U.S. patent application number 09/945402 was filed with the patent office on 2002-04-18 for electrode insertion tool.
Invention is credited to Bullara, Leo A., McCreery, Douglas B., Moore, Jean K., Waldron, Stephen H..
Application Number | 20020045927 09/945402 |
Document ID | / |
Family ID | 26803071 |
Filed Date | 2002-04-18 |
United States Patent
Application |
20020045927 |
Kind Code |
A1 |
Moore, Jean K. ; et
al. |
April 18, 2002 |
Electrode insertion tool
Abstract
A tool for inserting medical electrodes such as
nerve-stimulating electrodes into tissue. An electrode is
positioned fully within a tip of the tool so the tip end can be
placed directly against the tissue to be penetrated for precise
handheld positioning. A trigger on the tool is actuated to release
a compressed spring in the tool to drive the electrode out of the
tool tip into the target tissue. A viscous-damping means is
provided in the tool to control electrode acceleration and
velocity.
Inventors: |
Moore, Jean K.; (Los
Angeles, CA) ; McCreery, Douglas B.; (Pasadena,
CA) ; Bullara, Leo A.; (Glendora, CA) ;
Waldron, Stephen H.; (Camarillo, CA) |
Correspondence
Address: |
CHRISTIE, PARKER & HALE, LLP
350 WEST COLORADO BOULEVARD
SUITE 500
PASADENA
CA
91105
US
|
Family ID: |
26803071 |
Appl. No.: |
09/945402 |
Filed: |
August 31, 2001 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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09945402 |
Aug 31, 2001 |
|
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|
09428672 |
Oct 27, 1999 |
|
|
|
60105896 |
Oct 27, 1998 |
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Current U.S.
Class: |
607/116 |
Current CPC
Class: |
A61B 34/20 20160201;
A61N 1/0541 20130101 |
Class at
Publication: |
607/116 |
International
Class: |
A61N 001/00 |
Goverment Interests
[0002] The development of the invention disclosed in this
application was in part funded under NIH Contracts N01-DC-5-2105
and N01-DC-8-2102.
Claims
1. An electrode insertion tool, comprising: a hollow handle having
a rear end, and a front end which terminates in a reduced-diameter
tubular extension with a curved portion, and in which is moveably
positioned an injector, an electrode assembly to be inserted being
fully receivable within the tubular extension adjacent the
injector; spring means positioned within the handle between an
adjustable and normally fixed plug and a moveable ring, and a
trigger for holding the ring when the spring is compressed and
actuable to release the ring; a cocking knob extending from and
moveable within the rear end of the handle; an elongated connecting
means extending within the handle and secured to the injector,
moveable ring and cocking knob, whereby retraction of the knob
retracts the injector and ring to compress the spring means; a
damping means within the handle, and having a stationary part
secured to the connecting means for applying a force approximating
viscous damping to the connecting means, whereby release of the
ring by actuation of the trigger causes high initial acceleration
of the connecting means to drive the electrode out of the tubular
extension for initial penetration of a tissue surface, followed by
controlled velocity of the connecting means and electrode.
2. The tool of claim 1 in which the spring means is a compression
coil spring, and the connecting means is a flexible guide wire.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation of U.S. application Ser.
No. 09/428,672 filed Oct. 27, 1999, and which claimed the benefit
of U.S. Provisional Application No. 60/105,896 filed Oct. 27,
1998.
BACKGROUND OF THE INVENTION
[0003] This invention relates to a simple and reliable mechanical
tool for inserting medical electrodes into nerve tissue such as the
cerebral cortex, brain stem and the spinal cord. The tool can be
hand held, or mounted in a stereotactic positioning device. An
alternative embodiment of the tool uses a curved tip for holding
the electrode for insertion in the cochlear nucleus of the brain as
part of a procedure to assist a profoundly deaf patient.
[0004] The tool is especially useful with small medical electrodes
having a button-like cylindrical base, typically made of epoxy, of
about 2.5-mm diameter and about 0.5-mm thickness. Typically,
multiple (e.g., seven) relatively sharp tine-like electrodes (the
length depending on the application, but typically in the range of
1 to 6 mm) extend from the base, and connecting leads enable
individual or parallel energization of the electrodes depending on
the nerve-stimulation protocol being used.
