WO2000061017A1 - Appareil ameliore pour le guidage d'un catheter et le guidage d'un foret, et procede permettant son insertion perpendiculaire dans un orifice cranien - Google Patents

Appareil ameliore pour le guidage d'un catheter et le guidage d'un foret, et procede permettant son insertion perpendiculaire dans un orifice cranien Download PDF

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Publication number
WO2000061017A1
WO2000061017A1 PCT/US1999/009747 US9909747W WO0061017A1 WO 2000061017 A1 WO2000061017 A1 WO 2000061017A1 US 9909747 W US9909747 W US 9909747W WO 0061017 A1 WO0061017 A1 WO 0061017A1
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WO
WIPO (PCT)
Prior art keywords
catheter
guide
drill guide
drill
platform
Prior art date
Application number
PCT/US1999/009747
Other languages
English (en)
Inventor
Fathali Ghahremani
Jamshid Ghajar
Original Assignee
Neurodynamics, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Neurodynamics, Inc. filed Critical Neurodynamics, Inc.
Priority to AU38800/99A priority Critical patent/AU3880099A/en
Priority to PCT/US1999/009747 priority patent/WO2000061017A1/fr
Publication of WO2000061017A1 publication Critical patent/WO2000061017A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/02—Holding devices, e.g. on the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1695—Trepans or craniotomes, i.e. specially adapted for drilling thin bones such as the skull
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/02—Holding devices, e.g. on the body
    • A61M2025/028—Holding devices, e.g. on the body having a mainly rigid support structure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2210/00—Anatomical parts of the body
    • A61M2210/06—Head
    • A61M2210/0687—Skull, cranium

