A device for drainage of intracranial cavities

 

The invention relates to medicine and can be used in neurosurgery for long-term drainage of intracranial cavities containing liquid (e.g., cysts, chronic hematomas, Wagram, isolated fragments of brain ventricles and other). The device consists of a flexible proximal tube with side holes at one end, a hollow connector with two holes and a flexible distal tube. The distal tube made in the form of a tank, open at both ends. Holes of the connector are made coaxial, but have different diameters. The larger hole is connected to the distal tube. The proximal tube is supplied by an adapter, which is designed with the ability to change the angle of the bend tube. The adapter contains a cuff worn on the proximal tube and the filament threaded through the cuff with the possibility to change the angle of the tube by changing the distance between the cuffs. The tank has a cylindrical shape, a diameter which exceeds the diameter of the proximal tube and provided with notches. The technical result is increased efficiency, a reduction in the morbidity, simplifying the design. 4 C.p. f-crystals, 4 Il.

A device for long-term drainage of intracranial cavities containing liquid, which is made in the form of a catheter connected to the tank. The catheter is introduced into the drained cavity and the reservoir is placed under the soft tissues of the head. The liquid accumulating in the tank, remove with a needle, you have to repeatedly enter the tank, piercing and soft tissue located above it. An example is the ventricular catheter (Ventricular Catheter) connected to a reservoir of Ammaia (Ommaya CSF Reservoirs) [1].

This device has several disadvantages:

- no continuous outflow of liquid from the drained area;

- experience significant fluctuations in intracranial pressure;

- high risk of infectious complications because of the numerous perforations of the tank.

- loss of biologically important substances together with the drained fluid;

- the possibility of drainage by trained professionals only.

The known method [2], in which the device for long-term drainage of intracranial cavities containing liquid, ASTM tank (for example, valve type Rear Flex), placed under the soft tissues of the head; a long distal tube (peritoneal catheter), which separates the liquid from the reservoir into the internal cavity of the body, located outside of the head where the liquid is absorbed (for example, in the abdominal cavity); a valve located in the tank or in the distal tube and designed to maintain a drained cavity defined pressure. When this drainage is carried out by the outflow of fluid drained from the cavity into the cavity where it is absorbed at a pressure higher than the pressure that opens the valve device.

The disadvantages of this method:

- drainage is possible only when the viscosity of the drained fluid is low, otherwise disturbed permeability of the slit-like openings of the valve and draining stops;

- installation of such device is traumatic, because it requires the formation of a long subcutaneous tunnel from the head to the abdominal wall, as well as opening the abdomen for abdominal implantation of the distal end of the catheter into the abdominal cavity;

- the device is complicated in construction and very expensive (up to $ 1,000);

for the interruption, and then vosstanovlenie the risk of complications, dangerous for the child's life;

- given the high profile of the tank and the inability to move under the skin above it is possible trophic disturbances of the skin with subsequent purulent process, which eliminates the possibility of installation of the device specified in infants weighing less than 2 kg

Closest to the proposed device is the device [3] for continuous drainage of intracranial cavities containing liquid (Fig.2), consisting of an elastic proximal tube 1, a rigid connector 2 and a flexible distal tube 3. Moreover, the proximal and distal tubes have the same diameter (2-3 mm), hard connector 2 is made in the form of a curved right angle tube, the diameter of which corresponds to the inner diameter of the proximal and distal tubes. One end of the distal and proximal tube attached at opposite ends of the connector 2, the other end of the proximal tube equipped with multiple side holes 4 and is omitted in the intracranial cavity, and the distal tube second end 5 is closed, and in the immediate vicinity of the executed side of the slit valve 6.

The device is used as follows. At the selected point of the head cut me who thus forming an artificial cavity, able to absorb liquid (subgaleal pocket). In the field of skin incision in the bone is drilled a hole, through which in the intracranial cavity containing fluid is introduced proximal tube 1 with the device, the end region of the bone hole connects with a corner connector 2, to the other end of which joins the distal tube. Its free end is located in the area subgaleal pocket. The connector 2 is fixed by suture to the periosteum in the area of the holes in the bones of the skull.

The device operates as follows. The liquid from vnutricerepnae cavity flows via the button in her proximal tube in the corner connector and the distal tube, where it comes in subgaleal pocket, where it is absorbed by the soft tissues that make up the walls of this pocket. Unidirectional fluid flow is formed by the pressure in the cavity exceeds the pressure opening valve distal tube and the fluid pressure in the cavity subgaleal pocket. As the suction fluid pressure in subgaleal pocket decreases, the valve opens, and another portion of the fluid flows from the intracranial cavity into the pocket.

