US 3690323 A
A modified ventricular end for a ventriculo-cardiac shunt used in the treatment of hydrocephalus and similar conditions is provided for removing fluids which accumulate in the cavity of the brain and must be drained to the heart. An umbrella-shaped cover protects an apertured end of the shunt for preventing the same from becoming attachad to the ventricular walls by growth of brain tissue thereon. The device, which is inserted into the brain in a closed position and is subsequently opened, has supporting rib structures which may carry various sensing elements for observing conditions in the brain.
Description (OCR text may contain errors)
United States Patent Wortman et al.
1 51 Sept. 12, 1972  DEVICE FOR DRAINING VENTRICULAR FLUID IN CASES OF HYDROCEPHALUS  Inventors: Donald E. Wortman, Rockville,
Md.; Lawrence J. Mervis, Milwaukee, Wis.
 Assignee: The United States of America as represented by the Secretary of the Army 22 Filed: Dec. 1,1970 21 Appl.No.: 94,069
 US. Cl. ..128/350 R  Int. Cl. ..A61m 27/00  FieldofSeai-ch ..128/1 R,2l-l,2R,35 OR, 35 CV  References Cited UNITED STATES PATENTS 1,863,057 6/1932 Innes ..128/350 R 3,540,431 1 H1970 Mobin-Uddin ..128/1 R 3,565,056 2/1971 Statham ..128/2 R FOREIGN PATENTS OR APPLICATIONS 1,166,977 4/1964 Germany ..128/351 158,613 4/1957 Sweden ..128/2 R OTHER PUBLICATIONS Ellenwood, E. R. et al., Central-Body Temperature Apparatus," IBM Tech. Disclosure Bulletin, Vol. 11, N0. 11, Apr. 1969 Primary Examiner-Channing L. Pace Attorney-Harry M. Saragovitz, Edward J. Kelly, l-Ierbert Berl and Saul Elbaum  ABSTRACT A modified ventricular end for a ventriculo-cardiac shunt used in the treatment of hydrocephalus and similar conditions is provided for removing fluids which accumulate in the cavity of the brain and must be drained to the heart. An umbrella-shaped cover protects an apertured end of the shunt for preventing the same from becoming attachad to the ventricular walls by growth of brain tissue thereon. The device, which is inserted into the brain in a closed position and is subsequently opened, has supporting rib structures which may carry various sensing elements for observing conditions in the brain.
10 Claims, 4 Drawing Figures P'A'IENTEDSEP 12 m2 3.690.323
FIG 4 DONALD E. w R Aw'ENTOR LJ- MERVIS BY W' i ATTORNEYS DEVICE FOR DRAINING VENTRICULAR FLUID IN CASES OF HYDROCEPHALUS RIGHTS OF GOVERNMENT The invention described herein may be manufactured, used, and licensed by or for The United States Government for governmental purposes without the payment to us of any royalty thereon.
BACKGROUND OF THE INVENTION The invention relates generally to surgical devices for controlling the drainage of fluids between different portions of the body of a patient, and more particularly, to improvements in ventriculo-cardiac shunts for draining cerebrospinal fluid from the cerebral ventricles to other areas of the body in the treatment of hydrocephalus and similar conditions in which there is difficulty in the free circulation and absorption of cerebrospinal fluid.
The practice of treating communicating or obstructive hydrocephalus by establishing communication between the cerebrospinal fluid pathways and the vascular system is well known and several mechanical devices are presently available for draining away the cerebrospinal fluid which accumulates within the skull and exerts pressure therein. Once inserted, it is desirable that these devices permanently remain in the patient, to be replaced if some maloperation occurs. These devices normally include a closed-end drainage tube of quite small diameter which is inserted through an opening in the skull into the cranial cavity of the head, or more specifically, into a lateral cerebral ventricle of the patient, and which is provided with a plurality of small apertures in the wall thereof near the distal end of the tube in the brain of the patient for permitting passage therethrough of fluids collected from the'cerebral ventricles to the bloodstream. It has been found, however, that cerebral tissue ordinarily collects, or grows, about the end of these devices, or shunts, after they have been in use only a reasonably short period of time, causing the same to become attached to the ventricular or other membrane walls and thereby obstructing the normal flow of fluids thereinto. As a result, the patient often exhibits symptoms of intracranial hypertension (shunt malfunction). When this occurs, or, if the shunt fails for any other reason, it is necessary to replace the shunt, and this requires additional surgical procedures which could be of some danger to a patient.
