U.S. patent number 3,566,875 [Application Number 04/826,214] was granted by the patent office on 1971-03-02 for device for draining cerebrospinal fluid.
Invention is credited to Richard K. Stoehr.
United States Patent |
3,566,875 |
Stoehr |
March 2, 1971 |
DEVICE FOR DRAINING CEREBROSPINAL FLUID
Abstract
A device for draining cerebrospinal fluid automatically to the
venous system in cases of hydrocephalus. The device includes an
outer elastic tube which houses in its interior identically flow
oriented upstream and downstream check (unidirectional) valves
respectively communicating with the cerebrospinal fluid and the
venous system. Each check valve includes an inner elastic tubular
member within the outer tube and having an upstream open end and a
downstream closed end. At the region of its downstream closed end
each inner tubular member is formed with at least one axially
extending slit which forms the outlet of the valve. Within each
inner elastic tubular member is a freely movable ball member
located in the region of the closed end of the inner tubular member
where the slit is situated. A rigid tube is situated within each
inner elastic tubular member and has a downstream end at a short
distance from the closed end of the tubular member to provide the
freely movable ball member with a restricted extent of axially free
movement. Because of the free movability of this ball member within
each check valve the interior thereof is kept clean, particularly
at the region of the slits, and thus malfunctioning due to clot
formations at the slit is reliably avoided. Moreover, since the
slit extends to substantially the closed end of the tubular member,
dead space in which blood can clot to obstruct flow is
substantially eliminated and the danger of infection is
substantially reduced.
Inventors: |
Stoehr; Richard K. (Blue Point,
NY) |
Family
ID: |
25245991 |
Appl.
No.: |
04/826,214 |
Filed: |
May 20, 1969 |
Current U.S.
Class: |
604/9; 137/242;
137/848; 604/185; 604/247 |
Current CPC
Class: |
A61M
39/22 (20130101); A61M 27/006 (20130101); Y10T
137/4273 (20150401); Y10T 137/7884 (20150401) |
Current International
Class: |
A61M
27/00 (20060101); A61M 39/22 (20060101); A61M
39/00 (20060101); A61m 025/00 () |
Field of
Search: |
;128/350,350 (V)/
;128/231,232,273 ;137/242,525 |
References Cited
[Referenced By]
U.S. Patent Documents
Other References
nulsen et al. - Surgical Forum - -2, 1951, pp. 399-403 -
128/350.
|
Primary Examiner: Truluck; Dalton L.
Claims
I claim:
1. In a device for draining cerebrospinal fluid to the venous
system, an elongated outer elastic tube; upstream and downstream
identically flow oriented spaced check valves respectively located
in said tube and each having an upstream inlet and a downstream
outlet, means communicating with the upstream inlet of said
upstream check valve for placing the latter in communication with
cerebrospinal fluid, means communicating with the downstream outlet
of said downstream check valve for placing the latter in
communication with the venous system, and each check valve
comprising an inner tubular elastic member housed within said outer
elastic tube and having an open upstream end forming said inlet and
a closed downstream end, said inner tubular member of each check
valve being formed in the region of its closed downstream end with
an axially extending slit which forms an outlet in response to an
excess in the internal pressure of said inner tubular member with
respect to the external pressure at the region of said slit for
automatically opening the latter to provide for flow of fluid
downstream through each inner tubular member out through said slit,
each slit automatically closing in response to an increase in the
external pressure over the internal pressure of said tubular member
to prevent fluid from flowing in an upstream direction, a ball
member situated in the interior of each inner tubular member in the
region of said closed end thereof and being freely movable therein,
and a substantially rigid tube situated in each inner tubular
member and having a downstream end situated adjacent said ball
member at a distance from the closed end of each inner tubular
member sufficiently great to provide a predetermined extent of
movement of the ball member, so that the moving ball member will
maintain fluid in each inner elastic member in motion for
preventing malfunctioning of said slit due to clotting and also
eliminates dead space in the inner tubular member.
2. The combination of claim 1 and wherein said closed end of each
inner tubular member is of a substantially hemispherical
configuration and said slit extending in an axial plane through
part only of said closed end of hemispherical configuration.