[0005] The challenge met by the invention is to move the positioned
electrode with an initially high acceleration to enable the
electrode tines to penetrate at high velocity the tough and
puncture-resistant pia-arachnoid member overlapping the cortex and
spinal cord. It is then desirable to stabilize and cease
accelerating the penetration rate to prevent injury to the
underlying neuronal population, and to the delicate arterial and
venous blood vessels.
[0006] An important advantage of the invention is that the
electrodes and associated base are recessed within a tip of the
insertion tool prior to actuation. This feature enables the tool
tip to be positioned against the tissue to be penetrated, thus
enabling handheld operation as opposed to the sometimes cumbersome
mounting of the tool in a stereotactic positioning device.
[0007] Several alternative velocity-control mechanisms are
disclosed which approximate viscous damping of movement of the
electrode driving mechanism to enable high initial acceleration
until penetration is achieved, with controlled and relatively
stabilized velocity thereafter.
SUMMARY OF THE INVENTION
[0008] The electrode insertion tool of this invention includes a
tubular handle having a reduced-diameter tubular tip. A guide wire
extends through the handle and into the tip to be secured to an
injection piston slidably moveable within the tip. An electrode
assembly can be fully inserted against the injection piston to be
shrouded by the tip, thus enabling the tip to be placed directly
against the tissue into which the electrode assembly is to be
inserted.
[0009] A compression spring is positioned within the handle, and is
compressed between an adjustable normally stationary plug and a
moveable ring which is secured to the guide wire. A cocking knob
extends from a rear end of the handle and is secured to the guide
wire so the knob can be retracted to move the ring toward the
stationary plug to compress the spring. An external trigger on the
handle holds the plug in the spring-compressed "cocked" position,
and the trigger is moveable to release the plug and "fire" the tool
to move the electrode assembly forwardly out of the tubular
tip.
[0010] To provide a high initial acceleration of the guide wire and
electrode assembly, followed by a relatively constant velocity
(typically in the range of one-to-four meters per second), a means
is provided within the handle to provide motion control
approximating viscous damping, and restraining force approximately
proportional to velocity of the moving system, thus enabling high
initial acceleration. The damping means is described in terms of
both magnetic eddy-current braking force, and piston-cylinder drag
force.
DESCRIPTION OF THE DRAWINGS
[0011] FIG. 1 is a side elevational view, partly broken away and in
cross section, of the tool of this invention;
[0012] FIG. 2 is a sectional end view on line 2-2 of FIG. 1;
[0013] FIG. 3 is a top view of the tool shown in FIG. 1;
[0014] FIG. 4 is an enlarged sectional view of the tool tip at the
right end of FIG. 1;
[0015] FIG. 5 is a sectional end view on line 5-5 of FIG. 4;
[0016] FIG. 6 is a sectional side elevation of a second embodiment
of the tool;
[0017] FIG. 7 is an enlarged view of a viscous damper used in the
second embodiment;
[0018] FIG. 8 is an enlarged sectional elevation of a curved tip
used in the tool of FIGS. 6 and 7.
[0019] FIG. 9 is a sectional side elevation of a third embodiment
similar to FIG. 6, but using a different style of
velocity-controlling damping mechanism;
[0020] FIG. 10 is a side elevation of several components of the
damping mechanism; and
[0021] FIG. 11 is an end view on line 11-11 of FIG. 10.
DESCRIPTION OF THE PREFERRED EMBODIMENT
[0022] Referring to FIGS. 1 and 2, an electrode insertion tool 10
according to the invention has a hollow cylindrical handle 11
extending to an inwardly tapered portion 12 and a tubular extension
13. A bore 14 extends centrally through portion 12 and extension 13
at a forward end 15 of the handle at the right side of FIG. 1. A
hollow tube 16 is rigidly secured by a set screw 17 or other
fastening means to the handle within bore 14, and extends from
forward end 15 of the handle.
[0023] A larger diameter bore 18 extends from the inner end of tube
16 to a rear end 19 of the handle, and a central part of the bore
defines internal threads 20. An externally threaded
spring-compression plug 23 is fitted within the handle in
engagement with threads 20 to be axially adjustable in position.
Extending around the circumference of the plug are depressions 24
which are accessible through a slot 25 in the handle, and through
which a pin (not shown) can be inserted to turn the plug for axial
position adjustment. A spring-seat recess 26 is formed in a forward
end of the plug.
[0024] An externally threaded cup-shaped copper ring 29 is
positioned rearwardly of plug 23 within the handle in engagement
with threads 20 to be axially adjustable in position. Ring 29 has a
central recess 30, and a closed end 31, and in common with plug 23,
has circumferentially extending depressions 32 accessible through a
slot 33 in the handle sidewall (FIG. 2) to enable the ring to be
rotated to a desired axial position.
