WO2000059419A9 - A medical device for selective intrathecal spinal cooling in aortic surgery and spinal trauma - Google Patents
A medical device for selective intrathecal spinal cooling in aortic surgery and spinal traumaInfo
- Publication number
- WO2000059419A9 WO2000059419A9 PCT/US2000/007511 US0007511W WO0059419A9 WO 2000059419 A9 WO2000059419 A9 WO 2000059419A9 US 0007511 W US0007511 W US 0007511W WO 0059419 A9 WO0059419 A9 WO 0059419A9
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- tubular member
- csf
- spinal
- subarachnoid space
- catheter
- Prior art date
Links
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
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/71—Suction drainage systems
- A61M1/77—Suction-irrigation systems
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
- A61B10/0045—Devices for taking samples of body liquids
- A61B2010/008—Interstitial fluid
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F7/00—Heating or cooling appliances for medical or therapeutic treatment of the human body
- A61F7/12—Devices for heating or cooling internal body cavities
- A61F2007/126—Devices for heating or cooling internal body cavities for invasive application, e.g. for introducing into blood vessels
-
- 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
- A61M2210/0693—Brain, cerebrum
-
- 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
- A61M2210/10—Trunk
- A61M2210/1003—Spinal column
Definitions
- the present invention generally relates to medical devices useful in reducing and preventing spinal injury in patients with spinal trauma or patients undergoing aortic surgery. More specifically, the invention provides devices for insertion into the subarachnoid space for circulating and cooling the cerebral spinal fluid below body temperature. The flow rate of the cerebral spinal fluid is variably adjusted according to the pressure and temperature, respectively measured by a manometer and thermometer.
- Spinal ischemia resulting in neurological complications occurs in patients sustaining a traumatic injury to the spinal cord or patients undergoing aortic surgery.
- Spinal cord injury can be classified as penetrating or blunt.
- penetrating injuries such as stab wound or gun shot wound to the spinal cord
- complete severing of the spinal cord can occur, resulting in total muscular paralysis and loss of sensation below the level of injury.
- This condition of flaccid paralysis and suppression of all reflex activity following immediately upon transection of the spinal cord and involving all segments below the lesion is referred to as spinal shock.
- reflex activity returns within 1 to 6 weeks from the onset of the spinal shock. Once transection of the spinal cord has occurred, peripheral reinnervation by the nervous system does not occur.
- Spinal shock also occurs in blunt injuries, such as in motor vehicle accident, where compression of the spinal cord by impingement from fractured or dislocated vertebral bodies results in sensory and motor impairment below the level of cord involvement. Diagnosis of spinal fracture or dislocation is often made on X-rays. Spinal cord compression can be diagnosed on MRI, CT scan with myelogram, or lumbar puncture (Queckenstedt test). The mechanism of spinal ischemia is mostly caused by swelling of the cord. In these patients, hypotension may also occur as a result of loss of vascular sympathetic tone in the involved area. Urinary and/or bowel incontinence is a common complication due to impaired autonomic function.
- ischemia is also a common postoperative complication following aortic surgeries, such as abdominal aortic aneurysmectomy.
- the incidence of spinal cord ischemia/stroke during aortic surgery is typically over 10%.
- abdominal aortic aneurysm (AAA) repair for example, the spinal arteries, which provide blood supply to the spinal cord, are often severed from the diseased aorta, and some but not all of which are later resutured to the prosthetic graft. As a result, blood flow to the spinal cord is reduced.
- spinal ischemia/stroke may ensue, often resulting in anterior spinal artery syndrome.
- the classic syndrome is characterized by paraplegia, rectal and urinary incontinence, loss of pain and temperature sensation, but with sparing of vibration and proprioceptive sense. Patients may also sustain neurologic deficits in the lower extremities after abdominal aortic surgery due to loss of posterior column modalities.
- Brain damage associated with either stroke or head trauma is worsened by hyperthermia and improved with hypothermia.
- Current treatment for acute ischemic stroke and head injury is mainly supportive.
- a thrombolytic agent e.g., tissue plasminogen activator (t-PA)
- t-PA tissue plasminogen activator
- Current treatment for patients suffering from spinal injury is also supportive, e.g., to secure local hemostasis and to prevent infection by appropriate debridement, closure, and administration of antibiotics in penetrating spinal injury.
- surgical decompression of the spinal cord may be performed to restore neurological function.
- New devices and methods are thus needed in treating spinal ischemia/stroke in patients having spinal cord trauma or aortic surgery, in preventing spinal ischemia in patients anticipating a major thoracoabdominal surgery, or in cerebral ischemia, which minimizes neurological complication and improves the patients' quality of life without causing significant side effects.
- the invention provides devices and methods for reducing neurologic complications in patients sustaining trauma to the spinal cord or undergoing aortic surgery. More specifically, the invention provides devices and methods for cooling the cerebral spinal fluid (CSF) surrounding the spinal cord.
- CSF cerebral spinal fluid
- a first embodiment of the device comprises two elongate catheters, each having a proximal end, a distal end, and a lumen communicating with a port at the distal end.
- the distal ends of the first catheter and the second catheter are adapted for insertion into a patient's subarachnoid space.
- the proximal ends of the catheters are connected to a pump to facilitate circulation of the CSF through the lumens of the catheters.
- a refrigeration system is connected to the pump to provide adjustable cooling of the CSF, such that CSF flowing through the lumen of the first catheter is cooled to below body temperature before flowing into the lumen of the second catheter.