SUMMARY OF THE INVENTION Accordingly, it is an object of this invention to provide an improved ventricular end portion for a ventriculo-cardiac shunt which is simple in construction and highly reliable and can be utilized with the maxim um degree of safety to the patient.
Another object of this invention is to provide a device for draining cerebral-spinal fluid from the cerebral ventricles into other areas of the body for cases of hydrocephalus and similar conditions which does not tend to become obstructed with cerebral debris or tissue growths.
Still another object of this invention is to provide a ventriculo-cardiac shunt for draining cerebrospinal fluid having an improved ventricular end portion which is not susceptible to becoming blocked or obstructed by brain tissue growth thereon and which is capable of supporting sensing devices for detecting various environmental conditions in the brain to assist in the treatment of such illnesses as hydrocephalus, brain cancer, and stroke.
The foregoing and other objects are attained by a ventriculo-cardiac shunt having a tubular end portion which is provided with a plurality of apertures for receiving fluid which may have accumulated in the regions of the brain cavity and which is enclosed within a novel umbrella-type cover slidably disposed thereover that is normally closed during insertion of the same into the brain cavity and may be readily opened once in place for supporting the tubular end portion in a standup relation from the ventricular walls. The umbrella includes a gauze-like or cheesecloth type material porous to the cerebrospinal fluid and suitably attached to or covering a plurality of elongate rib constructions of a firm elastic material which are preconditioned as a whole to form an open or conical configuration when supported or retained at one end thereof and released at the other end for permitting the same to expand, or open. A tubular sleeve which is slidably disposed over the tubular end portion and the umbrella portion of the device is provided for the purpose of normally maintaining the umbrella in a closed position and, whenever desired, upon withdrawal of the same a predetermined amount, for permitting the umbrella portion to be opened. The rib constructions of the umbrella are designed to carry sensing devices and to support the necessary connections thereto for observing conditions such as pressure, temperature and the like within the brain for conducting long-term study and treatment of hydrocephalus, brain cancer, stroke, and similar illnesses.
BRIEF DESCRIPTION OF THE DRAWINGS Other objects and many of the attendant features and advantages of the present invention will be more readily appreciated as the same becomes better understood from the following detailed description when considered in connection with the accompanying drawings in which like reference numerals indicate like or corresponding parts throughout the several views thereof and wherein:
FIG. 1 is a longitudinal view in cross-section of a modified ventricular end portion of a ventriculo-cardiac shunt constructed in accordance with the teachings of the present invention and showing the same in a closed position ready for insertion into the brain cavity.
FIG. 2 is a similar cross-sectional view showing the umbrella portion of the device in an expanded condition, such as occurs following insertion of the device into the brain cavity, after the outer sleeve has been withdrawn a predetermined amount;
FIG. 3 is an enlarged view of the embodiment shown in FIGS. 1 and 2 which illustrates a preferred arrangement of a condition-sensing device in one of the rib constructions of the umbrella portion of this embodiment; and,
FIG. 4 is a diagrammatic representation of the application of the device in the establishment of a ventriculo-cardiac shunt.
DESCRIPTION OF AN ILLUSTRATED EMBODIMENT Referring now to the drawings, and more particularly, to FIGS. 1 and 2 thereof, the end portion of a ventriculo-cardiac shunt is generally indicated by the reference numeral 10. This ventricular end portion comprises a conventional elongated catheter member 12 of substantially tubular configuration which is provided with a plurality of radial, or lateral, passageways 14 near one end thereof which are adapted to form communication between the cerebral ventricles and the interior of the catheter, or main tube 12, for draining cerebrospinal fluid therefrom.