This device also has several disadvantages:

in, able to precipitate most adverse conditions in this regard are available in the area of the slit valve;

- it is impossible to get on the analysis of liquid directly from the drained cavity is easily accessible, only the contents of subgaleal pocket, however, it often differs significantly from that of the liquid, which is located in the cavity;

- you cannot enter directly into the cavity from which the flowing fluid, of drugs, if such a need arises (for example, drugs accelerate the resorption of bundles of blood in intraventricular hemorrhage in the newborn);

- to restore the patency of the tubes requires an additional operation, which increases the risk of inflammatory changes, dangerous for the child's life;

- removing device is long enough, traumatic and associated with an increased risk of loss of the proximal tube in the cavity of the skull, since the angular adapter and attached tube with a long stay in the body become overgrown scar tissue, to remove them, you select from scars adapter and the joints of the tubes, so the incision should be made in the field of bone holes, which, besides always the ery short path (this path is longer, the less the risk of leakage of the fluid through the post stitches);

- in the temporary absence in a pocket of fluid (for example, reducing the pressure in the cavity) possible adhesion of the walls of the pocket and a significant decrease in its volume, the need to restore its size requires re-operation, increase the risk of inflammatory changes, dangerous for the child's life;

- tube with a slit valve and adapters are made in individual foreign countries, therefore the device for dewatering costs about $ 100;

the deflection device can only be straight (right angle adapter - tube, bent at right angles), without taking into consideration the diversity of optimal angles depending on the size of the baby's head and localization of intracranial cavity; this is especially true for newborns and drainage of subdural hematomas in children of different age groups;

- at low pressure in the intracranial cavity outflow them it stops, which eliminates the possibility of complete emptying of the number of intracranial cavities that require a gradual reduction in pressure to almost zero (for example, in the cavity of chronic intracerebral haematomas).

All per the drainage of intracranial cavities, containing liquid, especially in infants.

The aim of the invention is to increase the efficiency, reduce the morbidity and simplify the design of the device for drainage of intracranial cavities containing liquid.

This objective is achieved in that the device for drainage of intracranial cavities, consisting of an elastic proximal tube with multiple side holes at one end, a hollow connector with two holes and a flexible distal tube, the distal tube made in the form of a tank with notches, open on both ends, the holes of the connector are made coaxial, but have different diameters, with the larger hole is connected to the distal tube and the proximal tube is supplied by an adapter, which is designed with the ability to change the angle of the bend of the tube.

In addition, the adapter may be made in the form of cuffs, worn on the proximal tube with a filament threaded through the cuff, and the tank may be cylindrical with a diameter greater than the diameter of the proximal tube, and having at one end a notch on the entire thickness of the tube wall, reaching its edge.

The inventive device for draining the interior is of a catheter with a modified angle;

Fig.3 - the position of the device on the patient's head.

The device (Fig.1) includes an elastic proximal tube 1 with multiple side holes 4 at one end, a distal tube in the tank 3, the rigid connector 2 and the angular adapter, which consists of the cuffs 5 and skipped through the thread 6. The connector 2 has a coaxial holes of different diameters. To lower his hole attached to the proximal tube 1, and a larger hole is connected to the tank 3. Cuff 5 angular adapter mounted on the proximal tube 1. The angle adapter is made by the thread tension 6 connecting the cuff 5.

The tank 3 may have a cylindrical shape and may be provided with notches 7, made for example in the form of end-to-end end-cuts to the vessel wall with one of its sides. Both ends of the tank are open, the diameter of both end holes corresponds to the inner diameter of the distal tube, called a reservoir.

In Fig.2 shows the possibility of changing the angle of bending of the proximal tube from acute (a) to blunt (B). The change in angle occurs when tightening the threads 6, passed through the cuff 5 (see legend of Fig.1). After reaching the desired angle is arranged, the closer the cuff angle adapter to each other and the more bends of the proximal tube. While its internal diameter at the point of bending varies slightly. To reduce the bending angle you need to untie the thread and loosen its tension, then tie the thread node.

