MD128Y - Device and method for drainage of ventricle of brain - Google Patents
Device and method for drainage of ventricle of brain Download PDFInfo
- Publication number
- MD128Y MD128Y MDS20090093A MDS20090093A MD128Y MD 128 Y MD128 Y MD 128Y MD S20090093 A MDS20090093 A MD S20090093A MD S20090093 A MDS20090093 A MD S20090093A MD 128 Y MD128 Y MD 128Y
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- Moldova
- Prior art keywords
- tube
- drainage
- ventricle
- cerebral
- distal end
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- 238000000034 method Methods 0.000 title claims abstract description 13
- 210000004556 brain Anatomy 0.000 title abstract description 4
- 230000002490 cerebral effect Effects 0.000 claims abstract description 8
- 210000001175 cerebrospinal fluid Anatomy 0.000 claims abstract description 8
- 230000002262 irrigation Effects 0.000 claims abstract description 5
- 238000003973 irrigation Methods 0.000 claims abstract description 5
- 239000007788 liquid Substances 0.000 claims abstract description 5
- 230000000844 anti-bacterial effect Effects 0.000 claims abstract description 4
- 210000004289 cerebral ventricle Anatomy 0.000 claims description 9
- 239000002504 physiological saline solution Substances 0.000 claims description 3
- 208000003906 hydrocephalus Diseases 0.000 abstract description 6
- 230000001154 acute effect Effects 0.000 abstract description 4
- 238000007917 intracranial administration Methods 0.000 abstract description 3
- 239000003814 drug Substances 0.000 abstract description 2
- FAPWRFPIFSIZLT-UHFFFAOYSA-M Sodium chloride Chemical compound [Na+].[Cl-] FAPWRFPIFSIZLT-UHFFFAOYSA-M 0.000 abstract 1
- 239000011780 sodium chloride Substances 0.000 abstract 1
- 208000015181 infectious disease Diseases 0.000 description 6
- 230000002861 ventricular Effects 0.000 description 6
- 206010022773 Intracranial pressure increased Diseases 0.000 description 5
- 201000009941 intracranial hypertension Diseases 0.000 description 5
- 238000002591 computed tomography Methods 0.000 description 3
- 239000012530 fluid Substances 0.000 description 3
- 239000000243 solution Substances 0.000 description 3
- 206010009719 CNS ventriculitis Diseases 0.000 description 2
- 201000009906 Meningitis Diseases 0.000 description 2
- 206010030113 Oedema Diseases 0.000 description 2
- 238000004458 analytical method Methods 0.000 description 2
- 230000000926 neurological effect Effects 0.000 description 2
- 230000002265 prevention Effects 0.000 description 2
- 208000000044 Amnesia Diseases 0.000 description 1
- 208000006740 Aseptic Meningitis Diseases 0.000 description 1
- 208000003322 Coinfection Diseases 0.000 description 1
- 102000009123 Fibrin Human genes 0.000 description 1
- 108010073385 Fibrin Proteins 0.000 description 1
- BWGVNKXGVNDBDI-UHFFFAOYSA-N Fibrin monomer Chemical compound CNC(=O)CNC(=O)CN BWGVNKXGVNDBDI-UHFFFAOYSA-N 0.000 description 1
- 206010019233 Headaches Diseases 0.000 description 1
- 208000032843 Hemorrhage Diseases 0.000 description 1
- 208000026139 Memory disease Diseases 0.000 description 1
- 206010027201 Meningitis aseptic Diseases 0.000 description 1
- 206010027202 Meningitis bacterial Diseases 0.000 description 1
- 206010041349 Somnolence Diseases 0.000 description 1
- 208000032851 Subarachnoid Hemorrhage Diseases 0.000 description 1
