WO2019066749A2 - Dérivation ventriculo-péritonéale pour patients atteints d'une hydrocéphalie - Google Patents

Dérivation ventriculo-péritonéale pour patients atteints d'une hydrocéphalie Download PDF

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Publication number
WO2019066749A2
WO2019066749A2 PCT/TR2018/050222 TR2018050222W WO2019066749A2 WO 2019066749 A2 WO2019066749 A2 WO 2019066749A2 TR 2018050222 W TR2018050222 W TR 2018050222W WO 2019066749 A2 WO2019066749 A2 WO 2019066749A2
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WO
WIPO (PCT)
Prior art keywords
ventriculo
liquid
ventricle
peritoneal shunt
distal end
Prior art date
Application number
PCT/TR2018/050222
Other languages
English (en)
Other versions
WO2019066749A3 (fr
Inventor
Selin YAVUZ
Original Assignee
Yavuz Selin
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 Yavuz Selin filed Critical Yavuz Selin
Publication of WO2019066749A2 publication Critical patent/WO2019066749A2/fr
Publication of WO2019066749A3 publication Critical patent/WO2019066749A3/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
    • A61M27/00—Drainage appliance for wounds or the like, i.e. wound drains, implanted drains
    • A61M27/002—Implant devices for drainage of body fluids from one part of the body to another
    • A61M27/006—Cerebrospinal drainage; Accessories therefor, e.g. valves
    • 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