[0025] A drive rod 36 extends centrally through the handle and tube
15, and is anchored at its rear end in an externally knurled
cylindrical cocking knob 37 by a set screw 38. A forward end of
knob 37 makes a slip fit within bore 18 of the handle, and an
opposite end of the knob extends rearwardly beyond the rear end of
the handle so it can be grasped and moved rearwardly to cock the
tool as described below.
[0026] A velocity damper 40 is rigidly secured by a set screw 41 to
drive rod 36 forwardly of cocking knob 37 and spaced rearwardly
from the open end of copper ring 29 when the tool is in a cocked
position as shown in FIG. 1. A ring magnet 42, preferably made of
samarium, is at the front end of damper 40 in a position to make a
slip fit within recess 30 of the copper ring, and is glued or
otherwise secured to a central stub 43 of an aluminum locking ring
44 which is secured to the drive rod by setscrew 41.
[0027] Drive rod 36 continues forwardly through a central clearance
opening 45 (FIG. 2) in closed end 31 of copper ring 29, and through
a similar central clearance opening 46 in spring compression plug
23 to extend through and to be rigidly and centrally secured to a
forward spring seat ring 47 by a setscrew 48. The rear end of ring
47 defines a recess 49, and a compression coil spring 50 is seated
at its forward end in recess 49, and at its rear end in recess 26
of plug 23.
[0028] A trigger 52 has a slender and resilient lower band 53 which
is welded at 54 to the outer surface of handle 11 just forward of a
slot 55 through the handle sidewall adjacent the forward surface of
ring 47. A forward end of band 53 is integrally joined to a thicker
and stiff upper knurled member 56, the rear end of which extends
inwardly through slot 55 to a tip 57 which bears against the
forward surface of ring 47 to restrain movement of the ring which
the tool is cocked by withdrawing cocking knob 37 to compress
spring 50. Depression of the forward end of upper member 56 bends
lower band 53, and lifts tip 57 out of engagement with ring 47 to
operate the insertion tool.
[0029] Referring to enlarged FIGS. 4 and 5, hollow tube 16 extends
from handle 11 to a forward open end 60. A cylindrical electrode
support post 61 is centrally positioned within tube 16 rearwardly
of forward end 60, and is rigidly secured to the tube by a pin 62
which is anchored in opposed sidewalls of the tube, and is secured
to and extends through the post as shown in FIG. 5.
[0030] An injection cylinder 65 is positioned within tube 16, and
has a closed end 66 which is rigidly secured to the forward end of
drive rod 36. The cylinder has an internal bore which is larger in
diameter than the outside diameter of support post 61, and is
fitted slightly over and in axial alignment with the support post.
A pair of slots 67 are formed in opposed sidewalls of the cylinder
in alignment with pin 62 so the cylinder can be moved forwardly
along the support post when the tool is activated.
[0031] An electrode assembly 69 having a short cylindrical base 70
and multiple tine-like electrodes 71 is positioned within the
forward end of tube 16, with the sharpened tips of the electrodes
being positioned slightly rearwardly of the forward end of the
tube. The electrode assembly is most easily so positioned by a
cylindrical insertion tube 72 which makes a slip fit within tube 16
and around electrodes 71 to press against the forward end of base
70 ,and thus push the assembly against the support post.
[0032] Before insertion, a relatively weak medical-grade adhesive
is applied to the forward end of the support post, or to the rear
surface of base 70. This adhesive weakly secures the inserted
electrode assembly to the support post, but the bond is easily
broken when the tool is activated to drive the injection cylinder
forwardly against the electrode assembly base. A suitable
pressure-sensitive silicone-based adhesive is available from NuSil
Technology in Carpenteria, Calif., as Product No. PSA 9839
(biocompatible).
[0033] With the electrode assembly thus positioned within the
insertion tool, the end of tube 16 is positioned over the
nerve-tissue area to be penetrated, and trigger 52 is depressed to
release ring 47 from trigger tip 57, and thereby to activate or
"fire" the tool. Initial acceleration of the drive rod, injection
cylinder, and other attached components is rapid and unimpeded to
insure quick penetration of the relatively tough pia-arachnoid
membrane which overlies the target nerve tissue. Thereafter, magnet
42 moves forwardly within copper ring 29, and the resulting
movement-generated eddy current impedes and slows the initial rapid
movement of the electrode assembly to minimize the risk of injury
to the target nerve tissue.