A protective cover for the end of the main tube 12 having the passageways 14 therein is provided by a plurality of rib constructions 16 which are arranged about the periphery of the main tube 12 substantially aligned with respect to one another and in parallel relation to the longitudinal axis of the main tube 12. Each of the rib constructions 16 is secured at one end to the main tube 12 by any suitable means, and the other ends of the rib constructions extend beyond the end of the main tube 12 a predetermined distance. A cheesecloth, or gauze-like, material 18 porous to the cerebrospinal fluids is suitably attached to the rod-like rib constructions 16 in the same manner as the cloth material of an umbrella is attached to the flexible, supporting ribs thereof.
An elongated sleeve 20 formed from a cylinder having a bore 22 and a counter-bore 24 is slidably disposed over the main tube 12 and-the rib constructions 16, with the main tube 12 being slidably received within the bore 22 and the end of the sleeve member 20 having the counter-bore 24 therein being slidably disposed over the rib constructions 16. As shown in FIG. 1, with the device in the normal, inoperative condition, ready for insertion into the brain cavity, one end of the sleeve member 20 extends beyond the end of the main catheter tube 12 substantially the same amount as do the rib constructions 16, and when the sleeve 20 is so fully extended, the ends of the rib constructions 16 abut the shoulder 26 formed between the bore 22 and the counter-bore 24 within the sleeve.
Both the sleeve 20 and the main tube 12 are made of material compatible with body tissues such as rubber and" nylon, which preferably have the property of necessary yielding when being inserted into a body cavity. The rib constructions 16 are preconditioned to assume an angular, or conical, configuration relative to the main catheter tube 12, as illustrated in FIG. 2, whenever the sleeve member 20 is withdrawn or retracted, a predetermined distance over such rib constructions. The rib constructions 16 are made from firm, flexible material'preferably selected from such suitable plastic or metallic materials having the desired resilient characteristics. It is contemplated also that some of the new materials having plastic memory characteristics so as to retain form and dimensions under normal temperature conditions but which, upon heating to a critical temperature, change their form and return to their pretreatment form and dimension, may be readily adapted for constructing the ribs 16 herein.
Another important feature of the present invention, which is illustrated in FIG. 3, the is provision of means for sensing various conditions in the brain cavity such as, for example, pressure, temperature and the like, for
the purpose of observing the same and thereby-detecting the presence of infection, brain damage, or the like. This is permitted by the provision of a plurality of sensing devices 28 which are disposed in cavities formed in the rib constructions 16. Connections to the sensing devices 28 are strung through slots, or channels, 32 and 34, respectively formed in the sleeve member 20 and the rib constructions 16.
FIG. 4 is a simplified diagrammatic representation of the apparatus of the present invention in use. It should be appreciated that nothing shown therein is actually visible, the entire ventricular end portion 10 containing the main catheter tube 12 is connected through a trephined opening 36 in the skull to a source of cerebrospinal fluid such as, for example, a lateral ventricle. The other end of the device 10 is connected to a suitable tubular valving arrangement 38, of conventional design, permitting flow in one direction only, and this, in turn, is connected to an outlet tube 40 which is directed to the circulatory system, such as, for example by having its distal end inserted into and secured to the the internal jugular vein or heart.
In the use of the device, therefore, the ventricular end portion 10 is inserted through the opening 36 in the skull to a cerebral ventricle whereby it is connected to a source of cerebrospinal fluid, and thereafter the sleeve member 20 is withdrawn, or retracted, a predetermined distance, whereupon the rib construction 16 opens, or assumes the predetermined position illustrated in FIG. 2. The device 10 is now ready to receive cerebrospinal fluid through the cheesecloth covering 18 and through the passageways 14 for draining the same from the cerebral ventricles. This novel arrangement reduces shunt failure by preventing blockage or obstruction of the passageways 14 in the catheter tube 12 due to growth of brain tissue thereon, and hence cuts down on the number of surgical procedures which, understandably, ought to be avoided. Through the sensing devices 28, the present invention also permits long term study and observation to readily be made when treating illnesses such as hydrocephalus, brain cancer, and stroke.
