DE2503990A1 - DISTRIBUTION SYSTEM FOR DRAINING CEREBROSPINAL LIQUID - Google Patents

Description

Patent attorneys Dipl.-Ing. R. B E ETZ sen. Dipl.-Ing. K. LAMPRECHT Dr.-lng. R. B E E T Z Jr.

8 Munich 22, steinsdorfstrasse 10 Tel. (089) 2272 O1 / 227244/295910

Telegr. Allpatent Munich Part (SX 5 22O48

65-23.737P (23.738H)

January 31, 1975

Cordis Corporation, Miami, Florida (V. St. A.)

Distribution system for draining cerebrospinal fluid

The invention relates to a cerebrospinal fluid distribution system from its area of origin to a predetermined body part, in which the area of liquid formation is via conduit tubes is connected to a check valve from which the liquid flows through further pipes into the receiving body part.

When treating hydrocephalus, it is common to use the excess Cerebrospinal fluid (CSF) from one part of the body to another

65- (438 217) -Sd-r (8)

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to direct. For example, a catheter can be inserted into a cerebral ventricle and connected to a cardiac catheter via a pressure-actuated check valve so that the fluid (CSF) enters the bloodstream got. On the other hand, a catheter can also be inserted into the body immediately next to the spine and via a check valve be connected to a catheter inserted into the abdominal cavity or a peritoneal space. This treatment is in the commonly referred to as a lumbar-peritoneal shunt or lead. It can only be used on patients suffering from hydrocephalus commutus in which an excess of CSF is not enclosed in the skull, but is present in the area of the spine.

The training and function of such drainage systems for treatment of hydrocephalus are described in detail in the following articles from medical journals:

"The Special Clinical Problem of Symptomatic Hydrocephalus with Normal Cerebrospinal Fluid Pressure - Observations on Cerebrospinal Fluid Hydrodynamics ", S. Hakim and R.D. Adams, Journal of the Neurological Sciences (1965) Vol. 2, pp. 307-327.

"Biomechanics of Hydrocephalus", S. Hakim, Acta Neurol. Latinoamer. (1971) Suppl. 1, pp. 169-194

"Initial Experience with the Hakim Valve for Ventriculovenous Shunt," Robert G. Ojemann, M, D, Journal of Neurosurgery (1968) Vol. XXVIII, No. 3, pp. 283-287.

"Hydraulic and Mechanical Mis-matching of Valve Shunts Used in the Treatment of Hydrocephalus: the Need for a Servo-valve Shunt ", Salomon Hakim, Developmental Medicine and Child Neurology, Vol. 15 (1973), pp. 646-653.

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"A Critical Analysis of Valve Shunts Used in the Treatment of Hydrocephalus", S. Hakim, F. Duran de la Roche, and J. D Burton, Developmental Medicine and Child Neurology, VoI 15, No- 2 (April 1973), pp. 230-255

Known shunt systems - are also described in U.S. Patents 3,288,142 and 3,527,226. The previously developed However, shunt systems do not sufficiently solve the problem of a pressure drop that occurs when the patient moves out of a horizontal position moved to an approximately vertical position. The check valve or check valve usually contains a spring, which the valve shuts off until the ZSF pressure has risen to a pressure corresponding to the preset valve value. If the patient is connected to a lumbar-peritoneal shunt system, the hydrostatic acting on the shut-off valve increases Height abrupt when the patient changes from a horizontal to a vertical position. This increase in pressure causes an opening of the valve, leading to excessive drainage of liquid. A similar change in the amount of fluid is due to the 'length of the Drainage tube in a ventricular atrial or a venticular peritoneal shunt system is traced back when the patient is out from a horizontal to a vertical position. The object of the invention is to prevent excessive drainage of cerebrospinal fluid to prevent when the patient stands up or lies down.

To solve this problem, a second valve connected in series with the first valve is provided according to the invention the action of gravity is moved into the closed position and can be actuated with a higher pressure when the patient is standing upright.

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This makes the ZSF pressure to create a drain automatically increased by a value that is very close to the increase made by the hydrostatic pressure or creates a negative pressure, when the patient stands up from a lying position.

In the shunt system according to the invention for the treatment of hydrocephalus is thus the cerebrospinal fluid from the Bildungsbzw. Accumulation space to a specific part of the body through pipelines initiated, in which a non-return valve and with these in series a second valve that responds to gravity is switched on are, this second valve remains closed or is held in its closed position until a higher pressure is reached when the patient is in an upright position. In a lying or largely horizontal position, this second Open valve freely. As a result, a pressure drop and thus a suction of the liquid is compensated, which was previously when standing up or Erect a patient occurs.

These and other inventive features and measures are described below with reference to an exemplary embodiment shown in the drawing described in more detail. Show it:

Fig. L a longitudinal section through an arrangement according to the invention the valves in a lumbar-peritoneal shunt system,

Fig. 2 is a schematic cross section along section line 2-2 in Fig. 1,

3 is a plan view of a colored sealing washer,

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Fig. 4 is a plan view of the valve housing and the two valves with the cap loosened in the direction of the line 4-4 in FIG. 1.

