U.S. patent number 3,595,240 [Application Number 04/756,713] was granted by the patent office on 1971-07-27 for hydrocephalus shunt with two-way flushing means.
Invention is credited to Alan J. Mishler.
United States Patent |
3,595,240 |
Mishler |
July 27, 1971 |
HYDROCEPHALUS SHUNT WITH TWO-WAY FLUSHING MEANS
Abstract
Drainage devices for use such as ventriculo-atrial shunts are
provided which are particularly useful in neurosurgery to divert
fluid from the cerebral ventricular system when abnormal
collections of cerebrospinal fluid occur secondary to obstruction
or failure of reabsorption. The surgical appliances of this
invention have a first chamber and an at least partially
surrounding second chamber with inlet means to the first and second
chamber and outlet means from the second chamber. A valve means
allows entrance of fluid to the first chamber from the inlet means
but prevents backflow of fluid to the inlet means from the first
chamber while allowing backflow of fluid from the second chamber to
the inlet means.
Inventors: |
Mishler; Alan J. (Pueblo,
CO) |
Family
ID: |
25044728 |
Appl.
No.: |
04/756,713 |
Filed: |
August 7, 1968 |
Related U.S. Patent Documents
|
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
Issue Date |
|
|
549517 |
May 12, 1966 |
|
|
|
|
Current U.S.
Class: |
604/9 |
Current CPC
Class: |
A61M
27/006 (20130101); A61M 39/0208 (20130101) |
Current International
Class: |
A61M
27/00 (20060101); A61M 39/02 (20060101); A61m
027/00 () |
Field of
Search: |
;128/350,232,35V |
References Cited
[Referenced By]
U.S. Patent Documents
Other References
HAKIM Valve System for Ventriculo-Atriostomy, Cordis pamphlet, Oct.
5, 1965, pp. 3, 6--8. .
Rickham -Brit. Med. Jour. - July 18, 1964, pg. 173,
128--350.
|
Primary Examiner: Truluck; Dalton L.
Parent Case Text
RELATED APPLICATION
This application is a continuation-in-part of copending application
Ser. No. 549,517 filed May 12, 1966 and now abandoned.
Claims
What I claim is:
1. A drainage device for use as a ventriculo-atrial shunt
comprising, means defining a first chamber having an outlet
passageway and an inlet passageway,
means defining a second chamber surrounding said first chamber,
an inlet means defining a first opening for passing fluids to said
first chamber,
said inlet means defining a second opening to said second
chamber,
and valve means for permitting passage of fluids to said first
chamber from said inlet means and preventing backflow of fluids to
said inlet means without closing said second opening.
2. A drainage device for use as a ventriculo-atrial shunt in
accordance with claim 1 wherein said inlet means comprises a tube
interconnected with said first chamber at one end and with said
second chamber at a point axially spaced from said one end and
defining orifices for passage of fluids to said second chamber and
first chamber.
3. A drainage device for use as a ventriculo-atrial shunt in
accordance with claim 1 wherein said means defining said first
chamber and said means defining said second chamber are composed of
a flexible, self-sealing rubbery material and said valve means is a
one-way flap valve positioned within said first chamber and
operative to close said inlet passageway.
4. A drainage device for use as a ventriculo-atrial shunt in
accordance with claim 1 wherein said inlet means comprises a tube
defining orifices positioned within said second chamber.
5. A drainage device in accordance with claim 1 and further
comprising means for preventing collapse of said first and second
chambers.
6. A drainage device for use in a living body comprising
means defining a first chamber and formed of a flexible, rubbery
material,
means defining a second chamber and formed of a flexible, rubbery
material,
said second chamber being positioned overlying and in contact with
said means defining said first chamber,
inlet means for passing fluid to said first and second
chambers,
outlet means for passing fluid out of said first chamber,
and valve means in fluid communication with said inlet means for
allowing entrance of fluid to said first chamber from said inlet
means but preventing backflow of fluid to said inlet means from
said first chamber while allowing backflow of fluid from said
second chamber to said inlet means.
7. A drainage device for use as a ventriculo-atrial shunt
comprising,
first flexible means defining a first chamber having an outlet
passageway and an inlet passageway,
said first flexible means comprising a wall,
second flexible means defining a second chamber overlying said
first chamber with said second chamber defined in part by said
wall,
an inlet means defining a first opening for passing fluids to said
first chamber,
said inlet means defining a second opening to said second
chamber,
and valve means in fluid communication with said first opening
permitting passage of fluids to said first chamber from said inlet
means and preventing backflow of fluids to said inlet means from
said first chamber without closing said second opening to said
second chamber.