- 208000007536 Thrombosis Diseases 0.000 description 1
- LKCWBDHBTVXHDL-RMDFUYIESA-N amikacin Chemical compound O([C@@H]1[C@@H](N)C[C@H]([C@@H]([C@H]1O)O[C@@H]1[C@@H]([C@@H](N)[C@H](O)[C@@H](CO)O1)O)NC(=O)[C@@H](O)CCN)[C@H]1O[C@H](CN)[C@@H](O)[C@H](O)[C@H]1O LKCWBDHBTVXHDL-RMDFUYIESA-N 0.000 description 1
- 229960004821 amikacin Drugs 0.000 description 1
- 229940035676 analgesics Drugs 0.000 description 1
- 239000000730 antalgic agent Substances 0.000 description 1
- 230000000845 anti-microbial effect Effects 0.000 description 1
- 230000001580 bacterial effect Effects 0.000 description 1
- 201000009904 bacterial meningitis Diseases 0.000 description 1
- 230000000721 bacterilogical effect Effects 0.000 description 1
- 230000002146 bilateral effect Effects 0.000 description 1
- 238000002512 chemotherapy Methods 0.000 description 1
- 238000003745 diagnosis Methods 0.000 description 1
- 230000010339 dilation Effects 0.000 description 1
- 230000004064 dysfunction Effects 0.000 description 1
- 229950003499 fibrin Drugs 0.000 description 1
- 231100000869 headache Toxicity 0.000 description 1
- 230000002458 infectious effect Effects 0.000 description 1
- 238000012423 maintenance Methods 0.000 description 1
- 230000006984 memory degeneration Effects 0.000 description 1
- 208000023060 memory loss Diseases 0.000 description 1
- QSHDDOUJBYECFT-UHFFFAOYSA-N mercury Chemical compound [Hg] QSHDDOUJBYECFT-UHFFFAOYSA-N 0.000 description 1
- 229910052753 mercury Inorganic materials 0.000 description 1
- 201000011107 obstructive hydrocephalus Diseases 0.000 description 1
- 230000001575 pathological effect Effects 0.000 description 1
- 229920001296 polysiloxane Polymers 0.000 description 1
- 230000002980 postoperative effect Effects 0.000 description 1
- 208000018316 severe headache Diseases 0.000 description 1
- 230000000391 smoking effect Effects 0.000 description 1
- 238000007920 subcutaneous administration Methods 0.000 description 1
Landscapes
- External Artificial Organs (AREA)
Abstract
Description
Invenţia se referă la medicină, în special la neurochirurgie şi poate fi utilizată pentru tratamentul hidrocefaliei acute şi hipertensiunii intracraniene primare sau secundare. The invention relates to medicine, in particular to neurosurgery and can be used for the treatment of acute hydrocephalus and primary or secondary intracranial hypertension.
Este cunoscut un dispozitiv pentru drenarea ventriculelor cerebrale în hidrocefalii acute şi hipertensiuni intracraniene, care reprezintă un tub din silicon cu orificii de drenare conectat la un sistem închis de evacuare şi colectare a lichidului cerebrospinal [1]. A device for draining the cerebral ventricles in acute hydrocephalus and intracranial hypertension is known, which is a silicone tube with drainage holes connected to a closed system for draining and collecting cerebrospinal fluid [1].
Dezavantajele dispozitivului menţionat constau în prezenţa riscului înalt al infectării drenajului, cât şi în disfuncţia şuntului cauzat de obstrucţia cu depuneri de fibrină şi cheaguri de sânge. The disadvantages of the mentioned device consist in the presence of a high risk of infection of the drainage, as well as in shunt dysfunction caused by obstruction with fibrin deposits and blood clots.