Definitions

  • the present invention relates to tools known as "ventriculo-peritoneal shunt" which provides transfer of liquid into the abdomen (peritoneum) in order to reduce liquid pressure in the ventricles inside the brain in case said pressure increases.
  • Ventricle describes the chamber inside the brain and peritoneum describes the inner section of the abdomen. Said tool realizes its function by transferring the excessive liquid inside the ventricles into the peritoneum. The peritoneum suctions said liquid and transfers said liquid to the body.
  • the ventriculo-peritoneal shunt can be used for decreasing the liquid pressure inside the brain in all cases which lead to hydrocephaly (increase of liquid pressure in the ventricles inside the brain) disease, for instance tumors, cerebral bleedings, congenital anomalies.
  • Ventriculo-peritoneal shunt (1 ') known from the present applications is shown.
  • Ventriculo-peritoneal shunt (1 ') comprises three sections. These sections are respectively a ventricular end (1 '), a valve (3') and a peritoneal end (distal end) (8').
  • the tubular ventricular end (2') enters into the ventricles inside the brain and receives the liquid therein through the bores.
  • the liquid entering through said ventricular end (2') is transferred to the valve (3').
  • the valve (3') arranges liquid output from the brain. For example, if the valve (3') opens at the pressures above 30 mmHg, it permits liquid flow when the pressure increases over this value.
  • the liquid, passing through the valve (3') advances to the distal end (8').
  • the tubular distal end (8') transfers the liquid into the abdomen.
  • ventriculo-peritoneal shunts (1 ') known from the present applications are used, in the first year, 40% of them malfunctions, in the second year, 50% of them malfunctions and in the tenth year, 70% of them malfunctions.
  • the reasons of deteriorations of the functions of said ventriculo-peritoneal shunts (1 ') can be classified as follows:
  • Ventricular end blockage In the ventriculo-peritoneal shunts (1 ') known from the present applications, the most frequent complication reason is blockage in the ventricular end (2').
  • the sponge-like structure named as "choroid plexus" in the ventricle, produces the liquid inside the ventricle, and at the same time, it is the structure which leads to blockage of the ventricular end (2') inside the brain.
  • Distal end (8) blockage The organs and structures in the abdomen may lead to blockage of the distal end (8'). According to an event recorded in the literature, an intestine tapeworm may lead to blockage of the distal end (8).
  • Infection In addition to the blockage of ventricular end (2') inside the brain, the distal end (8') blockage inside the abdomen and the excessive liquid output from the brain, infection may also occur. At the same time, the ventricular end (2') may damage the structures around it due to its tubular structure and may lead to infections. Moreover, for example, when the bacteria in the intestine pass through the distal end (8'), they may lead to infection. Due to the liquid stasis in the distal end, infection formation risk increases. All of the surgeries being realized bear more risk depending on the size of said surgery and increase infection risk.
  • Slit ventricle syndrome excessive liquid output from the brain:
  • the valve (3') which is normally a part of the ventriculo-peritoneal shunts (1 '), opens when the liquid pressure inside the ventricle increases and liquid passage occurs.
  • these pressures reflect to the liquid inside the brain and they reflect to the valve (3') from there.
  • the opened valve (3') leads to liquid output from the brain. In case of such excitability conditions, even when the liquid amount in the brain does not increase, liquid output may unnecessarily occur which leads to damage in the brain.
  • Insufficient ventriculo-peritoneal shunt (1 ') length When the height of the patients grows, the length of the ventriculo-peritoneal shunt which has been fixed beforehand is insufficient.
  • the ventriculo-peritoneal shunt (1 ') fixed to a child with a height of 60 cm has a length of 30 cm.
  • the length of the ventriculo- peritoneal shunt (1 ') shall be 50 cm. In this case, since the height of the child naturally increases, the child shall undergo surgery again.
  • the present invention relates to a ventriculo-peritoneal shunt, for eliminating the above mentioned disadvantages and for bringing new advantages to the related technical field.
  • the main object of the present invention is to provide a ventriculo-peritoneal shunt where at least some of the abovementioned syndromes in hydrocephaly patients can be prevented.
  • the subject matter ventriculo-peritoneal shunt is characterized by comprising one or more than one bulge having slippery surface which provides sliding of ventricular end on the structures existing in the ventricle and positioned in the vicinity of said bores and which provides prevention of direct contact of the bores to the structures existing inside the ventricle.
  • Figure 1 is the view of the ventriculo-peritoneal shunt of the known state of the art.
  • Figure 2 is the view of the ventriculo-peritoneal shunt in an embodiment of the present invention.
  • Figure 3a is the external view of the ventricular end on the ventriculo-peritoneal shunt in an embodiment of the present invention.
  • Figure 3b is the schematic inner view of the ventricular end on the ventriculo-peritoneal shunt in an embodiment of the present invention.
  • Figure 4 is the inner view of chamber and first valve provided on the ventriculo-peritoneal shunt in an embodiment of the present invention.
  • Figure 5a is the schematic inner view of the chamber and first valve provided on the ventriculo-peritoneal shunt in another embodiment of the present invention.
  • Figure 5b-5d are the schematic cross sectional views in the sections shown by I, II and III of the ventriculo-peritoneal shunt in Figure 5a in another embodiment of the present invention.
  • Figure 6a is the schematic inner view of the reservoir, discharge path and second valve provided on the ventriculo-peritoneal shunt in an embodiment of the present invention.
  • Figure 6b is the lateral schematic cross sectional view of the ventriculo-peritoneal shunt provided in Figure 6a in an embodiment of the present invention.
  • Figure 7a is the schematic inner view of the distal end apparatus provided on the ventriculo- peritoneal shunt in an embodiment of the present invention.
  • Figure 7b is the schematic inner view of the distal end apparatus provided on the ventriculo- peritoneal shunt in another embodiment of the present invention.
  • Figure 8 is the view of notched/non-notched membranes and various duck-billed valves used in the distal end apparatus provided on the ventriculo-peritoneal shunt in another embodiment of the present invention.
  • Figure 9a-9c are the schematic views of the operation of the mechanism which prevents back-flow of liquid used in the distal end apparatus of ventriculo-peritoneal shunt in an embodiment of the present invention.
  • ventriculo-peritoneal shunt (1 ) is explained with references to examples without forming any restrictive effect only in order to make the subject more understandable.
  • ventriculo-peritoneal shunt (1 ) in an embodiment of the present invention is given.
  • the subject matter ventriculo-peritoneal shunt (1 ) is suitable to be used for hydrocephaly patients.
  • the sections of the ventriculo-peritoneal shunt (1 ) will be described in detail below.
  • FIG. 2 there is a ventricular end (2) on the ventriculo-peritoneal shunt (1 ).
  • a ventricular end (2) on the ventricular end (2), there is one or more than one bore (2a) preferably in the form of arrays.
  • the liquid, existing in the ventricle is transferred into the ventricular end (2).