8. A drainage device for use as a ventriculo-atrial shunt in
accordance with claim 6 and further comprising said valve means
being a one-way flap valve lying within said first chamber and
operative to close said inlet passageway.
9. A drainage device for use as a ventriculo-atrial shunt in
accordance with claim 7 wherein said second flexible means defines
said second chamber lying partially surrounding said first chamber,
and said first and second flexible means are formed of self-sealing
rubber.
10. A drainage device for use as a ventriculo-atrial shunt in
accordance with claim 9 wherein said second flexible means defines
said second chamber completely surrounding said first chamber.
11. A drainage device for use as a ventriculo-atrial shunt
comprising, means defining a first chamber having an outlet
passageway and an inlet passageway,
means defining a second chamber with said second chamber
surrounding at least one surface of said first chamber,
an outlet means from said first chamber for removing fluid from
said first chamber through said outlet passageway,
an inlet means for passing fluids to both said first and second
chamber,
and valve means in fluid communication with said inlet means for
permitting passage of fluids to said first chamber from said inlet
means through said second chamber but preventing backflow of fluids
from said first chamber to said second chamber while simultaneously
not obstructing backflow of fluids from said second chamber to said
inlet means.
12. A drainage device in accordance with claim 11 wherein said
second chamber completely surrounds said first chamber.
13. A drainage device in accordance with claim 11 wherein said
means defining said first chamber and said means defining said
second chamber include a common wall.
14. A drainage device in accordance with claim 11 wherein means
defining said first chamber and said means defining said second
chamber are formed of flexible self-sealing material.
15. A drainage device in accordance with claim 14 wherein said
means defining said first chamber and said means defining said
second chamber include a common wall,
said outlet means comprising a tube passing through said second
chamber.
16. A method of relieving fluid pressure in a ventricle by the use
of a drainage device having an inlet means, a second chamber about
overlying a first chamber, a valve means in said first chamber and
an outlet means from said first chamber leading to a distant area,
said method comprising,
positioning said drainage device with said inlet means in said
ventricle,
passing said fluid through said inlet means to said second chamber
and collecting foreign materials in said second chamber if present
in said fluid,
passing said fluid to said first chamber and through said outlet
means,
and subsequently applying pressure to said second chamber and
simultaneously to said first chamber through said second chamber to
flush said second chamber through said inlet means and to activate
said valve means to prevent backflow of fluid from said first
chamber to said inlet means.
17. A drainage device in accordance with claim 1 wherein said means
defining said first chamber and said means defining said second
chamber are each formed of a flexible, self-sealing rubbery
material.
Description
BACKGROUND OF THE INVENTION
Ventriculo-atrial shunts have been used in neurosurgery in the
past. Such shunts are particularly useful in the treatment of
hydrocephalus which most frequently occurs in young children. In
this condition, fluids secreted by the brain collect in the lateral
ventricle of the brain and exert considerable pressure which can
cause distortion of the ventricle and in some cases, distortion of
the skull along with attendant unwanted effects on an individual.
Common neurosurgical procedure now alleviates hydrocephalous
conditions by surgical implantation of a shunt which carries excess
fluids from the ventricle of the brain to the venous system where
the foreign fluids are eventually absorbed and/or eliminated as
through the kidneys.
Conventional drainage or shunt devices for use in alleviating
hydrocephalus include those disclosed in U.S. Pat. No. 3,020,913
and U.S. Pat. No. 3,111,125. These devices are often implanted in a
burr in the skull by a surgical operation. Devices of the type
disclosed by the patents are extremely useful but have certain
limitations. After implantation and use over extended time periods,
such devices tend to become clogged in certain individuals. Such
clogging tends to occur at the catheter or passageway from the
ventricle of the brain leading into inner chambers of the devices
due to foreign materials which collect in the narrow tubular
passageways and at their openings to the drains. Consequently, it
is often necessary to perform second or subsequent operations on an
individual to remove devices which have become clogged. The
inconvenience, cost and physical and psychological problems
involved in performing such additional operations are
considerable.
SUMMARY OF THE INVENTION
An important object of this invention is to provide a drainage
device for use as a medical shunt which is highly effective in
alleviating hydrocephalus and other conditions.
Another object of this invention is to provide a drainage device in
accordance with the preceding object which permits flushing and
cleaning of all portions thereof without the necessity of removing
the shunt from the body once implanted.
Still another object of this invention is to provide a drainage
device in accordance with the preceding objects which permits
injection or aspiration of materials for cleaning, treating or
diagnostic purposes.