Este cunoscută o metodă de tratament a hidrocefaliei pronunţate obstructive şi a hipertensiunii intracraniene prin aplicarea drenajului ventricular extern temporar, care constă în aceea că se efectuează trepanarea cerebrală în regiunea frontală precoronară, se introduce dispozitivul de drenaj pe un mandren în cavitatea ventriculului. După verificarea funcţionării, drenajul este exteriorizat printr-un tunel subcutanat şi conectat la un sistem închis de colectare. Lichidul sub presiune este colectat într-o pungă sterilă printr-un sistem închis cuplat la un dispozitiv de măsurare a tensiunii intracraniene. Dispozitivul de drenare se menţine până la rezolvarea stării patologice [2]. A method of treating severe obstructive hydrocephalus and intracranial hypertension by applying temporary external ventricular drainage is known, which consists in performing cerebral trepanation in the precoronary frontal region, inserting the drainage device on a mandrel into the ventricular cavity. After checking its functioning, the drainage is externalized through a subcutaneous tunnel and connected to a closed collection system. The pressurized fluid is collected in a sterile bag through a closed system coupled to a device for measuring intracranial pressure. The drainage device is maintained until the pathological condition resolves [2].
Această metodă este larg răspândită şi reprezintă standardul de bază în urgenţele neurochirurgicale pentru a evita angajarea crierului şi riscul iminent de deces al pacientului cu hidrocefalie pronunţată şi hipertensiune intracraniană. This method is widespread and represents the basic standard in neurosurgical emergencies to avoid brain involvement and the imminent risk of death of the patient with pronounced hydrocephalus and intracranial hypertension.
Dezavantajul acestei metode constă în riscul dezvoltării unor complicaţii infecţioase, şi anume a ventriculitei, a meningitei secundare etc. Rata infecţiei legate de drenajul ventricular extern este de 10% în prima zi şi creşte exponenţial la 70% în următoarele 3…4 zile. The disadvantage of this method is the risk of developing infectious complications, namely ventriculitis, secondary meningitis, etc. The infection rate related to external ventricular drainage is 10% on the first day and increases exponentially to 70% in the next 3…4 days.
Problema pe care o rezolvă invenţia constă în lărgirea gamei dispozitivelor de drenare şi a metodelor de drenare a ventriculelor care ar preveni complicaţiile precoce şi tardive. The problem that the invention solves consists in expanding the range of drainage devices and methods of draining the ventricles that would prevent early and late complications.
Problema invenţiei se soluţionează prin în aceea ca dispozitivul de drenare a ventriculelor cerebrale conţine un tub elastic cu orificii de drenare şi cu capătul distal orb, pe partea proximală a tubului este îmbrăcat un manşon, iar capătul proximal al tubului este unit la un racord, în interiorul tubului este amplasat un tub elastic cu diametrul de 2…3 ori mai mic, capătul distal al căruia este unit la una din conexiunile racordului. The problem of the invention is solved by the fact that the cerebral ventricle drainage device contains an elastic tube with drainage holes and a blind distal end, a sleeve is worn on the proximal part of the tube, and the proximal end of the tube is connected to a connector, an elastic tube with a diameter 2...3 times smaller is placed inside the tube, the distal end of which is connected to one of the connector connections.
Se revendică totodată şi o metodă de drenare a ventriculelor cerebrale, care constă în aceea că se efectuează trepanarea cerebrală în regiunea frontală precoronară, se introduce dispozitivul menţionat cu capătul orb în cavitatea ventriculului şi se efectuează evacuarea pasivă a lichidului cerebrospinal concomitent cu irigarea continuă prin introducerea în tubul cu diametrul mai mic a serului fiziologic, unui lichid similar lichidului cerebrospinal sau unui preparat antibacterian. A method of draining the cerebral ventricles is also claimed, which consists in performing cerebral trepanation in the precoronary frontal region, inserting the aforementioned device with the blind end into the ventricle cavity and performing passive evacuation of the cerebrospinal fluid simultaneously with continuous irrigation by introducing physiological saline, a liquid similar to cerebrospinal fluid or an antibacterial preparation into the tube with a smaller diameter.