  • bulges (2b) which are preferably made of silicon material. Said bulges (2b) have smooth slippery surfaces. Thanks to said slippery surfaces, the ventricular end (2) is slid on the structures existing in the ventricle. Moreover, the bulges (2b) are positioned in the vicinity of said bores (2a).
  • the bores (2a) remain between the bulges (2b). Said bulges (2b) prevent contact of the bores (2a) to the structures inside the ventricle. Thanks to the subject matter bulges (2b), the contact of the ventricular end (2) to the formations existing in the ventricle is minimized and blockages can be prevented.
  • septum (2c) exist in the ventricular end (2). Said septum (2c) provide the front section of the ventricular end (1 ) to be separated into preferably four chambers (2, 3 or can be more in number) which provide separate liquid flow therein. Said bores (2b) are opened to each of said chambers.
  • the bores (2b) and the bulges (2b) are preferably arranged in a single array in an alternate manner.
  • start of a probable blockage as the flow in the blocked chamber of the ventricular end (2) decelerates, the balance of the ventricular end (2) is deteriorated and it begins movement and it is separated from the present location which leads to adhesion.
  • the ventricular end (2) can continue to sustain its function. Thanks to the subject matter septum (2c), the complications depending on ventricular end (2) blockage can be prevented.
  • the baffle surface (4a) is preferably provided in the middle of the chamber (4) and it is before the valve (3). Moreover, said chamber (4) has gaps (4b) which provide guiding of the liquid flow towards the first valve (3). The gaps (4b) are preferably provided on the lateral sides of the baffle surface (4a). Thanks to said baffle surface (4a), the first valve (3) senses only the pressures depending on the increase of liquid, however, when the patient is excited, it is not affected by the pulsatile pressure increases resulting from heart beating power. By means of this, excessive liquid output from the brain is prevented and the patient can be protected from being harmed by the excessive liquid loss.
  • the output of the liquid stored in the reservoir (5) is controlled by the second valve (7) provided at the lower side.
  • the second valve (7) When the pressure of the liquid accumulated in the reservoir (5) exceeds a specific level, the second valve (7) is opened. When the pressure of the liquid is lower than a specific level, the second valve (7) is closed.
  • the second valve (7) has anti-siphon characteristic and it prevents back-flow of the liquid.
  • the distal end (8) by means of the distal end (8), the liquid coming through the second valve (7) and the liquid coming through the discharge path (6) are transferred together into the abdomen.
  • the reservoir (5) comprises an ultrasound permeable material.
  • the level of the liquid stored in the reservoir (5) can be detected by means of ultrasound.
  • the first advantage provided by the reservoir (5) and the second valve (7) will be explained below.
  • the liquid level inside the reservoir (5) is for instance 2 mm in the first observation and it is for instance 4 mm in the second observation.
  • the sections of the ventriculo-peritoneal shunt (1 ) before the reservoir (5) work well.
  • the liquid level inside the ventriculo-peritoneal shunt (1 ) is for instance 5 mm in the first observation and it is for instance 3 mm in the second observation. This shows that the liquid have reached the distal end (8).
  • ventriculo-peritoneal shunts (1 ) shown essentially in Figure 1 While the patient stands up, there is a pressure difference between the distal end (8') in the abdomen and the valve (3') at the head level. This pressure difference may lead to undesired output of the liquid inside the ventricle.
  • ventriculo-peritoneal shunt (1 ) the reservoir (5) functions as an intermediate chamber, it minimizes the pressure difference which may affect the first valve (3) which is close to the ventricular end (1 ).
  • the discharge path (6) will be explained below. When the patient is in lying position, the liquid will pass through the discharge path (6) and it will be transferred towards the distal end (8).
  • the distal end apparatus (9) provides the liquid to be transferred into the abdomen.
  • the distal end apparatus (9) has a smooth slippery and round surface (9a). Thanks to the smooth, slippery and round surface (9) of the distal end apparatus (9), the distal end apparatus (9) can slide over the organs and other structures and it can be saved from the blocking effect of the surrounding tissues and the damage to the formations occurring inside the abdomen can be prevented.
  • said mechanism (9b) which prevents back-flow of the liquid existing inside the abdomen and of the other structures like bacteria and parasite into the distal end (8).
  • said mechanism (9b) may comprise at least one membrane (9b-2) and/or at least one duck-billed valve (9b-1 ) which prevent(s) back-flow of the liquid inside the abdomen into the distal end (8) or the back-flow prevention characteristic can be utilized which results from the structure of the design without using membrane or valve according to physical dimensions.
  • the blockages are prevented and the infections related to this are also prevented.
  • the subject matter distal end apparatus (9) since liquid is permitted to pass in single direction, the liquids existing in the abdomen will not move upwardly and in this manner, bacteria and parasite are prevented from reaching the brain and thus, infections are also prevented. By means of this, liquid stasis can be prevented. By means of this, moreover, the blockages inside the abdomen are localized at a specific area and they are prevented from spreading.
  • the ventriculo-peritoneal shunt (1 ) comprises removable-fixable sections. By means of this, in case of blockage, the related sections can be changed by means of separate and small interventions instead of changing the whole ventriculo-peritoneal shunt (1 ).
  • the first valve (3) and the second valve (7) provided on the ventriculo-peritoneal shunt (1 ) are removable and fixable.
  • the distal end apparatus (9) can be removed/fixed from/to the distal end (8).
  • the ventriculo-peritoneal shunt (1 ) has an extendable structure by fixing an additional part between the removable/fixable sections.
  • additional part can be fixed and extended in the abdomen region between the distal end (8) and the distal end apparatus (9).
  • ventriculo-peritoneal shunt (1 ) when the height of the patient increases, for instance, when the height of the patient, who is 1 year old and who has a height of 70 cm and to whom ventriculo-peritoneal shunt (1 ) is fixed, increases up to 130 cm, only the distal end apparatus (9), connected to the distal end (8), is removed and the length of the ventriculo-peritoneal shunt (1 ) is extended by means of an additional part without completely changing the ventriculo-peritoneal shunt (1 ). After the extension process, the distal end apparatus (9) is fixed again and can be changed with a new one.
  • ventriculo-peritoneal shunt (1 ) Thanks to the removable/fixable sections in the subject matter ventriculo-peritoneal shunt (1 ), the patient gets rid of subcutaneous surgeries where the ventriculo-peritoneal shunt (1 ) is completely removed and changed with a new one and the patient is protected from complications of these surgeries like infection.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Public Health (AREA)
  • Anesthesiology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Hematology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Veterinary Medicine (AREA)
  • Otolaryngology (AREA)
  • Ophthalmology & Optometry (AREA)
  • Neurology (AREA)
  • Biophysics (AREA)
  • Pulmonology (AREA)
  • External Artificial Organs (AREA)