Definitions

  • IPC(6) A61 B 17/56 US CL .606/96 According to International Patent Classification (IPC) or to both national classification and IPC
  • the invention relates to an improved apparatus and method for penetrating a human cranium at an angle of 90 degrees to the surface. More particularly, the invention relates to an improved guide for a drilling device and an improved guide for ventricular catheter placement to ensure that both the perforation of the cranium and the catheter insertion are oriented at the correct angle of 90 degrees.
  • the drill guide may be used in combination with a drill to ensure the the drill perforates the cranium at the required 90 degree angle.
  • An improved guide for ventricular catheter placement may, subsequent to the removal of the drill, be inserted into the drill guide to facilitate the correct positioning of a catheter device within a ventricular portion of the patient's
  • the four ventricles of the human brain are interconnected cavities that produce and circulate cerebrospinal fluid (CSF).
  • CSF cerebrospinal fluid
  • General areas of application of ventricular catheter placement include intracranial pressure monitoring (ICP), draining or shunting of CSF, and the instillation of pharmacological therapeutic agents.
  • Intracranial pressure monitoring i.e., the monitoring of ventricular pressure
  • Intracranial pressure monitoring is critical to the management of patients after severe head trauma, fulminant meningitis, Reyes' syndrome, encephalitis, stroke, cerebral hemorrhage, or subarachnoid hemorrhage producing stupor or coma.
  • the ventricles are usually compressed after head trauma and thus they are technically difficult to cannulate for ICP monitoring.
  • subarachnoid pressure monitoring which is not as true a measure of cerebral pressure as intraventricular pressure monitoring, is generally used.
  • CSF drainage is essential for patients with congenital or acquired hydrocephalus.
  • This procedure which can only be performed with an intraventricular catheter, is a life-preserving step, because it can immediately reduce intracranial pressure.
  • the ventricular catheter used to drain cerebrospinal fluid is connected to a peripheral subcutaneous drainage system, i.e., to the peritoneal cavity or systemic circulation via the heart.
  • the ventricles are enlarged and are an easier target for cannulation.
  • reports in neurosurgical literature indicate that suboptimal placement in dilated ventricles can subsequently produce catheter obstruction when the ventricles are decompressed and become smaller, thus emphasizing the need for accurate placement.
  • Catheter placement in cerebral ventricles is widely performed on patients with carcinomatous and fungal meningitis for the administration of well-known anti- 3 neoplastic and antifungal chemotherapeutic agents, respectively.
  • the ventricles in these patients are small or normal sized and difficult to cannulate.
  • the most frequently chosen site for ventricular catheterization is the coronal region.
  • a catheter is inserted in the anterior horn of the lateral ventricle through an orifice or burr hole drilled just anterior to the coronal suture in the midpupillary line of the cranium, i.e., in the frontal bone over the ventricle. This is known in the field as Kocher's point.
  • the burr hole only slightly larger than the diameter of the selected catheter to ensure a snug fit and provide a seal against CSF leakage, is placed approximately 1 cm. anterior to the coronal suture, approximately 10 to 12 cm. above the nasion, and approximately 2 to 3 cm. from the midline over the nondominant hemisphere.
  • the dura and underlying pia- arachnoid are opened and coagulated, for example, with a fine-tipped blade, after cauterizing the dural surface.
  • the lateral ventricles of the human brain form an arc parallel to the arc of the cranium, i.e., the contour of the lateral ventricles parallels the arc of the surface of the skull.
  • a catheter guided perpendicular to the cranial surface at the point of entry into the cranium will enter the ventricular system.
  • any line penetrating a burr hole in the surface of the skull at a 90° angle also bisects the lateral ventricle.
  • One such 4 method involves the use of a pre-measured catheter having a stylet which may be introduced and directed freehand through the burr hole, approximately in the coronal plane, and angled towards the medial canthus of the ipsilateral eye, using external landmarks such as the inner canthus of the eye in the frontal plane and a point just in front of the external auditory meatus in the lateral plane as guided to placement.
  • CSF should flow freely from the catheter tip at a depth of approximately 4 to 5 cm. from the interior cranial surface.
  • Intraoperative fluoroscopy and air ventriculography have been used to confirm freehand catheter placement. While these procedures can be helpful in placing the catheter if the ventricles are small, they also add to the complexity of the overall procedure.
  • the apparatus comprises a guide assembly which, when positioned over an orifice drilled in the cranium above the anterior horn of the lateral ventricle, guides a catheter and obdurator through the orifice and into the lateral ventricle at an angle normal to an imaginary plane formed by a tangent to the cranium at the orifice.
  • the method of utilizing the claimed device of the '324 patent comprises providing an orifice in the cranium just anterior to the coronal suture in a midpupillary line of the cranium and inserting a ventricular catheter containing an obdurator through the orifice towards a lateral ventricle, wherein the catheter containing the obdurator is guided through the orifice, by means of a guide assembly, at an angle normal to an imaginary plane formed by a tangent to the cranium at the orifice.
  • This orientation of 90° is required for proper placement of the catheter within the ventricular portion of the patient's brain since, if the burr hole deviates by more than about 7 degrees from the perpendicular to a plane tangent to the point on the cranium where the catheter is inserted, the catheter will be directed away from the ventricular region and into other areas of the organ not conducive to the intended purposes of the apparatus disclosed.
  • aligning the burr hole in such a precise manner greatly simplifies the subsequent task of correctly aligning the catheter within the ventricular