3. The combination of claim 2 and wherein each inner tubular member
is formed with a pair of said slits which are diametrically opposed
to each other.
4. The combination of claim 3 and wherein the distance between said
slits at said closed end of each inner tubular member is equal to
the inner diameter of the latter tubular member so that said slits
have at said closed hemispherical end of each inner tubular member
inner edges respectively forming continuations of the inner surface
of said inner surface of said inner tubular member.
5. The combination of claim 1 and wherein said slit of each inner
tubular member extends from the immediate vicinity of said closed
end thereof in an upstream direction beyond said downstream end of
said rigid tube.
6. The combination of claim 1 and wherein each inner tubular member
has at its downstream closed end a pair of said slits diametrically
opposed to each other and extending partly only into said closed
end, said closed end being of a hemispherical configuration and
said slits respectively terminating at said closed end in inner
edges respectively forming continuations of the inner surface of
said inner tubular member, said pair of diametrically opposed slits
of each inner tubular member extending axially from said closed end
thereof in an upstream direction at least about equal to the axial
length of the slits.
7. The combination of claim 1 and wherein each rigid tube is formed
at its downstream end with a circular end face to be engaged by
said ball member during movement thereof in an upstream direction
in each inner tubular member, so that said ball member and rigid
tube also functions as an inner check valve to prevent back-flow of
fluid.
8. The combination of claim 1 and wherein each ball member is made
of nylon.
9. The combination of claim 8 and wherein said outer tube and inner
tubular members are made of silicone rubber, said rigid tubes being
made of stainless steel.
Description
BACKGROUND OF THE INVENTION
The present invention relates to devices for draining cerebrospinal
fluid to the venous system. The device of the invention is that
type of device which is disclosed in U.S. Pat. No. 2,969,066.
Such a device conventionally includes an outer elongated elastic
tube within which identically flow oriented spaced upstream and
downstream check valves are situated for respective communication
with the cerebrospinal fluid and the venous system. Each check
valve includes an inner elastic tubular member within the outer
tube. Formed in the region of the downstream end of each inner
tubular member is an axially extending slit which forms a valve
opening. The valves are designed to automatically open when the
pressure within each inner tubular member exceeds the pressure at
the exterior thereof by a given slight amount, a slit automatically
opening due to this pressure differential, while the slit will
automatically close when the internal pressure is less than the
external pressure of each tubular member, by less than the pressure
required to open the slit.
According to the theory of operation of this type of drainage
device, it will permit ready flow of fluid from the brain to the
venous system; if the fluid clogs as by clotting, or if flow
reverses, pressing on the outer elastic tube between the check
valve will constrict the inner space of the outer elastic tube
between the check valves to force fluid out through the downstream
check valve to the venous system. When the outer elastic tube is
released, so that it expands back to its initial configuration,
additional fluid is sucked from the cerebrospinal space into the
space between the check valves through a slit of the upstream check
valve. Such pumping action, brought about by way of pressing and
releasing the outer elastic tube between the check valves, is
intended to keep the slits clean and avoid clogging thereof.
However, it has been found that there is a serious drawback to this
construction, in that clotting of blood at the slits of the valves
takes place in some cases to such an extent that pressing and
releasing the outer elastic tube between the check valves is not
capable of opening the slit of each valve, with the result that the
device malfunctions and causes the death of the person who carries
the device unless suitable measures are taken soon enough.
SUMMARY OF THE INVENTION
It is accordingly a primary object of the present invention to
improve a structure of the above type in such a way that clogging
thereof, as by the formation of blood clots, in the slits or outer
elastic tube, is reliably avoided.
In particular, it is an object of the present invention to provide
for a device of the above type a structure which will operate
automatically to maintain the device clean, particularly at the
slits thereof, so that the valve slits cannot become clogged.
In addition, it is an object of the present invention to provide
for a device of the above type slits which in themselves have a
construction which will contribute to the reliability of the
operation.
Also, it is an object of the invention to provide a construction of
this type which is composed of a relatively small number of
elements, in addition to those which are required by the
conventional structure, which can be readily and easily assembled
with the remainder of the structure and which will reliably prevent
malfunctioning.