[0034] Typically, handle 11 is about 10 cm in length, and tube 16
extends about 4 cm beyond the forward end of the handle. Apart from
the materials previously specified, the tool components are
preferably made from stainless steel to withstand sterilization by
autoclaving or similar processes.
[0035] FIGS. 6-8 show a second embodiment of an electrode insertion
tool 80 which differs from tool 10 in several ways. First, an
adjustable viscous friction damper is substituted for the magnetic
damper of tool 10 to provide additional damping force to control
electrode insertion speed. Second, a curved insertion tip is
provided for improved access to the cochlear nucleus for insertion
of an electrode used in an auditory-prosthesis system. Third, the
electrode is held in the tip by a partial vacuum which is released
when the electrode is inserted to enable immediate removal of the
tool.
[0036] Tool 80 includes a hollow cylindrical housing 81 which is
closed at a forward end 82 by a press-fitted plug 83 having a
central opening 84 in which is rigidly secured the rear end of a
hollow tube 85 having a curved tip 86 which extends at an angle of
about 55 degrees from the central axis of tube 85. A cylindrical
piston 88 makes a close slip fit within a central bore 89 in
housing 81. A trigger 90 is pivotally mounted on the outer surface
of the housing, and has a tip 91 which is spring urged downwardly
into engagement with a recess 92 in piston 88 when the tool is
cocked as shown in FIG. 6.
[0037] A chamber 93 is formed within the housing between the front
end of the piston, and the rear surface of plug 83, and a laterally
extending tube 94 secured to the housing opens into the chamber and
is adapted for connection to a vacuum pump so the pressure in the
chamber can be reduced below ambient atmospheric pressure. A drive
wire 96 extends centrally completely through housing 81 and tube
85, and corresponds in function to drive rod 36 of tool 10. Piston
88 is secured to the drive wire by a set screw 97 which is
accessible through a small slot 98 in the sidewall of the handle.
The outer end of set screw 97 may be extended (not shown) to fit
within slot 98 and bottom against the forward end of the slot to
provide a positive movement stop.
[0038] A compression coil spring 99 is positioned within the
housing between the rear end of piston 88 and the front surface of
a longitudinally adjustable spring compression plug 100
corresponding to plug 23 in tool 10. The plug has a central
clearance opening through which drive wire 96 extends.
[0039] A cylindrical cocking knob 102 (corresponding to knob 37 of
tool 10) makes a slip fit within the rear end of housing 81, and is
secured to the rear end of the drive wire by a setscrew 103. A
reduced diameter sleeve 105 (FIG. 7) extends forwardly from the
knob within central bore 89 of the housing between the knob and
plug 100.
[0040] Fitted over the end of sleeve 105 forwardly of knob 102 is a
silicone-rubber tube 108 having a rear end which abuts the end of
the knob, and a front end which contacts an enlarged head 109 to a
plastic screw 110 having a shank 111 threaded into a mating central
bore 112 of sleeve 105. Screw 110 has a central opening 114
therethrough to provide clearance for drive wire 96. Preferably, a
plurality of slits 115 are cut in the forward end of tube 108
enabling the tube to be longitudinally compressed by tightening
screw 110, and thereby enlarging in diameter to contact the surface
of bore 89 as shown in FIG. 6. The outer surface of tube 108 and
the inner surface of bore 89 are coated with a viscous material
(high-vacuum silicone grease as available from Dow Corning is
suitable) to provide a viscous damping force opposing forward
movement of the cocking knob and drive wire at a level proportional
to the forward velocity of these moving parts. The force level is
adjustable by rotating screw 110 to vary the compressive force
exerted by the screw head against tube 108.
[0041] Referring to FIG. 8, fitted within the forward or outer end
of curved tubular tip 86 of tube 85 is a hollow injection piston
119 which makes a close slip fit within the tip. The forward end of
drive wire 96 is rigidly secured to an inner sidewall of the
injection piston, leaving an open passage 120 through the piston
The forward end of the piston is flat to make a mating fit with the
rear surface of an electrode assembly (not shown) so the electrode
assembly is held in place against the piston when chamber 93 (and
hence the interior of tube 85 and passage 120) is evacuated. A
longitudinal slot 122 is formed in the outer end of the sidewall of
tip 86, and provides clearance space for lead wires extending from
the electrode assembly, as well as venting of the evacuated
interior of the tool after the electrode is inserted.