  • the apparatus of the '056 patent comprises a first guide means adapted to rest on the human cranium and a catheter guide means inserted within the first guide means.
  • An object of the present invention is to provide an improved method and apparatus for perforating the human cranium, and inserting a catheter therein at an angle of substantially 90 degrees.
  • It is a further object of the present invention is to provide an improved method and apparatus for perforating and catheterizing a human cranium at an angle of substantially 90 degrees to the surface thereof.
  • This improved method and apparatus facilitates the placement at the required 90 degree angle of a cranial drill and insertion
  • It is a further object of the invention is to provide an improved method and apparatus which permits the catheter to be pre-loaded on the catheter guide, allowing the neurosurgeon to place the catheter into the catheter guide and direct it into the ventricular system of the brain without touching the catheter and without compromising sterility.
  • It is a further object of the invention is to provide an improved method and apparatus which permits a guide to be removed from the side of the catheter rather than over the end of the catheter. This allows for the use of more complex and instrumental catheters that are now available or being developed.
  • It is a further object of the invention is to provide an improved method and apparatus for guiding a drill through the cranial surface and for guiding the insertion of a catheter into the anterior horn of the lateral ventricle of the human brain which optimizes accurate and reproducible placement of the catheter.
  • It is a further object of the invention is to provide a method and apparatus for accurately and reproducibly perforating the patient's skull and inserting a catheter through the cranial surface into the anterior horn of a lateral ventricle of the patient's brain in a manner which prevents insertion of the catheter into the cerebral matter or subarachnoid space.
  • a first embodiment of the present invention comprises an improved apparatus for drilling a hole in a human cranium at an angle of substantially 90 degrees to a surface portion thereof.
  • the improved apparatus comprises a drill guide 10 with drill guide slot or opening 20.
  • the drill guide 10 directs and aligns a drill for cutting through 9 the substrate at a proper angle, i.e., substantially 90 degrees to a plane defined by a tangent to the substrate during the perforation thereof.
  • the drill guide slot or opening 20 allows the neurosurgeon to have direct visual access to the drilling point. This visual access allows the neurosurgeon to more accurately place the drill and also to maintain the drill guide 10 in an accurate position relative to the hole in the cranium for catheter placement.
  • the drill guide slot or opening 20 preferably extends the full height of the member 18.
  • the drill guide opening is a slot with a width which is between 1 to 3.5 mm to match the width of the catheter guide slot or opening 38.
  • the improved apparatus further comprises a drill 50, such as that disclosed in U.S. Patent No. 4,931 ,056, which is insertable within an open bore portion of the drill guide 10, which is operable to perforate the substrate.
  • the drill may be provided with a number of spacer rings.
  • the purpose of the spacer rings is to prevent the penetration of drill 50 past a predetermined distance in to the patient's cranium. As drill 50 penetrates the cranium at a certain depth, a lower surface of lower ring contacts the upper portion of tubular member 18 and thus prevents further passage of drill 50 therethrough until at least one ring member is removed.
  • the spacer rings are preferably "C" shaped, but may alternatively be circular or of some other alternative shape.
  • the open portion of the spacer engages the shaft 52 of the drill. Any number of desired spacer rings may be employed. In the preferred embodiment,
  • the improved apparatus further comprises a drill tip where the angle on the tip of the drill bit is designed to prevent skidding.
  • This improved drill tip also makes a very clean hole through the inner table of the cranium.
  • a preferred embodiment of the drill 10 tip is a flattened split point design.
  • the invention also includes an improved catheter guide 32, having an open bore portion with a diameter reduced in relation to the bore of the drill guide 10, and having a catheter guide slot or opening 38.
  • the catheter guide 32 is insertable within the open bore portion of the drill guide 10 upon removal of the drill therefrom so as to effectively reduce the diameter of the drill guide 10.
  • the catheter guide slot or opening 38 allows the catheter 100 to be pre-loaded into the catheter guide 32.
  • the neurosurgeon can place the catheter 100 into the catheter guide 32 and direct it into the ventricular system without touching the catheter and without compromising sterility.
  • the catheter guide slot or opening 38 and drill guide slot or opening 20 allow the drill guide 10 and catheter guide 32 to be removed from the side of the catheter rather than over the end of the catheter 100.
  • These guide slots or openings 38 and 20 allow for the apparatus to be used with more complex and instrumental catheters than would otherwise be possible, including the complex catheters that are currently available or those that are being developed. Other openings to accommodate such complex catheters may be provided consistent with the present invention, as well.
  • Fluid transport means such as a catheter 100, may be inserted through the catheter guide 32 and thereafter into a ventricular portion of the patient's brain, in order to, for example, drain or shunt CSF therefrom or for the instillation or delivery of pharmacological therapeutic agents.
  • the drill guide 10 of the embodiment comprises a tubular member 18 with drill guide slot or opening 20 and a support for the tubular member 18.
  • the tubular member 18 is adapted to receive the catheter guide 32.
  • This support is adapted to rest unsecured on the patient's cranium.
  • the support and the tubular member 18 are 11 related to each other and to the cranium so as to guide the catheter through the orifice and in a direction perpendicular to a plane defined by a tangent to the cranium at the orifice, independent of the orientation of the orifice.