According to the invention, the outer elastic tube houses in its
interior identically flow oriented spaced upstream and downstream
check valves for respectively communicating with the cerebrospinal
fluid and the venous system. Each check valve includes an inner
elastic tubular member having an open upstream end and a closed
downstream end, and in the region of its closed downstream end each
inner tubular member is formed with at least one axially extending
slit. The downstream end of each inner tubular member is of a
substantially hemispherical configuration and the slit which is
formed therein intersects the hemispherical portion of the inner
member so that the opening of the slit takes place not only along
an axially extending portion of the inner tubular member but also
at a curved transversely extending portion at the hemispherical
closed end, to greatly enhance the springy opening and closing of
the slit, greater opening, i.e., a wider spacing between the lips
of the opened slit and better opening and closing accuracy, as
compared to the functioning of a slit which extends only through a
purely axial cylindrical wall portion of the inner tubular member,
and also to eliminate dead space at the downstream ends of the
inner tubular members.
Moreover, the new arrangement will eliminate the formation of
stagnant pools of cerebrospinal fluid, thus reducing infection
problems experienced with prior art devices.
Each inner tubular member is provided in its interior, in the
vicinity of its closed downstream end, with a freely movable ball
member. In the interior of each inner tubular member is a rigid
tube having a downstream end situated upstream of the ball member
and spaced from the closed end of the inner elastic tubular member
by a distance which will provide for the ball member, a given
extent of free axial movement for at least about the length of the
associated slit. Because the ball members in the check valves are
capable of moving about freely due to any movements of the person
who carries the device, these ball members are constantly moving so
as to maintain fluid within the inner tubular elastic members
constantly in motion, thus preventing clogging of the valve
slits.
Other objects of the invention in part will be obvious and in part
will be pointed out hereinafter.
The invention accordingly consists in the features of construction,
combinations of elements and arrangements of parts which will be
exemplified in the device hereinafter described, and of which the
scope of application will be indicated in the appended claims.
BRIEF DESCRIPTION OF THE DRAWINGS
The invention is illustrated by way of example in the accompanying
drawings which form part of this application and in which:
FIG. 1 is a schematic representation of the manner in which the
device of the invention is emplaced.
FIG. 2 is an enlarged longitudinal sectional elevation of the
device of the invention.
FIG. 3 is a transverse section taken along line 3-3 of FIG. 2 in
the direction of the arrows and showing the structure on a scale
which is enlarged as compared to FIG. 2; and
FIG. 4 is a perspective illustration of one of the check valves,
also shown on an enlarged scale as compared to FIG. 2.
DESCRIPTION OF A PREFERRED EMBODIMENT
Referring to FIG. 1, the device 10 of the invention is
schematically indicated in the condition it has during use. An
elongated inlet tube 12 made of medical grade silicone rubber, for
example, extends through a skull opening 14 into the lateral
ventricle to communicate with the cerebrospinal fluid. For this
purpose the inlet tube 12 may terminate within the skull in a
closed end in the region of which the tube 12 is formed with a
plurality of openings extending through its wall, so that the
cerebrospinal fluid can freely enter into the tube 12. The fluid
can then flow through the inlet tube 12 into an outer elongated
elastic tube also made of medical grade silicone rubber and housing
the series of check valves of the invention, which are described in
greater detail below. A discharge tube 18, made, for example, of
polyethylene, is connected at its bottom end to the jugular vein,
so that in this way the device 10 provides a path of flow for the
cerebrospinal fluid to the venous system in the event that pressure
in the former exceeds pressure in the latter by an amount
sufficient to open the check valves. This discharge tube 18 is
secured in the jugular vein 20, schematically shown in FIG. 1,
through a suitable incision.
Secured within the upstream end of the outer elastic tube 16 is an
upstream check valve 22, while a downstream check valve 24 spaced
from the valve 22 is housed within the tubular member 16 in the
region of its downstream end FIG. 2. Both valves are identically
flow oriented to pass fluid in an upstream-downstream direction
upon a slight pressure differential.