Dispozitivul şi metoda revendicată prezintă o serie de avantaje faţă de soluţiile apropiate: prevenirea infecţiei secundare, prevenirea obstrucţiei drenajului, şi deci necesitatea reviziei sau schimbului drenajului, posibilitatea aplicării acestei metode şi în caz de meningită, menţinerea şuntului pe o perioadă îndelungată. The claimed device and method present a series of advantages over similar solutions: prevention of secondary infection, prevention of drainage obstruction, and therefore the need for revision or replacement of the drainage, possibility of applying this method also in case of meningitis, maintenance of the shunt for a long period.
Rezultatul obţinut constă în lărgirea gamei dispozitivelor de drenare şi a metodelor de drenare a ventriculelor care previn eficient complicaţiile precoce şi tardive. The result obtained consists in expanding the range of drainage devices and ventricular drainage methods that effectively prevent early and late complications.
Invenţia se explică prin figura care reprezintă: aspectul general al dispozitivului de drenare a ventriculelor cerebrale, care constă dintr-un tub elastic 1, cu orificii de drenare 3 şi cu capătul distal orb. Pe partea proximală a tubului 1 este îmbrăcat un manşon 4, iar capătul proximal al tubului este unit la un racord 5, în interiorul tubului este amplasat un tub elastic 2 cu diametrul de 2…3 ori mai mic, capătul distal al căruia este unit la una din conexiunile racordului 5. The invention is explained by the figure which represents: the general appearance of the device for draining the cerebral ventricles, which consists of an elastic tube 1, with drainage holes 3 and a blind distal end. A sleeve 4 is worn on the proximal part of the tube 1, and the proximal end of the tube is connected to a connection 5, inside the tube is placed an elastic tube 2 with a diameter 2…3 times smaller, the distal end of which is connected to one of the connections of the connection 5.
Metoda de drenare a ventriculelor cerebrale constă în aceea că se efectuează trepanarea cerebrală în regiunea frontală precoronară, se introduce dispozitivul conform invenţiei cu capătul orb în cavitatea ventriculului şi se efectuează evacuarea pasivă a lichidului cerebrospinal concomitent cu irigarea continuă prin introducerea în tubul cu diametrul mai mic a serului fiziologic, unui lichid similar lichidului cerebrospinal sau unui preparat antibacterian. The method of draining the cerebral ventricles consists in performing cerebral trepanation in the precoronary frontal region, inserting the device according to the invention with the blind end into the ventricle cavity and performing passive evacuation of the cerebrospinal fluid simultaneously with continuous irrigation by introducing physiological saline, a liquid similar to cerebrospinal fluid or an antibacterial preparation into the tube with a smaller diameter.
Exemplu de realizare a invenţiei. Example of embodiment of the invention.
Pacientul B, 64 de ani, acuza cefalee pronunţată, instalată de 2 zile, cefaleea nu a cedat la administrarea analgezicilor, s-a constatat agravarea stării generale a pacientului şi apariţia somnolenţei. Pacientul intră dificil în contact, prezintă confuzie, pierderi de memorie. Din antecedente s-a constatat tabagism. La internare a fost efectuată tomografia coputerizată (TC) cerebrală, care pune în evidenţă o hemoragie în cisternele subarahnoidiene, dilatarea sistemului ventricular, edem periependimar. Examenul fundului de ochi pune în evidenţă un edem papilar bilateral. Diagnosticul stabilit a fost: Hemoragie subarahnoidiană, Hunt şi Hess 3, Fisher 2, Hidrocefalie acută. Hipertensiune intracraniană. Statutul neurologic Glasgow 12. Patient B, 64 years old, complained of a severe headache, which had been present for 2 days, the headache did not subside with the administration of analgesics, the patient's general condition worsened and drowsiness appeared. The patient has difficulty making contact, presents confusion, memory loss. A history of smoking was noted. Upon admission, a cerebral computed tomography (CT) scan was performed, which revealed a hemorrhage in the subarachnoid cisterns, dilation of the ventricular system, and periependymal edema. The fundus examination revealed bilateral papillary edema. The established diagnosis was: Subarachnoid hemorrhage, Hunt and Hess 3, Fisher 2, Acute hydrocephalus. Intracranial hypertension. Glasgow neurological status 12.