  • the support of the drill guide may comprise a plurality of legs 14, each leg terminating in a free end.
  • the free ends 16 of these legs form a polygon defining a plane and the tubular member 18 guides the catheter through the orifice in a direction perpendicular to this plane defined by the polygon and through the geometric center thereof.
  • the legs are three in number and of equal length. Therefore, in the preferred embodiment, the polygon is an equilateral triangle formed by the free ends of these legs.
  • a cone can be used instead of a plurality of legs.
  • the support may be connected to the tubular member 18 through a connecting platform 12.
  • the platform 12 is preferably contoured to provide indented sections 24. These indented sections make the drill guide 10 more stable by impeding the neurosurgeon from placing his fingers over the platform 12 other than over the sections of the platform 12 which attach to the legs 14. When the neurosurgeon grips the platform 12 over the legs 12 the drill guide 10 is more stable than when the platform 12 is not gripped over the legs 12.
  • the drill guide as described above should be constructed of a rigid, non-deformable material such as thermoplastic or stainless steel.
  • An insert within the tubular member 18, forming a catheter guide 32 is adapted to be in guiding engagement with the catheter while the free end of the catheter is inserted into the ventricle of the brain.
  • the catheter tubular member 34 is adapted to receive and guide the catheter therethrough.
  • the catheter guide 32 may partially 12 extend into the orifice which has been formed in the cranium. Additionally, this catheter guide 32 has a catheter guide opening 38 which advantageously allows the neurosurgeon to visualize the catheter and direct it without compromising sterility.
  • the catheter guide opening 30 is a slot which extends the full height of the catheter guide 32.
  • the preferred width of the catheter guide slot 38 is between 1 to 3.5 mm to allow for insertion and removal of a variety of catheter sizes.
  • Another embodiment of the invention comprises a method for drilling an orifice in a human cranium at an angle at substantially 90° to a plane defined by a tangent to the cranium at the orifice and subsequently inserting a catheter into a ventricular portion of the brain within the cranium.
  • the method initially comprises positioning a drill guide upon a portion of an outer surface of the patient's cranium such that an open tubular portion of the drill guide is oriented at an angle of substantially 90° to a plane defined by a tangent to the cranium at the orifice.
  • the neurosurgeon visualizes the drill point through the drill guide slot or opening 20. This visualization allows the neurosurgeon to achieve accurate 90 degree penetration of the cranium.
  • the drill guide as described above, comprises a tube with an opening, such as a slot, and a support therefore.
  • the method further comprises drilling an orifice in the cranium by drilling means proximally anterior to a coronal suture in a midpupillary line of the cranium.
  • the orifice extends through the cranium at an angle of substantially 90° to a plane defined by a tangent to the cranium at the orifice.
  • a catheter guide is thereafter inserted into the open tubular portion of the drill guide so as to render the diameter of the drill guide more consistent with that of a standard catheter.
  • the catheter may be preloaded on the catheter guide or inserted on the catheter guide when needed.
  • a catheter is subsequently guided through the open portion of the catheter guide and thereafter 13 through the orifice in a direction perpendicular to a plane defined by a tangent to the cranium at the orifice.
  • the opening or slot in the catheter guide allows the neurosurgeon to visualize the catheter during this procedure. Through the use of the present invention, therefore, the catheter accurately penetrates the ventricular portion of the brain upon the first insertion.
  • the method additionally comprises supporting the drill guide by a support comprising a plurality of legs.
  • the legs are preferably three in number, each terminating in a free end.
  • the free ends thus form a triangle defining a plane.
  • the support can comprise a cone, instead of a plurality of legs.
  • An alternate embodiment of the invention comprises guiding the catheter through a catheter guide inserted within the drill guide and into the orifice and into the ventricular portion of the patient's brain in a direction perpendicular to the plane defined by the triangle formed by the legs of the support and through the geometric center thereof.
  • the drilling of the cranium can be performed manually, pneumatically, electrically or hydraulically by use of suitable drilling means. Also, the method includes the step of limiting the depth of penetration of the drilling means to a predetermined distance within the cranium by providing stop means on the drilling means for contacting the drilling guide means.
  • FIG. 1 is a side elevational view of applicants' drill guide
  • Fig. 2 is a perspective view of applicants' guide assembly with catheter
  • Fig. 3 is a perspective view of applicants' catheter guide
  • Fig. 4 is an exploded perspective view of applicants' catheter guide with catheter
  • Fig. 5 is a side elevational view of applicants' catheter guide, configured for insertion into the drill guide of the invention
  • Fig. 6 is a perspective view of applicants' drill guide
  • Fig. 7 is another perspective view of applicants' drill guide
  • Fig. 8 is still another perspective view of applicants' drill guide
  • Fig. 9 is a perspective view of applicants' guide assembly with drill, and with removable clips for limiting the depth of penetration of the drill;
  • Fig. 10A is a plan view of applicants' catheter guide
  • Fig. 10B is a side plan view of applicants' catheter guide
  • Fig. 10C is a perspective view of applicants' catheter guide
  • Fig. 10D is a cross sectional view of applicants' catheter guide.
  • Fig. 11 are various views of applicant's drill guide.
  • Fig. 11 A is a perspective view of applicant's drill guide.
  • Fig. 11B is another perspective view of applicant's drill guide.
  • Fig. 11C is another perspective view of applicant's drill guide.