According to the invention a drainage device comprises a
ventriculo-atrial shunt having a means defining a first chamber
with an outlet passageway and an inlet passageway. A second chamber
is provided with an inlet means defining a first opening for
passing fluids to the first chamber and a second opening for
passage of fluids to the second chamber. Valve means are provided
for permitting passage of fluids to the first chamber from the
inlet means and preventing backflow of fluids to the inlet means
without closing the second opening. Preferably the valve means is a
one-way flap valve lying within the first chamber and operative to
close the inlet passageway and the second chamber completely
surrounds the first chamber.
In an alternate embodiment of this invention, the second chamber
surrounds only a portion of the first chamber.
It is a feature of this invention that the drainage device is
useful in introducing drugs into the brain for tumor chemotherapy,
fighting infection or other purposes. Thus, the second chamber can
be used both to alleviate clogging problems by aspiration and to
introduce materials in a backflow through the inlet means.
BRIEF DESCRIPTION OF THE DRAWINGS
These and other objects, features and advantages of the present
invention will be better understood from the following detailed
description of a preferred embodiment thereof when read in
connection with the accompanying drawings in which:
FIG. 1 is a pictorial illustration of a preferred embodiment of
this invention implanted in a young child;
FIG. 2 is an enlarged perspective view thereof;
FIG. 3 is a cross-sectional view through a central vertical plane
thereof;
FIG. 4 is a cross-sectional view taken through line 4-4 of FIG.
3;
FIG. 5 is a top plan view of an alternate embodiment thereof;
and
FIG. 6 is a cross-sectional view through line 6-6 of FIG. 5.
BRIEF DESCRIPTION OF PREFERRED EMBODIMENTS
With reference now to the drawings and more particularly FIG. 1, a
drainage device or ventriculo-atrial shunt 10 is shown with an
inlet tube 11 acting as a catheter positioned in the lateral
ventricle of the brain in accordance with known practice. The
outlet passageway formed by the tube 12 is interconnected with the
venous system of the body and preferably the jugular vein of an
individual in accordance with known practice. Thus, cerebrospinal
fluid can be drained from the ventricle of the brain as pressure
builds up and passed through the shunt 10 to the blood system as is
known in the treatment of hydrocephalus.
The drainage device 10 has an inner chamber 13 formed by a
preferably flexible rubbery material such as silicone rubber or
natural gum. Silastic, a trademark product of the Dow-Corning
Company is preferred for use in all of the members of the device
10. The chamber wall 14 is preferably rounded and has the form of a
flattened sphere although other shapes may be used if desired.
Chamber 13 is opened by its interconnection with the outlet
catheter 12 and the inlet catheter 11 as best shown in FIG. 3.
Preferably a portion of the wall 14 is thickened at 15 to prevent
unwanted puncture of the wall 14 during aspiration or injection as
will be later described.
A flap valve 16 is provided opening inwardly into the chamber 13
and providing for one-way passage of fluids from the ventricle into
the chamber while preventing passage of fluids out of the chamber
towards the ventricle. The flap valve 16 may be a simple thin
rubber flap adhesively or otherwise secured to the inner surface of
wall 14 as suggested in FIG. 3. The one-way flap valve is preferred
for use although other known one-way valves can be used if
desired.
Completely surrounding the chamber 13 is a second chamber 17 formed
by a wall 18 preferably of the same material as the wall 14 and
dimensioned slightly larger than the dimensions of wall 14 to
provide an adequate space between the two walls. The chamber 17
acts as a collection chamber in use and tends to accumulate any
solid particles carried by the fluid into the device 10.
The inlet catheter 11 is joined directly to the wall 18 of the
second chamber and has an upper end 19 connected to the wall 14 of
the chamber 13. Preferably at least two orifices 20 are provided
about the circumference of portion 19. The portion 19 and plural
orifice end portion 24 of the catheter 11 are normally the
locations where clogging and accumulation of foreign particles
occur in normal use of the shunt 10. However, since the orifices 20
are provided, many of the particles that would normally tend to
clog the catheter 11 are passed into the chamber 17 in use or
flushed back into the ventricle of the brain.
In use of the double chambered ventriculo-atrial shunt 10,
cerebrospinal fluids pass through the catheter 11 and a portion of
the fluids is passed to the chamber 17 as indicated by the
directions arrows 21. As soon as the chamber 17 is filled,
additional fluids which tend to build up slight pressures pass
through the flap valve 16 into the chamber 13 and from there onto
the venous system through the outlet catheter 12. If the pressure
differential between the fluid in the ventricle and that in the
venous system to which the device 10 is attached should equalize or
the venous system pressure should exceed that of the ventricle
fluid pressure, flap valve 16 closes preventing backflow as does a
conventional slit valve (not shown) at the distal end of catheter
12. On the other hand, in normal operation, flow through is easily
accomplished due to the normally small pressure differential
forcing fluids towards the venous system. If a reversal of normal
pressure is encountered, the wall 14 of chamber 13 can be used as a
pump. Since the device is normally positioned in a burr in the
skull underlying the skin, finger pressure can be exerted at the
thickened portion 15 to aid in desired flow through the shunt.