It will be seen from the foregoing description that there has been provided a number of new and useful improvements in ventriculo-cardiac shuts for draining cerebrospinal fluids from he cerebral ventricles to the jugular vein or to the heat in the treatment of hydrocephalus and similar conditions.
We wish it to be understood that we do not desire to be limited to the exact details of construction shown and described, for obvious modifications will occur to a person skilled in the art.
What is claimed is:
l. A device suitable for placement in a body cavity for draining fluids therefrom, comprising:
a drainage tube having a closed distal end provided with lateral passageways adjacent thereto, the tube being of sufficient length so that its proximal end is adapted to extend beyond a body cavity into the atmosphere;
porous means covering said distal end of said tube and said lateral passageways therein, said porous means including expansible means for providing an umbrella-like liner thereabout for permitting passage therethrough of fluid but preventing obstruction of said lateral passageways; and,
means for normally retaining said porous means in an unexpanded state during insertion of said drainage tube into a body cavity.
2. The device set forth in claim 1, further comprising means supported on said porous means for sensing predetermined conditions when inserted into a body cavity.
3. The device set forth in claim 2, wherein said porous means comprises a plurality of elongate, resilient rib constructions normally disposed on said tube parallel to the longitudinal axis thereof and to each other when in said unexpanded state, with one end of each of said ribs being secured to the outer wall of said tube, said ribs being preconditioned to assume a funnel-shaped configuration when the unsecured ends thereof are released by said retaining means; and,
a porous material covering the same and attached thereto at spaced intervals for permitting said ribs to expand into said substantially funnel-shaped configuration.
4. The device set forth in claim 3, wherein said retaining means comprises a sleeve member slidably disposed over said drainage tube and said porous covering means,
said sleeve member having a stop therein for engaging said ribs upon being fully extended thereover, and,
said sleeve member, upon withdrawal thereof at a predetermined distance substantially equal to the length of said unsecured portion of said ribs, permitting said porous covering means to assume said I funnel-shaped configuration.
5. The device set forth in claim 4, wherein said sensing means comprises sensing devices disposed in cavities formed in said ribs, and further including channels formed in said ribs and said sleeve member communicating with said cavities for receiving connecting leads to said sensing devices.
6. The device set forth in claim 5, wherein said sensing devices are responsive to pressure.
7. The device set forth in claim 5 wherein said sensing devices are responsive to temperature.
8. In an apparatus for draining cerebrospinal fluid into the circulatory system, the combination of a resilient conduit adapted to be connected to said circulatory system;
catheter means for connecting the proximate end of said conduit to a source of cerebrospinal fluid;
porous means covering the end of said catheter means and including expansible means for providing an umbrella-like liner thereabout for permitting passage therethrough of said cerebrospinal fluid but preventing the obstruction of said catheter means;
means for normally retaining said porous means in an unexpanded state during insertion into said source of cerebrospinal fluid; and,
means supported on said expandible porous means for sensing predetermined conditions within said source of cerebrospinal fluid.
9. The combination set forth in claim 8, wherein said catheter means is substantially tubular having a closed distal end provided with a plurality of lateral passageways adjacent to said distal end; and,
said porous means comprises a plurality of elongate rib constructions normally disposed on said catheter tube parallel to the longitudinal axis thereof and to each other when in said unexpanded state, with one end of each of said ribs being secured to the outer wall of said catheter tube on the side of said passageways opposite said distal end, said ribs being preconditioned to assume a conical configuration when the unsecured ends thereof are released by said retaining means; and,
a porous material covering said rib constructions and attached thereto at spaced intervals for permitting the same to expand to said conical configuration while providing a tight porous cover thereabout.
10. The combination set forth in claim 9, wherein said means for normally retaining said porous means in an unexpanded state comprises a substantially tubularshaped sleeve member having a stop therein for engaging said ribs upon being fully extended thereover,
said sleeve member, upon withdrawal thereof a predetermined distance substantially equal to the length of said unsecured portion of said ribs, permitting the expansion of said porous covering means, and,
said sensing means comprises sensing devices disposed in cavities formed in said ribs, and channels formed in said ribs and said sleeve member communicating with said cavities for receiving connecting leads for said sensing devices.