  • Fig. 11 D is a cross-sectional view of applicant's drill guide.
  • Fig. 11 E is a diagram showing measurements of applicant's drill guide.
  • Fig. 11 F is a partial perspective view of the top of applicant's drill guide.
  • Fig. 11G is a diagram showing measurements of applicant's drill guide. 15
  • Fig. 11 H is a diagram of the top of applicant's drill guide.
  • Fig. 11 I is a diagram showing the top of applicant's drill guide.
  • drill guide 10 for controlling and directing a twist drill device during the formation of a burr hole through the cranium of a patient.
  • the initial function of drill guide 10 is to control the drill during the perforation of the cranium, thus preventing the bit from skipping on the bone or the scalp, especially at the start of the drilling procedure.
  • Drill guide 10 may be seated, for example, directly upon the scalp of the patient, above an incision therein measuring on the order of from about 1-2 millimeters. Since, however, the skin of the scalp is loose and prone to movement relative to the cranial bone, the placement of drill guide 10 in one position throughout the operative procedure serves to provide a means for readily locating the burr hole located beneath the incision. Since the diameter of the catheter placed within the burr hole ranges between only about 2-3 millimeters, the hole in the cranium need not be much greater in size, if at all, and it may therefore be difficult to relocate without the assistance of drill
  • Drill guide 10 is thus preferably constructed of a rigid, non-deformable material such as a rigid engineering plastic or a metal such as stainless steel in order to fulfill these functions.
  • the entire apparatus 16 may be manufactured inexpensively from a plastic material, as a disposable assembly, thus reducing the cost of the assembly and assuring a sharp, sterilized drilling device for each operation. The availability of such a pre-sharpened, sterilized drilling device also serves to reduce the time required to complete each operation.
  • drill guide 10 further comprises platform 12. Extending from platform 12 in a diverging manner are three legs 14, which terminate in free ends 16. Free ends 16 of legs 14 define a triangle lying within a defined plane. Drill guide 10 further includes guide means for guiding the drill in a direction perpendicular to the plane defined by the triangle formed by legs 14 and through the geometric center thereof.
  • the guide means comprises a tubular member 18 extending through platform 12 in a direction perpendicular to the triangular plane described above.
  • Tubular member 18 is hollow, defining a central lumen to permit the passage therethrough of a drilling device (described in the 4,931 ,056 patent). The diameter of this lumen is not critical but it must, at a minimum, be sufficient to permit the passage of the drill.
  • tubular member 18 is further provided with a drill guide slot or opening 20.
  • the drill guide slot or opening 20 allows the neurosurgeon to have direct visual access to the drilling point. This visual access allows the neurosurgeon to more accurately place the drill and also to maintain the drill guide 10 in an accurate position relative to the hole in the cranium for catheter placement.
  • drill guide 10 directs the drilling device perpendicular to this tangential plane, ensuring the production of a burr hole through the cranial bone at an angle of 90 degrees to the surface of a plane tangent to the cranium. This alignment assures that a ventricular catheter, inserted into the brain in a direction perpendicular to the curvature of the cranium, will not deviate from a preferred course due to a misaligned skull hole.
  • the catheter is much more likely to be misaligned and to miss the ventricular portions of the brain entirely.
  • legs 14 of drill guide 10 are of equal length, equidistantly spaced and symmetrically disposed relative to each other, whereby the free ends 16 define an equilateral triangle.
  • Tubular member 18 directs the drill perpendicular to the plane defined by this equilateral triangle at the geometric center thereof and hence, perpendicular to the tangent plane upon the surface of the patient's cranium.
  • tubular member 18 is illustrated as being cylindrical in shape, any shape which allows an unencumbered passage of the drill there-through may be employed. 18
  • drill guide 10 While the preferred embodiment of drill guide 10, as described above, includes platform 12 for connecting legs 14 to tubular member 18, platform 12 is not an essential element of drill guide 10.
  • legs 14 may be connected directly to tubular member 18 as long as tubular member 18 guides the drill in the direction perpendicular to the plane of the triangle formed by the free ends 16 of legs 14 and through the geometric center of the triangle.
  • the height of drill guide 10 and the distance between free ends 16 of legs 14 may be varied, as long as the following principles are observed.
  • the base portion of drill guide 10 must preferably form an equilateral triangle defined by free legs 16 of legs 14.
  • a line passing through the central lumen of tubular member 18 must be normal to the plane of the triangle thus defined and must pass through the geometric center thereof.
  • the internal diameter of the central lumen may be varied, as long as the lumen is constructed of a sufficient width to accept applicants' twist drill.
  • the distance between free ends 16 of legs 14 ranges from about 1 cm to about 6 cm.
  • the lower limit is established based on the smallest burr hole or orifice necessary for passing a catheter therethrough. These catheters may range from about 2-3 millimeters in diameter.
  • the upper limit is established based on the change in skull curvature which occurs when the midline of the skull is crossed.
  • the orifice or burr hole is drilled generally from about 2 cm to about 3 cm from the midline, an upper limit of about 6 cm is preferred so that one or more legs do not rest on the skull at a point beyond the midline where the skull
  • member 18 would not be directed normal to the imaginary plane defined by a tangent 19 to the orifice at the point of entry.
  • the specific height of drill guide 10 is also not a critical parameter.
  • a preferred height range is about 2 cm to 10 cm.
  • the lower limit is established on the basis of the usual length of a catheter (15 cm) minus the standard intracranial distance to the ventricle (5 cm).
