 and / or the measuring device 50 to be designed as a separate, hand-held probe, so that the attending physician manually guides the infrared light beam 16 over the surgical field 7.
    The above components can also be designed as a retrofit kit, which can be connected to an existing surgical microscope 1 or grown to locate the functional areas in the cortex 6.
    LIST OF REFERENCES: Surgical microscope 2 Housing 3 Eyepiece 4 Lens 5 Observation beam path 6 Cortex 7 Operating field 8 Magnification changer 9 Thermal imaging camera 10 Infrared stimulation device 11 Control 12 Infrared irradiation device 13 Infrared light source 14 Mirror 15 Irradiation optics 16 Infrared light beam 18 Housing 19 Interface 20 Pilot light generation device
    权利要求:
    Claims (6)
    [1]
    21 Pilot light source 22 Mirror 23 Pilot light optics 24 Pilot light beam 25 Data line 50 Measuring device 51 Measuring optics 52 Measuring device 53 Controller 54 Interface Patent claims
    A surgical microscope (1) for magnified viewing of a surgical field (7) on a patient, comprising a measuring device (50) for detecting optical characteristics of the surgical field (7), characterized in that the surgical microscope (1) equipped with an infrared stimulation device (10) is.
    [2]
    2. Surgical microscope (1) according to claim 1, characterized in that the intensity and / or the time course and / or the diameter of an infrared light beam (16) is variable.
    [3]
    3. Surgical microscope (1) according to claim 1 or 2, characterized in that with a pilot light generating means (20), a pilot light beam (24) can be generated, which is synchronized with the infrared light beam (16).
    [4]
    4. surgical microscope (1) according to one of claims 1 to 3, characterized in that the surgical microscope (1) and / or the infrared light source (13) is equipped with a distance meter to a distance between the surgical field (7) and the surgical microscope ( 1) and / or the infrared light source (13) to determine.
    [5]
    5. Surgical microscope (1) according to one of claims 1 to 4, characterized in that a location at which the infrared light beam (16) hits the surgical field (7) is variable.
    [6]
    6. Retrofit kit for a surgical microscope (1) comprising an infrared stimulation device (10), which is designed according to one of claims 1 to 5.
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    同族专利:
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    DE102016208743A1|2017-11-23|
    引用文献:
    公开号 | 申请日 | 公开日 | 申请人 | 专利标题
    US6196226B1|1990-08-10|2001-03-06|University Of Washington|Methods and apparatus for optically imaging neuronal tissue and activity|
    US5215095A|1990-08-10|1993-06-01|University Technologies International|Optical imaging system for neurosurgery|
    DE102009015598B4|2009-04-02|2015-10-01|Carl Zeiss Meditec Ag|Method and device for finding functional tissue areas in a tissue area|
    DE102009018633A1|2009-04-17|2010-10-21|Technische Universität Dresden|Method and device for intraoperative imaging of brain areas|
    法律状态:
    2020-07-31| AZW| Rejection (application)|
    优先权:
    申请号 | 申请日 | 专利标题
    DE102016208743.6A|DE102016208743A1|2016-05-20|2016-05-20|Surgical microscope for examination of the cortex|
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