Abstract: This document discusses, among other things, a fiducial marker assembly that includes an internally engagable base. The base is sized and shaped to be mounted flush to or recessed from an outer surface of a patient's skull, thereby reducing or avoiding patient discomfort. The fiducial marker assembly includes an imagable locator and a registration receptacle. A base insertion instrument is engaged to the base to attach the base to the patient's skull. In one example the base includes a faceted head, permitting a socket-like device to screw or unscrew the base into or out of the skull. In another example, the base includes at least one step or slot for engaging an insertion or extraction tool.

Abstract: This document discusses, among other things, a fiducial markers capable of use in image guided surgery (IGS) procedures, such as neurosurgery, or other applications. One example includes a positioning instrument with a cap that mates directly to an imageable sphere to perform registration. Another example includes a jointed positioning instrument that, when placed in a base, pivots about a location defined by a center of the imageable sphere when it was in the base. Another example includes a fiducial marker with two imageable spheres defining a line intersecting a desired point on the base. Another example includes a base with a receptacle for receiving a positioning instrument. Another example includes an imageable sphere with a removable imageable portion to allow access to a center of the imageable sphere by a positioning instrument.

Abstract: This document discusses, among other things, a fiducial marker assembly that includes an internally engagable base. The base is sized and shaped to be mounted flush to or recessed from an outer surface of a patient's skull, thereby reducing or avoiding patient discomfort. The fiducial marker assembly includes an imagable locator and a registration receptacle. A base insertion instrument is engaged into the interior of the base to attach the base to the patient's skull. A guide tube and scalp-stabilizer are provided for assisting in the base-attachment procedure. A trajectory guide can be coupled to the base. An alternative conformal cap to a raised fiducial marker base is also discussed.

Abstract: A device and method of placement of a chronic micro-catheter is shown that allows effective guiding of micro-catheters through a host catheter that is later removable while leaving the micro-catheter implanted in place within the patient. The novel configuration allows the micro-catheter to be completely radially enclosed during insertion, and still allows the host catheter to be removed, leaving the micro-catheter behind. Additionally, the configuration allows several micro-catheters to be placed at any number of depths and orientations while still using a minimally invasive host catheter.

Abstract: Devices and methods provide accurate targeting, placement, and/or stabilization of an electrode or other instrument(s) into the brain or other body organ, such as to treat severe tremor or other neurological disorders. Targeting is performed using any form of image-guidance, including real-time MRI, CT, or frameless surgical navigation systems.

Abstract: Devices and methods provide accurate targeting, placement, and/or stabilization of an electrode or other instrument(s) into the brain or other body organ, such as to treat severe tremor or other neurological disorders. Targeting is performed using any form of image-guidance, including real-time MRI, CT, or frameless surgical navigation systems.

Abstract: This document discusses an exovascular approach to treating an aneurysm using a minimally-invasive instrument guided by magnetic resonance imaging (MRI), computed tomography (CT), or another suitable imaging device. A trajectory guide entry device assists in targeting the aneurysm and determining the proper trajectory thereto. Examples of the aneurysm treatment device include a clip, a clasp, a snare, a loop, a hook, a staple, and an electrocautery or other electrode, or any combination of such devices. The aneurysm treatment device is delivered by a probe, such as a tube or other catheter.

Abstract: A full-thickness resection system comprises a flexible endoscope and a stapling mechanism, wherein the endoscope is slidably received through at least a portion of the stapling mechanism. The stapling mechanism comprises an anvil and a stapling head mounted to the anvil so that the anvil and the stapling head are moveable with respect to one another between a tissue receiving position and a stapling position and wherein a gap formed between the stapling head and the anvil is larger in the tissue receiving position than it is in the stapling position. A position adjusting mechanism is provided for moving the anvil and the stapling head between the tissue receiving and stapling positions and a staple firing mechanism sequentially fires a plurality of staples from the stapling head across the gap against the anvil and through any tissue received in the gap and a knife cuts a portion of tissue received within the gap.

Abstract: An introducer is described that is coupled to a patient, specifically a patient's skull. The introducer may include an advancer that is remote from the patient, the advancer communicating with the introducer by means of a cable system. The introducer may also include a local position sensor that indicates the position of the primary medical device being introduced. The introducer may also include a frameless reference system that locates the primary medical device relative to a table that the patient is fixed to.

Abstract: A surgical alignment device is shown that is controlled remotely through the use of an actuator, where the actuator in turn controls at least one local adjustment device. The alignment device is suited for neurosurgery, although it is not exclusively limited to neurosurgery. The alignment device includes an insertion guide that is coupled to the local adjustment device, the insertion guide being used to guide a device such as a catheter into a patient. The alignment device may also be coupled to a control module such as a microcomputer that controls the orientation of the insertion guide in response to inputs from the surgeon as to a location of interest within the patient.

Abstract: An elongate elastic metal alloy member for use in a medical device. The elongate member may be formed from a linear elastic metal alloy which may be twisted such that the torsional elasticity of the member is removed while the longitudinal flexibility of the member is maintained. The elongate member may further be placed under tension, fixed to prevent rotation, and heat treated such that the stress caused by tensioning and twisting the member is relieved without transforming the linear elastic metal alloy into a super-elastic metal alloy. The resulting elongate elastic metal alloy member may have increased straightness and may be easier to grind.