  • drill guide 10 of the present invention has been illustrated with three legs 14, this is not a critical limitation.
  • drill guide 10 of the present invention may be constructed with four legs.
  • the free ends of each of the four legs define the corners of a polygon such as a square or rectangle and the axis of tubular member 18 passes through the geometric center of the square or rectangle, wherein the axis is normal to the plane thereof.
  • a cone shaped support can be used, as long as the support meets the geometric criteria described herein.
  • drill guide 10 is seated upon the patient's scalp over a small incision made therein or, alternately, directly over the skull itself.
  • Shaft 52 of drill 50 is then inserted into the tubular member 18 of drill guide 10 to a point where drill bit 54 contacts the patient's cranium.
  • a perforation is subsequently made through the cranial bone by the surgeon pressing on and turning the handle of drill 56 with one hand while holding drill guide 10 with the other hand.
  • the device thus produces a burr hole 20 at an angle of substantially 90 degrees to a plane defined by a tangent to the surface of the cranium, thus assuring that a catheter width is subsequently to be inserted into the ventricular portion of the brain, perpendicular to the curvature of the cranium, will not deviate due to a misaligned skull hole.
  • catheter guide 32 is inserted into catheter tubular member 34 with a lumen having reduced diameter relative to tubular member 18 of drill guide 10.
  • Catheter guide 32 is further provided with a relatively wider top portion 36 which can be used to position catheter guide 32 within drill guide 10.
  • Catheter tubular member 34 of catheter guide 32 has a catheter guide slot or opening 38. The catheter guide slot or opening 38 allows the catheter 100 to be pre-loaded into the catheter guide 32. Thus, the neurosurgeon can place the catheter 100 into the catheter guide 32 and direct it into the ventricular system without touching the catheter and without compromising sterility.
  • the catheter guide slot or opening 38 and drill guide slot or opening 20 allow the drill guide 10 and catheter guide 32 to be removed from the side of the catheter rather than over the end of the catheter. This allows the more complex and instrumental catheters that are now available or are being developed to be used with the present devices. These complex catheters can be inserted and removed from the catheter guide slot or opening and the drill guide slot or opening with ease, as opposed to the catheter guides and drill guides of the prior art which do not accept such complex catheter devices.
  • the catheter guide slot or opening 38 and the drill guide slot or opening 20 each accommodate projections off of 21 the catheter, including tubing, instrumentation or any other protuberances or additions to the catheter which are desired or to be developed in the art.
  • the disclosed slot is the preferred opening in the disclosed devices for allowing protuberances off of the catheter, it is understood that other openings, whether of different size or shape, or even multiple openings, can be provided to the catheter guide and/or the drill guide consistent with the present invention.
  • the devices be provided with an opening or design suited to accommodate projections or protuberances off of a catheter, or additions to a catheter, to allow the present devices to be used with more complex and developed catheters that consist of more than merely a straight length of tubing.
  • the drill guide 10 has a locking receiver 22 which comprises striations molded into the top of the drill guide 10.
  • the locking receiver 22 is at the top portion of the tubular member 18 and mates with the locking tabs 40 of catheter guide 32.
  • the locking tabs 40 of catheter guide 32 are attached between the top 36 and catheter tubular member 34.
  • the locking tabs 40 insert into the tubular member 18 of the drill guide and lock with the locking receiver 22 to prevent displacement of the catheter guide 32 relative to the drill guide 10.
  • the top 36 in a preferred embodiment has ribs 42 which allows the neurosurgeon to have a good finger grip.
  • Drill 50 operates within drill guide 10 and is visible to the neurosurgeon through drill guide slot or opening 20. As noted above, drill 50 is inserted into tubular member 18 of drill guide 10 until the point of drill bit 54 contacts the cranium. Handle 56 is then grasped by the surgeon and rotated until the drill bit 54 passes completely through the cranium. Thereafter, the underlying dura and pia-arachnoid tissue may be pierced with the assistance of a needle inserted therethrough and thus prepared for the passage of 22 a catheter.
  • catheter guide 32 is inserted within the tubular member 18 of drill guide 10, as shown in FIG. 1.
  • the purpose of catheter guide 32 is to reduce the lumen diameter of drill guide 10 to a size more correlative with that of catheter 100 to be inserted therethrough.
  • catheter guide 32 may be constructed having a length sufficient to pass completely through drill guide 10 and at least partially into the burr hole. In the event, therefore, that the guide assembly is moved or is removed from the patient's cranium for any reason, the burr hole may be easily relocated by positioning drill guide 10 over the incision in the patient's scalp and simply rotating the assembly until catheter guide 32 slips into the burr hole for the convenient passage of catheter 100 therethrough into the ventricular portion of the brain.
  • a burr hole may be drilled on the right or left side of a patient's cranium in the midpupillary line.
  • the orifice is located above the anterior horn of lateral ventricle approximately 10 cm. posterior to the nasion and approximately 3 cm. lateral to midline 46 of the cranium.
  • the dura and underlying a pia-arachnoid are cut and coagulated, in a manner well known in the art.
  • a catheter 100 containing a rigid obturator (not shown) is then accurately guided through the orifice and dural opening into the ventricle by the drill guide 10 and catheter guide 32 assembly, which is placed and rests on the skull over the orifice.
  • Any well known catheter 100 and obturator such as the commercially-available Codman Accu-flo ventricular catheter and obturator, made by the Codman and