Moreover, a finger pressure can be exerted at preselected intervals
to flush the outlet tube by causing a rapid surge of relatively
high-pressure fluid.
The shunt 10 can be periodically cleaned without removal from the
body by inserting a hypodermic syringe into the chamber 17 through
the skin of the individual in which it is implanted and through
self-sealing wall 18 and aspirating the chamber thereby cleaning
the chamber and removing any particles that might tend to have
accumulated particularly at the portion 19. It is an important
feature of this invention that aspiration of the chamber can be
accomplished while the flap 16 is closed. In certain cases it is
preferred to slightly depress the wall 14 during aspiration to
assure closing of the valve. In addition, since a hypodermic needle
can readily penetrate the wall of chamber 17, various medicaments
can be introduced into this chamber with sufficient back pressure
to directly irrigate and carry the medicaments to the ventricle for
treatment of infections, cancer or various other disorders.
Preferably injection or aspiration is accomplished by having the
hypodermic needle penetrate the area directly above the portion 15
with the thickened portion 15 aiding in assuring that the point of
the needle enters only chamber 17 and does not pass through to the
chamber 13. It is also possible to introduce a hypodermic needle
into chamber 13 if desired to add treating medicaments or suitable
additives to aid in flushing and cleaning the catheter 12.
Preferably the walls 18 and 14 are flexible, resilient rubbery
materials as previously described. Such materials are selected to
be self-sealing after puncture by conventional hypodermic needles.
The size and dimensions of the walls and passageways may vary
considerably depending upon the age of the individual into which
the shunt 10 is to be surgically implanted, as well as its specific
usage. Preferably molded bosses 22 and 23 are provided on walls 14
and 18 to prevent collapse of chambers 17 and 13 respectively.
In a specific example, silicone rubber materials were used in all
portions of the shunt. The overall dimensions of the shunt 10 were
such that it fits into a burr hole of approximately 15 to 20
millimeters diameter. Flap 16 had a thickness of approximately
0.005 inch, catheters 11 and 12 had 1/16-inch diameters and
1/64-inch wall thicknesses, orifices 20 had diameters of about one
sixteenth inch. Thickened wall portion 15 was approximately twice
as thick as the remainder of wall 14 which had an overall thickness
of about 0.03 inch as did wall 18. The axial length of portion 19
is approximately one twelfth inch.
Turning now to an alternate embodiment of the invention, a
ventriculo-atrial shunt 30 is shown in FIG. 5 which is generally
similar to the device 10 described above. However, in the device
30, the second chamber only partially surrounds the first
chamber.
As best seen in FIG. 6, the drainage device 30 defines an inner
chamber 33 having a flat bottom 35 and a hemispherical wall 34
covered by a second chamber 37 defined by a hemispherical wall 36.
The first chamber has an outlet passageway 32 formed by a flexible
tube sealed from the second chamber 37 and generally identical to
the outlet passageway 12 of FIG. 3. The inlet passageway 44 is
formed by a flexible inlet tube 11' having a first opening 38 and
at least one second opening 39 between the tube passageway and the
second chamber 37. Preferably a plurality of orifices 39 are
provided opening to the second chamber 37 as previously described
with reference to orifices 20.
The inlet passageway to the first chamber 33 has a valve means 40
as shown in FIG. 6 and can comprise a sievelike plate 41 having a
plurality of openings 42 to the inner chamber 33. A flap 42a for
the valve permitting movement of fluid only in the direction of
arrows 43 is provided. Other types of valves can be substituted for
the flap valve. For example, a stainless steel valve seat can be
molded onto the device and a lightweight ball as of a nonmetallic
plastic such as Teflon can be utilized in place of the flap.
The device 30 is generally identical to the device 10 in that
thickened portions 15 can be provided in the wall 34 and spacers 22
can be provided where desired with walls of the device being made
of a rubbery material as previously described to permit flexing of
the walls when desired.
While a specific example of this invention has been described in
detail, it should be understood that many variations thereof are
possible. In all cases, it is important to have the double chambers
which act as a pump to provide a separate chamber or passageway
that bypasses the valve. The specific dimensions of the components
can vary greatly and the specific positioning and attachment of
catheters 11 and 12 can be varied to suit specific applications as
is known in the art. In some cases, portions of walls 14 and 18 can
be relatively rigid although flexible materials are preferred. The
ventriculo-atrial shunt of this invention is useful in a variety of
shunting applications in the medical field.
In view of the many variations possible, this invention is to be
limited only by the spirit and scope of the appended claims.
* * * * *