Abstract: An end effector assembly for an endoscopic instrument includes first and second end effectors, a screw and optionally a washer. The end effectors have arms which are biased away from each other. The screw has a threaded portion dimensioned to engage the distal end of the endoscopic instrument and a head portion with a pair of arm receiving grooves. In a presently preferred embodiment, the washer extends over arms of the end effectors which pass through grooves in the head of the screw. In this manner, the arms of the end effectors are captured between the screw and the washer. The grooves are preferably provided with upstanding pins which engage mounting holes in the arms of the end effectors.

Abstract: An elongate elastic metal alloy member for use in a medical device. The elongate member may be formed from a linear elastic metal alloy which may be twisted such that the torsional elasticity of the member is removed while the longitudinal flexibility of the member is maintained. The elongate member may further be placed under tension, fixed to prevent rotation, and heat treated such that the stress caused by tensioning and twisting the member is relieved without transforming the linear elastic metal alloy into a superelastic metal alloy. The resulting elongate elastic metal alloy member may have increased straightness and may be easier to grind.

Abstract: A device for cutting tissue, the device comprising a first tube having a side window; a second tube positioned within the first tube, the second tube having a side window and being movable within the first tube; a third tube positioned within the second tube, the third tube having a side window and being movable within the second tube; and a needle insertable within the second tube, the needle housing a suture. The windows in the first, second, and third tubes are alignable with each other. The invention includes methods for the cutting and suturing of tissue by using the device.

Abstract: An endoscopic instrument is provided with a hollow tube, first and second end effectors coupled to the hollow tube and having arms biased away from each other, a cylindrical member slidably disposed over the hollow tube, a push/pull wire extending through the tube, a handle assembly coupled to the push/pull wire and the hollow tube, and a disk segment connected to the push/pull wire and connected to the cylindrical member by a crimp in the cylindrical member. When the handle assembly is actuated, the push/pull wire moves the disk segment and hence the cylindrical member relative to the end effectors and causes the cylindrical member to ride over the arms of the end effectors, thereby forcing the end effectors closed or permitting them to open. Preferably, the disk segment has two curved sides which are coupled to the cylindrical member by crimping, and two substantially parallel sides which provide room for the arms of the end effectors so that the disk segment can move relative to the end effectors.

Abstract: A protected microbiological sampling brush assembly includes a sampling brush mounted on the distal end of a control wire, an inner catheter which houses the brush, an outer catheter which houses the inner catheter, and an elastomeric tip which is rigidly attached to the distal end of the outer catheter and which has a weakened end. The proximal ends of the control wire and catheters are coupled to a handle for independently moving the control wire, the inner catheter, and the outer catheter relative to each other. The weakened end of the elastomeric tip is preferably a slit which defines lips which are parted when the distal end of the inner catheter is moved distally against the elastomeric tip to allow the inner catheter to pass therethrough. When the inner catheter is moved proximally relative to the outer catheter, the lips of the elastomeric tip close to protect the inner catheter (and the sampling brush) from contamination.

Abstract: An end effector assembly for an endoscopic instrument includes first and second end effectors, a screw, and optionally a washer. The end effectors have arms which are biased away from each other. The screw has a threaded portion dimensioned to engage the distal end of the endoscopic instrument and a head portion with a pair of arm receiving grooves. In a presently preferred embodiment, the washer extends over the arms of the end effectors which pass through grooves in the head of the screw. In this manner, the arms of the end effectors are captured between the screw and the washer. The grooves are preferably provided with upstanding pins which engage mounting holes in the arms of the end effectors.

Abstract: A guide wire for a catheter has a tubular portion with a flexible body fixed to its distal end. The distal end of the body may be composed of a radiopaque material. Optical fibers are disposed within the assembly and terminate in a radiopaque tip at the distal end of the body. The guide wire may have a longitudinal marker wire or mandrel for providing stiffness and radioscopic tracking characteristics, as well as providing torsional control and tip shaping capabilities. The guide wire has a proximal end attached to the tube and a distal end that also terminates in the tip. The wire may be maneuvered in a vascular area like a conventional guide wire and may be used in conjunction with a support catheter to increase its maneuverability. Then, laser energy is conveyed to the vascular area by the optical fibers to ablate an obstruction. The proximal end of the guide wire is then removed and a larger catheter may then be slid over the guide wire to continue the ablation operation.

Abstract: A vacuum powered pump includes a spring biased piston or diaphragm in a vacuum chamber coupled to a source of vacuum. When vacuum is applied to the vacuum chamber, the piston or diaphragm is moved in a first direction against the spring. A delayed action valve is coupled to the vacuum chamber to allow ambient air to enter the chamber only after the piston or diaphragm has been moved a substantial distance in the first direction. When the delayed action valve opens, air enters the vacuum chamber and the force of the entering air together with the bias of the spring propels the piston or diaphragm in a second direction opposite the first direction. The delayed action valve automatically closes and the process repeats so long as a vacuum source is coupled to the vacuum chamber. The reciprocal movement of the piston or diaphragm effects a pulsatile pumping of fluid through a fluid chamber having at least one check valve.

Abstract: An endoscopic irrigation instrument includes a fluid chamber, a cannula coupled to a distal end of the fluid chamber, a tapered irrigation tube which couples at its proximal end to a fluid source and which couples at its distal end to an irrigation port of the fluid chamber, and a pinch valve which controls the flow of fluid from the irrigation source to the fluid chamber and hence through the cannula to the surgical site. The tapered irrigation tube is arranged so that it has a first relatively larger constant inner diameter and relatively larger wall thickness on its proximal end until it tapers down in both inner diameter and wall thickness at a location slightly proximal the pinch valve. By the time the tapered irrigation tube passes the pinch valve in the endoscopic instrument, the tapered irrigation tube is at a second relatively smaller constant inner diameter and a relatively smaller wall thickness.