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Abstract

L'invention concerne un appareil amélioré pour le forage d'un orifice dans un crâne humain à un angle sensiblement égal à 90° par rapport à un plan défini par une tangente à la surface du crâne au niveau de l'orifice, et pour le guidage en vue de la mise en place d'un cathéter ventriculaire. L'appareil comprend un premier guide tubulaire (10) en vue de diriger un foret à un angle approprié, ledit premier guide tubulaire étant maintenu au-dessus du crâne par une pluralité d'éléments à branches, et présentant une fente ou une ouverture permettant de visualiser le point de forage. L'appareil comprend en outre un second guide tubulaire (32) destiné à diriger un cathéter (100) dans la portion ventriculaire du cerveau du patient. Le second guide tubulaire présente une fente ou une ouverture permettant le pré-chargement du cathéter. Le second guide tubulaire est introduit dans le premier guide tubulaire, reçoit le cathéter et le dirige dans le ventricule. Grâce à la conception du type à fente prévue pour le premier et le second guides tubulaires, les guides peuvent être retirés à partir de la partie latérale du cathéter et non pas au-dessus de l'extrémité de ce cathéter.
PCT/US1999/009747 1999-04-12 1999-05-04 Appareil ameliore pour le guidage d'un catheter et le guidage d'un foret, et procede permettant son insertion perpendiculaire dans un orifice cranien WO2000061017A1 (fr)

Priority Applications (2)