The upstream check valve 22 includes an inner elastic tubular
member 26 also made of silicone rubber of medical grade, for
example. This inner elastic tubular member 26 extends into the
interior of a thin substantially rigid -316 stainless steel sleeve
28 fixed within the upstream end of the interior of the outer
elastic tube 16. At its upstream end which is open, the inner
elastic tubular member 26 is provided with an outwardly extending
flange 30 engaging an inner shoulder of the rigid sleeve 28, and a
substantially rigid inner metallic tube 32 which is made of -316
stainless steel, extends into the interior of the elastic tubular
member 26. This tube 32 has between its ends a flange 34 engaging
the upstream end of the flange 30 and holding it against the
shoulder of the sleeve 28. Flange 34 may have a press fit within
the sleeve 28 so as to remain reliably fixed thereto. Upstream of
its flange 34 the rigid tube 32 is connected with the inlet tube
12. The exterior surface of the sleeve 28 and the exterior surface
of the part of tube 32 which is received in the tube 12 may be
corrugated so that with the use of silk string or the like it is
possible to tie the outer elastic member 16 against the exterior
surface of sleeve 28, extending into the corrugations thereof, and
the inlet tube 12 against the exterior surface of the tube 32, also
extending into the corrugations thereof. In this way a secure
connection is provided between the elastic tubular members 16 and
12 and the metallic tubular members 28 and 32, respectively.
The inner elastic tubular member 26 of the check valve 22
terminates in a closed downstream end 36 which is of hemispherical
configuration. According to one of the features of the invention
the tube 26 (see FIG. 4) is formed with a pair of diametrically
opposed axially extending slits 38 which have at their downstream
ends inner edges 40, respectively, which form extensions of the
inner surface of the tube 26. As a result these axially extending
slits 38 directly intersect and extend through a portion of the
hemispherical end 36 leaving the latter only with a central
permanently closed portion whose diameter is equal to the distance
between the edges 40 of the slits 38 and thus equal to the inner
diameter of the tube 26. Thus, the downstream end of each slit 38
extends through a portion 42 at the hemispherical end 36, this
portion 42 being curved inwardly from the exterior surface of the
tube 26 so as to extend substantially transversely thereof toward
the central region of the end 36.
Therefore, when each slit 38 opens, the manner in which it opens,
and also the manner in which it closes are exceedingly efficient
because of the possibility of circumferential spreading of the
downstream ends of the slit surfaces at the transverse wall portion
formed by the outer peripheral region of the hemispherical closed
end 36 which is intersected by each of the opposed axially
extending slits 38.
The situation of the slits 38 so that they extend all the way
through to the downstream surface of the tube 26, where it is
convexly curved at its hemispherical end portion, is of great
importance. If the slits 38 were to terminate inwardly of the
hemispherical end, where the exterior surface of the tube 26 did
not curve inwardly, then opening of such a slit could be brought
about only by an accompanying reduction in the length of the tube,
so that a considerable force would be required to open each slit
due to the necessity of shortening the length of the tube when the
slit opens. In other words, the closed end of such a tube would
have to be pulled toward the upstream open end thereof when a slit
situated inwardly of the hemispherical end of the tube opened.
However, with the construction of the invention, as shown in FIGS.
2 and 4, the wall thickness of the tube gradually diminishes in the
region of the downstream end of the slit, and the fact that each
slit cuts into the closed hemispherical end of the tube increases
the flexibility of this hemispherical end and permits the
downstream ends of the slit to turn away from each other so that
this construction greatly reduces the opening resistance which
would be present if the slits terminated at their downstream ends
upstream of the closed end of the tube.
A further feature of the invention resides in situating in the
interior of the tubular member 26 a freely movable ball member 44
made of nylon, for example. The rigid steel tube 32 extends from
its flange 34 axially along the interior of the tube 26 in a
downstream direction and terminates in an open downstream end 46
situated at a given distance upstream of the closed end 36 so as to
provide for the ball member 44 a given degree of free axial
movement about equal to the length of the slits before it will
engage either the closed end 36 or the end 46 of the tube 32. Thus,
the ball member 44 can move freely between the closed end 36 and
the end 44 in response to any motion of the individual who has
implanted in him the device of the invention. Therefore, the ball
member 44 constantly moves about and maintains the fluid within the
elastic member 26, constantly in motion. In this way the interior
of the inner elastic tube 26 is kept clean, particularly at the
region of the slits 38, so as to further prevent the possibility of
clogging of these slits, as by the formation of blood clots.