The device is used as follows (Fig.3). At the selected point of the head dissected soft tissue 8, to a considerable extent exfoliate the skin and aponeurosis (galea aponevrotica) 9 from the underlying periosteum and bone 10, thus creating artificially formed cavity 11, is able to absorb liquid (subgaleal pocket). In the field of skin incision in the bone is drilled a hole 3 mm in diameter. Inside of the assembled device is inserted guidewire, which gives rigidity to the device. The proximal tube 1 through the opening in the bone is inserted into the lumen of the intracranial cavity 72, three cuff 5 angular adapter installed so that the bottom of them was in the bone hole, and the other above the cuff (at a distance of 1-2 mm from each other). The guidewire is removed. The device becomes elastic.

The tank 3 is placed in subgaleal pocket, and thread stitched through narcos and is formed by bending the proximal tube 1 to the desired angle (Fig.2). Then the wound is closed.

Through the device, the liquid flows into the pocket 11, which absorbed the surrounding soft tissues of the head and neck. If the absorption rate is insufficient regular puncture pocket and excretion of fluids. The tank is well nemopilema through the skin. Periodically moving it in the pocket cavity, prevention of adhesion of its walls. To receive fluid directly from the intracranial cavity or the necessity of injecting drugs with a needle punctured the tank, and the free edge is temporarily closed by pressure of the finger on the skin on the opposite end of the tank. The presence of notches on the tank allows you to overlap its clearance at the minimum pressure, which is especially important in newborns, in which the bones of the skull are very mobile and any excessive pressure can lead to the displacement of the bones of the skull and brain damage. Thus, temporarily closes the hole which connects the tank with pocket, and the message with the drained cavity remains free. In violation of the patency of the proximal tube she washed similarly with a puncture of the tank.

After treatment device is removed rationae seams. When this incision is very small, the device is removed easily, because in the bone hole is smooth tube, not rigid rectangular connector attached to two tubes, angle adapter at pulling for the tank straightens up, which greatly simplifies the removal of the device.

Advantages of the proposed device are:

- low risk of impaired patency of the tubes in the conditions when the liquid contains various substances that can precipitate or high viscosity fluid (no slit valve and the distal tube of small diameter), and

- the ability of the washing device through the reservoir;

- the possibility of obtaining fluid analysis, directly from the cavity, from which it is given;

- the possibility of introducing directly into the cavity from which the flowing fluid, medication (for example, drugs that accelerate the resorption of bundles of blood in intraventricular hemorrhage in the newborn);

- reducing the risk of inflammatory changes associated with repeated operations aimed at restoring the patency of the device;

- simplification of device removal process, segeneiti replaced with soft simulated adapter);

- reducing the risk of leakage of the fluid through the post stitches, because removing device through an additional incision;

- in the temporary absence in a pocket of fluid (for example, reducing the pressure in the cavity) adhesion of the walls of the pocket is prevented by repeated movements of the tank in the pocket cavity;

- ease of manufacture of the device;

the deflection device can be different and depends on the specific conditions during the operation (this is especially important in infants and drainage of subdural hematomas in children of different age groups);

- at low pressure in the intracranial cavity outflow from it does not stop, which eliminates the possibility of incomplete emptying of the intracranial cavity, for which you need a gradual reduction in pressure to almost zero (for example, in the cavity of chronic intracerebral haematomas).

Thus, the claimed device easier to manufacture (no complicated valves), easier to produce, does not require expensive parts that can significantly reduce the product's cost. The device is also easier to use, provides a more effective and less traumatic drainage than the known device is armacia medical company BIP of shunt systems. - S. 12.

3. Continuing Experirns with Subgaleal Shunting / M. H. Savitz, L. I. Malis - The Mount Sinai Journal of Medicine.- 2000, Vol.67, No. 4. - P. 322-326.

Claims

1. A device for drainage of intracranial cavities, consisting of an elastic proximal tube with side holes at one end, a hollow connector with two holes and a flexible distal tube, wherein the distal tube made in the form of a tank, open at both ends, the holes of the connector are made coaxial, but have different diameters, with the larger hole is connected to the distal tube and the proximal tube is supplied by an adapter, which is designed with the ability to change the angle of the bend of the tube.

2. The device under item 1, characterized in that the adapter contains a cuff worn on the proximal tube and the filament threaded through the cuff with the possibility to change the angle of the tube by changing the distance between the cuffs.

3. The device according to PP.1 and 2, characterized in that the tank has a cylindrical shape, a diameter which exceeds the diameter of the proximal tube.

4. The device under item 1 or 2, characterized in that the tank is provided with notches.

5. The device according to p. 3, characterized in that

 

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