Application Number Priority Date Filing Date Title
AU38800/99A AU3880099A (en) 1999-04-12 1999-05-04 Improved catheter guide and drill guide apparatus and method for perpendicular insertion into a cranium orifice
PCT/US1999/009747 WO2000061017A1 (fr) 1999-05-04 1999-05-04 Appareil ameliore pour le guidage d'un catheter et le guidage d'un foret, et procede permettant son insertion perpendiculaire dans un orifice cranien

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/US1999/009747 WO2000061017A1 (fr) 1999-05-04 1999-05-04 Appareil ameliore pour le guidage d'un catheter et le guidage d'un foret, et procede permettant son insertion perpendiculaire dans un orifice cranien

Publications (1)

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WO2000061017A1 true WO2000061017A1 (fr) 2000-10-19

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PCT/US1999/009747 WO2000061017A1 (fr) 1999-04-12 1999-05-04 Appareil ameliore pour le guidage d'un catheter et le guidage d'un foret, et procede permettant son insertion perpendiculaire dans un orifice cranien

Country Status (2)

Country Link
AU (1) AU3880099A (fr)
WO (1) WO2000061017A1 (fr)

Cited By (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2008100253A1 (fr) * 2007-02-12 2008-08-21 Neurodynamics, Inc. Appareil de forage amélioré
EP2258437A1 (fr) * 2002-03-12 2010-12-08 Renishaw (Ireland) Limited Cathéter pour application intra-cérébrale
CN104665918A (zh) * 2015-02-15 2015-06-03 陆爱清 导针进针点位置显影器
CN107088257A (zh) * 2017-04-27 2017-08-25 哈尔滨医科大学 一种y型两用双腔两囊引流器
US11298041B2 (en) 2016-08-30 2022-04-12 The Regents Of The University Of California Methods for biomedical targeting and delivery and devices and systems for practicing the same
EP3886736A4 (fr) * 2018-11-29 2022-10-26 Huby Inc. Système et procédé pour moyeu de guidage chirurgical et foret intégrés avec protection guidée de forage et de plongée
US11497576B2 (en) 2017-07-17 2022-11-15 Voyager Therapeutics, Inc. Trajectory array guide system
WO2023164406A3 (fr) * 2022-02-25 2023-10-19 The Penn State Research Foundation Systèmes et méthodes de drainage de liquide céphalorachidien

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5520692A (en) * 1995-02-28 1996-05-28 Wright Medical Technology, Inc. Adjustable depth patella recessing guide and method
US5833693A (en) * 1997-05-02 1998-11-10 Abrahami; Israel Drill guide

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5520692A (en) * 1995-02-28 1996-05-28 Wright Medical Technology, Inc. Adjustable depth patella recessing guide and method
US5833693A (en) * 1997-05-02 1998-11-10 Abrahami; Israel Drill guide

Cited By (11)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP2258437A1 (fr) * 2002-03-12 2010-12-08 Renishaw (Ireland) Limited Cathéter pour application intra-cérébrale
WO2008100253A1 (fr) * 2007-02-12 2008-08-21 Neurodynamics, Inc. Appareil de forage amélioré
CN104665918A (zh) * 2015-02-15 2015-06-03 陆爱清 导针进针点位置显影器
US11298041B2 (en) 2016-08-30 2022-04-12 The Regents Of The University Of California Methods for biomedical targeting and delivery and devices and systems for practicing the same
US11298043B2 (en) 2016-08-30 2022-04-12 The Regents Of The University Of California Methods for biomedical targeting and delivery and devices and systems for practicing the same
CN107088257A (zh) * 2017-04-27 2017-08-25 哈尔滨医科大学 一种y型两用双腔两囊引流器
CN107088257B (zh) * 2017-04-27 2023-06-09 哈尔滨医科大学 一种y型两用双腔两囊引流器
US11497576B2 (en) 2017-07-17 2022-11-15 Voyager Therapeutics, Inc. Trajectory array guide system
EP3886736A4 (fr) * 2018-11-29 2022-10-26 Huby Inc. Système et procédé pour moyeu de guidage chirurgical et foret intégrés avec protection guidée de forage et de plongée
US11684376B2 (en) 2018-11-29 2023-06-27 Hubly Inc. System and method for integrated surgical guide-hub and drill with guided drilling and plunge protection
WO2023164406A3 (fr) * 2022-02-25 2023-10-19 The Penn State Research Foundation Systèmes et méthodes de drainage de liquide céphalorachidien

Also Published As

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