In addition it will be noted that the end 46 of the tube 32 is of a
circular configuration and has an outwardly flaring end surface
which will, in fact, form the equivalent of a valve seat for the
ball member 44. Thus, when this ball member 44 engages the end 46
of the member 32, these elements will coact as a check value to
prevent back-flow of fluid. There is, in effect, an inner reverse
check valve situated within the outer check valve formed by the
tube 26.
It is to be noted that the tubular member 26 is provided with an
exterior diameter equaling the inner diameter of the sleeve 28 only
upstream of the slits 38. This portion of larger diameter is
connected by a shoulder 48 to the downstream elongated portion of
the tube 26 which is of lesser wall thickness so as to be spaced
inwardly from the inner surface of the sleeve 28. This portion of
thinner wall thickness is formed with the slits 38 described above.
The ball 44 is of slightly lesser diameter than the internal
diameter of the tube 26 to prevent sticking.
The downstream check valve 24 is substantially identical with the
upstream check valve 22. This check valve 24, in fact, has an inner
elastic tubular member 50 identical with the tubular member 26.
This member 50 is housed within a rigid metallic sleeve 52 which at
the downstream end of the outer tube 16 has a tubular extension 54
about which the outlet tube 18 is constricted in the manner shown
in FIG. 2. An elongated rigid inner -316 stainless steel tube 56
extends along the interior of the inner elastic tubular member 50
and terminates at its downstream end in the circular end face 58
which coacts with a nylon ball member 60 in the same way that the
end 46 of tube 32 coacts with the ball member 44. The ball member
60 has within the inner tubular elastic member 50 the same degree
of movement that the ball member 44 has within the tubular member
26. The diametrically opposed slits 62 of the tubular member 50 are
indentical with the diametrically opposed slits 38 described above
and operate in the same way. It will be noted that both of the
rigid tubes 32 and 56 have downstream end portions of reduced wall
thickness extending beyond the upstream ends of the slits and
spaced from the inner elastic members adjacent the slits so as to
increase the ease with which the slits can be opened. The rigid
tube 56 terminates at its upstream end in a flange 64 which
functions in the same way as the flange 34 described above.
The operation of the structure described above is believed to be
clear. The cerebrospinal fluid can flow through the inlet 12 to the
left, as viewed in FIG. 2, as indicated by the dot-dash lines and
arrowheads in FIG. 2. Assuming that the pressure of the fluid in
the interior of the inner elastic tubular member 26 of the upstream
check valve 22 is sufficiently in excess of the pressure of the
fluid between the pair of check valves, then the slits 38 will
automatically open and the fluid will flow through the open check
valve into the space within the outer elastic tube 16 between the
pair of check valves. In this way the fluid will reach the
downstream check valve 24 where with the same pressure differential
the latter valve will also automatically open to pass the fluid
into the discharge tube 18.
All of the elastic components may be made of medical grade silicone
rubber while all of the metal components may be made of stainless
steel, and the ball members 44 and 60 may be made of nylon. The
check valves are designed to respond (open) to a pressure
differential of between 23 and 27mm. of water. In the reverse,
back-flow direction, the valves will reliably remain closed since
they are capable of withstanding a pressure in the reverse (back)
direction of up to the region of 200mm. of mercury. In an actual
construction, the inner elastic tubular members 26 and 50 each have
an inner diameter of 0.070 inches while the diameter of each ball
member 44 and 60 is 0.0625 inches. The overall length of the device
10 is about 2 -3/16 inches. The entire device, and the tubes 12, 18
are implanted under the wearer's skin to be removed only in the
event of the cure of the hydrocephalus or for replacement. Medical
grade silicone rubber is made of silicone polymers, silica filler,
and catalysts (organic peroxides).
It thus will be seen that there is provided a device which achieves
the various objects of the invention and which is well adapted to
meet the conditions of practical use.
As various possible embodiments might be made of the above
invention, and as various changes might be made in the embodiment
above set forth, it is to be understood that all matter herein
described or shown in the accompanying drawings is to be
interpreted as illustrative and not in a limiting sense.
* * * * *