The shunt system shown in the drawing consists essentially from a cast valve housing'12 made from a tissue-compatible resistant plastic, e.g. B. a certain rubber, and has the shape of an elongated rhombus with a Chamber 16 at one end. An inlet 14 forms the receptacle of a hollow, tissue-compatible plastic tube 10, which is connected to an im Spinal area or any other part of the body from which the Cerebrospinal fluid is supposed to drain, connected to inserted catheter is. The inlet chamber 16 goes into a cylindrical cavity 18 about, in which a check valve or check valve 20 is seated. This valve 20 comprises a hollow cylindrical housing 22, preferably made of stainless steel, which is clamped in the cylinder bore 18 and in which a sapphire ball 26 interacts as a valve member with a valve seat 24. The sapphire ball 26 is supported by a compression spring 28 pressed against the valve seat 24, which is located on a hollow threaded zap ^ fen 32 is supported, which engages in a threaded bore 30 in the valve housing 22 and at its outer end a socket 34 for insertion owns a key. To adjust the acting on the ball 26 The plug 32 can be adjusted axially in the housing 22 by spring force. This arrangement allows the presetting of the pressure at which opens the valve and enables the attending physician to change the preset pressure with the help of a hypodermic Needle after implantation.

The valve housing 22 extends over the end of the housing

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12, with a sealing washer 38 protruding on part of this Housing 22 is attached. The sealing washer 38 can be colored with a specific index color or other markings wear, which indicate the pressure at which one or both valves in the housing 12 open. A resilient plastic cap 36 is attached to the sealing washer 38 to complete the valve housing, the housing 12, the sealing washer 38 and the Plastic cap 36 can be held together by a common adhesive.

In the cap 36, a chamber 40 connected to the through-flow bore in the plug and a second valve 41 are provided which is received in a tube holder 43 arranged on the valve housing 12 and aligned parallel to the cylinder space 18. The cylinder space 18 and the interior of the holder 43 are separated from one another by an inner wall 42. The second valve 41 has a flush Housing fixed in the receptacle 43, in which a hollow plug 46 with a frustoconical opening 48 to form a valve seat for a sapphire ball 50 is arranged. In the housing there are also several balls 52 of something which serve as weights larger diameter than the ball 50. To hold this ball 52, the outer end of the housing 44 is bent inward.

With this arrangement, in the horizontal position of the valve according to FIG. 1, the balls 52 can roll away freely from the valve 48, as through release valve crank 50 and open the valve to allow ZSF to flow through. However, if the valve is almost vertical, then press Balls 52 push the ball 50 to the valve seat 48 by their own weight.

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In this vertical position, a higher fluid pressure is required, to let the ZSF through the valve system. Different numbers of weight balls can be used in the valve device 52 can be provided so that the operating pressure to open the valve can be adjusted depending on the specific circumstances of the treatment can be. The color of the sealing washer 38 provides a simple means of indicating the set pressure of a given system represents, the setting of the plug 32 allows a sensitive change in the operating pressure.

The housing 12 also has an outlet chamber 56 which is connected to a connecting tube 60 "which is to a suitable Can lead to drainage space in the patient.

The valve system according to the invention can expediently be lumbar-periteal Tributary flow (shunt) can be used, in which ZSF is to be conveyed from the spinal column area into a peritoneal space. However, the same system can also be called the venticular shunt system can be used, with the valve group implanted under the scalp and connected to catheters inserted into a ventricle (Brain chamber) and lead into a suitable drainage space. The housing 12 and the cap 36 are provided with openings 62 so that the valve group can be housed and fixed in a position in the body by means of sutures, which is horizontal when the patient is lying down Alignment of the valve group and a substantially vertical alignment guaranteed when the patient is standing.

From the above description it can be seen that the valve

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always responds depending on the preset operating pressure and that the valve 41 is actuated by a higher pressure when the patient is standing and is open with the patient lying down. In this version of the lumbar-peritoneal shunt system results in an abrupt increase in pressure on the valves when the patient stands up is brought about by the additional hydrostatic pressure that takes effect. Is the shunt system under the scalp implanted, then the patient's standing up from a horizontal to a vertical position leads to an abrupt drop in pressure at the outer side of the valves, but in any case the balls compensate for such changes.

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Claims (7)

Claims 1.1 Shunt or drainage system for cerebrospinal fluid from its area of origin to a predetermined body part, in which the area of liquid formation is connected via conduit tubes with a non-return valve, from which the liquid flows through further pipes into the receiving body part, characterized in that with the first Valve (20), a second valve (41) is connected in series, which opens at a higher pressure in the vertical valve position and is unloaded and open in the horizontal valve position. . 2. Shunt system according to claim 1, characterized in that the first check valve (20) and the second downstream of this Valve (41) are arranged in a valve housing (12) that the second valve (41) a valve seat (48), a valve ball (50) assigned to this valve seat and at least one further ball (51) has whose dead weight in the vertical valve position the valve ball (50) is loaded in the closing direction and releases it in the horizontal valve position, wherein the valve housing is inserted into the body that when the patient is lying only the first valve (20) to an increase in Fluid pressure responds and that when the patient is erect, both valves are effective under a greater fluid pressure. 3. Shunt system according to claim 1, characterized in that the closing member (50) of the second valve (41) only the force of gravity is subjected to a weight (52). 5Ö9833 / Ö62Ö 4. Shunt system according to claim 3, characterized in that the valve ball (50) acting on the weight at least one in a housing receptacle (44) is freely movable ball (50). 5. Shunt system according to claim 4, characterized in that a sealing washer (38) is provided in the housing (12), which with an index color is provided to indicate the respective closing pressure of the second valve (41). 6. Shunt system according to one of the preceding claims, characterized in that the housing (12) has a hollow cap (36)
comprises an elastic plastic and that the two valves (20 and 41) are detachably arranged in separate bores (18, 43) of the housing (12) with the cap (36) removed. 7. Shunt system according to claim 6, characterized in that the valve seat (48), the valve ball (50) and the weight ball (52) are arranged in a tubular receptacle (44) and can be mounted as a whole. 509833/0620