[0042] In use, tube 94 is connected to a vacuum pump, and tool 80
is cocked by retracting knob 102 until tip 91 of trigger 90 is
urged downwardly by a trigger spring (not shown) into engagement
with recess 92 in piston 88. In this cocked position as shown in
FIG. 6, injection piston 119 is retracted within curved tip 86, and
the vacuum pump reduces the pressure within chamber 93 and tube 85
to about 300 to 400 millimeters of mercury below ambient air
pressure. The electrode assembly is sucked into the curved tip to
seat the assembly base against the front of the injection piston,
with lead wires of the electrode assembly fitted through slot
122.
[0043] The surgeon then places the end of the tool tip against the
surface of the cochlear nucleus, and fires the tool by depressing
trigger 90. Electrode insertion speed is controlled and adjustable
by the extent of compression of spring 99, the level of vacuum
formed within the tool, and the setting of screw 110 which adjusts
the degree of viscous damping of forward velocity. A preferred
range of insertion speed is 0.5 to 2 meters per second.
[0044] When the tool is fired, piston 88 moves forwardly to occlude
tube 94, and thereby to disconnect the vacuum source from the tool
interior. Simultaneously, the rear end of the injection piston
moves forwardly to an extended position which is ahead of the rear
end of slot 122, thus venting the interior of the curved tip to
ambient pressure, and releasing the now-inserted electrode
assembly. Release of the electrode assembly occurs within a few
milliseconds so inadvertent post-firing movement of the tool does
not affect the inserted electrode assembly.
[0045] Tool 80 can of course also be used with a straight tube 16
as shown in FIGS. 1 and 3, and is illustrated with a curved tube to
show the suitability of the tool for electrode insertion in the
cochlear nucleus.
[0046] FIGS. 9-11 illustrate a third and presently preferred
embodiment of an insertion tool 130 of this invention. The
components of tool 130 extending from compression coil spring 99 to
tip 86 are identical to those shown in FIGS. 6 and 8 with respect
to tool 80, and those parts are not renumbered, and need not be
reidentified. The difference between tools 80 and 130 resides in
the substitution of a viscous-friction damping assembly 132 which
is free of silicone grease, and is hence more readily
sterilized.
[0047] Assembly 132 includes a spring compression plug 134
(corresponding in shape and function to plug 100 in tool 80) to the
rear end of which is cemented or otherwise secured a thin-wall
plastic tube or cylinder 135 having a bore 136. The cylinder
typically has an outside diameter of about 0.40 inch, and an inside
diameter of about 0.34 inch, and can be made of polyethylene. The
cylinder makes a loose slip fit within central bore 89 of housing
81. A single narrow slit 137 is cut in the sidewall of cylinder 135
as shown in FIGS. 10 and 11.
[0048] A resilient piston 139 made of an elastomer such as Neoprene
is cemented at its rear end to the head of a plastic screw 140
corresponding to screw 110 of tool 80. The screw is threaded into a
mating threaded bore centrally formed in a stud or sleeve 141
integrally formed with and extending from a cylindrical cocking
knob 142 (corresponding to knob 102 of tool 80). A central bore 143
extends through the piston, screw, sleeve and cocking knob to
receive drive wire 96 which is secured to the knob by a set screw
144.
[0049] Piston 139 has a circumferential groove 146, and the piston
makes a snug slip fit within cylinder 135 to slightly expand slit
137. It has been found that the compressive force of the slit
cylinder against the accelerating piston when the tool is actuated
or fired approximates the desired viscous damping which permits
high initial acceleration followed by stabilization of
velocity.
[0050] Just as in tool 80, spring compression plug 134 has a
central hexagonal bore 147 to enable adjustment of longitudinal
position of the plug which in turn establishes the compression of
spring 99 when the tool is cocked. Access to the bore is achieved
by loosening set screw 144 and withdrawing the cocking knob and
piston. A hollow hexagonal key (not shown) can then be fitted over
drive wire 96 and fitted into bore 146 to rotate the plug.
[0051] There have been described several embodiments of an
electrode insertion tool which can be handheld for precision
placement of an electrode assembly which is then inserted into
tissue with good penetration and minimum risk of tissue damage.
Depending on the nature of the tissue to be penetrated, insertion
speeds in the range of one-to-four meters per second are typical,
and are selected by the degree of compression of the cocked
actuating spring.
* * * * *