Abstract

La présente invention concerne une dérivation ventriculo-péritonéale (1) pour patients atteints d'une hydrocéphalie comprenant une extrémité ventriculaire (2), un ou plusieurs trous (2a) ménagés dans l'extrémité ventriculaire (2) et qui assurent le transfert du liquide existant dans le ventricule à l'intérieur de l'extrémité ventriculaire (2). La dérivation ventriculo-péritonéale (1) est caractérisée en ce qu'elle comprend un ou plusieurs renflements (2b) ayant une surface glissante qui assure le glissement de l'extrémité ventriculaire (2) sur les structures existantes dans le ventricule et positionnés à proximité desdits trous (2a) et qui empêchent le contact des trous (2a) avec les structures existantes à l'intérieur du ventricule.
PCT/TR2018/050222 2017-06-02 2018-05-11 Dérivation ventriculo-péritonéale pour patients atteints d'une hydrocéphalie WO2019066749A2 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
TR201708119 2017-06-02
TR2017/08119 2017-06-02

Publications (2)

Publication Number Publication Date
WO2019066749A2 true WO2019066749A2 (fr) 2019-04-04
WO2019066749A3 WO2019066749A3 (fr) 2019-05-09

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Family Cites Families (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4377169A (en) * 1981-06-10 1983-03-22 Banks Bruce A Ion beam sputter-etched ventricular catheter for hydrocephalus shunt
AU2001289580A1 (en) * 2000-09-11 2002-03-22 Csf Dynamics A/S A fluid shunt system and a method for the treatment of hydrocephalus
JP5059028B2 (ja) * 2006-01-31 2012-10-24 エイ． クラリック、フランシス 水頭症治療用埋め込みマイクロシステム

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