Evoluţia în dinamică a pacientului cu agravare a stării neurologice cu 3 puncte după scara Glasgow. A fost luată decizia de a efectua drenarea ventriculelor cerebrale în regim de urgenţă, conform metodei propuse şi cu dispozitivul revendicat. Pentru irigarea continuă a fost utilizată soluţia Ringher şi o soluţie de Amicacină. Nivelul de reglaj al presiunii intracraniene a fost stabilit la 18 mm ai coloanei de mercur. În total au fost evacuate pe parcursul a 7 zile 2000 mL de lichid. Înlăturarea drenajului a fost realizată după ce s-a făcut TC cerebrală de control, cât şi închiderea drenajului pentru mai mult de 24 de ore. Pe toată durata funcţionării dispozitivului de drenare au fost realizate analize repetate ale lichidului cerebral evacuat pentru a monitoriza debutul unei eventuale infecţii. Analizele bacteriologice efectuate după utilizarea dispozitivului au fost negative. Realizarea invenţiei s-a efectuat la Catedra de Neurochirurgie a Universităţii „N. Testemiţanu” şi Laboratorul de Neurochirurgie a INN. The dynamic evolution of the patient with worsening neurological condition by 3 points according to the Glasgow scale. The decision was made to perform emergency drainage of the cerebral ventricles, according to the proposed method and with the claimed device. Ringher solution and an Amikacin solution were used for continuous irrigation. The intracranial pressure adjustment level was set at 18 mm of mercury. In total, 2000 mL of fluid were evacuated over 7 days. The drainage was removed after a control cerebral CT scan was performed, as well as the drainage was closed for more than 24 hours. Throughout the operation of the drainage device, repeated analyses of the evacuated cerebral fluid were performed to monitor the onset of a possible infection. Bacteriological analyses performed after using the device were negative. The invention was implemented at the Department of Neurosurgery of the University "N. Testemiţanu” and the Neurosurgery Laboratory of INN.
1. Bronne V., Aschoff A., Hund E., Hampl J., Kunze S. Comercial external ventricular drainage sets: unsolved safety and handling problems. Acta Neurochir (Wien) 1991, 110, p. 49-56. 1. Bronne V., Aschoff A., Hund E., Hampl J., Kunze S. Commercial external ventricular drainage sets: unsolved safety and handling problems. Acta Neurochir (Wien) 1991, 110, p. 49-56.
2. Infection in Neurosurgery Working Party of the Britisch Society for Antimicrobial Chemotherapy: The management of neurosurgical patients with postoperative bacterial or aseptic meningitis or external ventricular drain-associated ventriculitis. Br. J. Neurosurg, 2000, 14, p.7-12. 2. Infection in Neurosurgery Working Party of the British Society for Antimicrobial Chemotherapy: The management of neurosurgical patients with postoperative bacterial or aseptic meningitis or external ventricular drain-associated ventriculitis. Bro. J. Neurosurg, 2000, 14, p.7-12.
Claims (2)
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| MDS20090093A MD128Z (en) | 2009-05-21 | 2009-05-21 | Device and method for drainage of ventricle of brain |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| MDS20090093A MD128Z (en) | 2009-05-21 | 2009-05-21 | Device and method for drainage of ventricle of brain |
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| Publication Number | Publication Date |
|---|---|
| MD128Y true MD128Y (en) | 2010-01-29 |
| MD128Z MD128Z (en) | 2010-08-31 |
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|---|---|---|---|
| MDS20090093A MD128Z (en) | 2009-05-21 | 2009-05-21 | Device and method for drainage of ventricle of brain |
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| Country | Link |
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| MD (1) | MD128Z (en) |
Families Citing this family (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| MD795Z (en) * | 2014-01-16 | 2015-02-28 | Валерий ТИМИРГАЗ | Controlled catheter |
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| Publication number | Publication date |
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| MD128Z (en) | 2010-08-31 |
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