- the CSF pressure in the circuit is measured by a manometer included in the catheters, the pump, or the refrigeration system. It will be understood that although the pump is advantageous, it may not be included in all embodiments for circulation of the CSF.
- each catheter carries a needle which facilitates introduction of the devices into the subarachnoid space.
- a suture flange is mounted on a distal region of the first catheter and/or the second catheter for securing the devices after insertion into the subarachnoid space.
- Other embodiments of the devices include radiopaque markers mounted at the distal end of each catheter for identifying the position of the catheters in the subarachnoid space.
- the proximal end of each catheter includes a port for infusing fluid, such as Ringer's lactate solution, or pharmaceutical agents into the subarachnoid space. The port can be used to drain the CSF for reducing pressure in the subarachnoid space.
- a release valve may be included proximally in one of the catheters to drain the CSF when the pressure exceeds a desired threshold.
- a distal region of each catheter may be angled relative to the proximal end to facilitate entry and rostral advancement in the subarachnoid space.
- the devices include at least one thermometer.
- the thermometer can be included in the proximal end of the first and/or second catheter for measuring the temperature of the CSF or CSF/fiuid mixture entering and exiting the subarachnoid space.
- the methods for cooling the spinal cord to prevent neurologic damage during inadequate spinal perfusion utilize the devices disclosed herein.
- the distal end of the first catheter is inserted percutaneously between the spinous processes of lumbar vertebrae L3 and L4 or L4 and L5 into the subarachnoid space.
- the distal end of the second catheter is inserted in the lumbar region at a level above or below the insertion of the first catheter.
- the second catheter is advanced rostrally in the subarachnoid space so that the distal port is positioned preferably in the low cervical or high thoracic region of the spine or optionally in the lumbar region.
- the position of the catheters can be verified under fluoroscopy in the embodiments where the distal ends of the catheters include one or more radiopaque marker.
- the CSF is aspirated from the first catheter, cooled by the refrigeration system, and passed into the second catheter.
- the CSF is aspirated from the second catheter, cooled by the refrigeration system, and passed into the first catheter. In this manner, the CSF is cooled to below normal body temperature, which can be monitored by thermometers included in either or both catheters. The greater the cooling the greater the degree of protection is likely for the spinal cord.
- the CSF is drained in the lumbar region to reduce the CSF pressure to zero.
- the CSF pressure can be monitored by a manometer included in either or both catheters.
- the CSF is collected in a bag and discarded after the procedure.
- Fluid such as Ringer's lactate, is infused through one of the catheters, preferably the second catheter, and drained passively through the first catheter.
- the CSF collected in a bag may be discarded or reintroduced at the end of the procedure.
- the CSF/Ringer's lactate mixture is cooled through the refrigeration system and circulated by activating the pump.
- the pump can be either volume limited or pressure limited.
- the temperature of the CSF mixture can be reduced rapidly, and the flow rate is adjusted to maintain the desired temperature.
- the CSF pressure is maintained preferably at a minimum, i.e., at approximately zero, to maximize perfusion to the spinal cord.
- a port protecting mechanism e.g., a net or a fence guard, is mounted at the distal ends of the catheters. When the pump is activated, the mechanism prevents the arachnoid from folding over and obstructing the suction and port, and prevents nerve roots from being sucked into the catheter.
- the mechanism may be an integral part of the catheter, or be operably mounted on the inner catheter wall and deployed when the needle is withdrawn.
- the distal end of the first catheter is inserted between the spinous processes of lumbar vertebrae L3 and L4 or L4 and L5 into the subarachnoid space.
- the distal end of the second catheter is inserted between the spinous processes of low cervical vertebrae or high thoracic vertebrae, e.g., between C-6 and C-7, between C- 7 and T-l, or between T-l and T-2, into the subarachnoid space.
- the CSF is aspirated preferably through the first catheter, cooled through the refrigeration system to below body temperature, and passed into the second catheter.
- the CSF is aspirated from the second catheter in the low cervical or high thoracic region and passed into the first catheter in the lumbar region to provide spinal cooling.
- This method may be desirable in situations where the second catheter can not be advanced rostrally in the subarachnoid space due to an edematous spinal cord after injury.
- the devices and methods are most useful in treating patients with spinal trauma or undergoing aortic surgery, they can be utilized to reduce neurologic damage during cerebral hypoperfusion in situations, such as cardiac arrest, cardiac failure, low cardiac output states, stroke, head injury, cerebral aneurysm surgery, open and closed cardiac surgery and aortic surgery.
- the distal end of the first catheter is inserted between the low cervical vertebrae or high thoracic vertebrae into the subarachnoid space.
- the distal end of the second catheter is inserted either in the lumbar region as described above or between the cervical vertebrae, in the foramen magnum, or through a skull burr hole into the subarachnoid space or the lateral ventricle.
- the CSF is preferably aspirated from the first catheter in the cervical subarachnoid space, cooled to below body temperature, and passed through the second catheter into the subarachnoid space in the cervical region or the brain.
- the patients may be tilted back and forth to improve circulation of the hypothermic CSF in patients with stroke, head trauma, or spinal injury.
- the flow rate of the CSF is adjusted according to the
- the devices can be used (1) to provide continuous and variable spinal cooling, (2) in patients with either blunt or penetrating spinal trauma immediately after injury, (3) to selectively provide protective hypothermia to the spinal cord, thereby avoiding complications associated with systemic cooling, (4) by an anesthesiologist prior to aortic surgery, (5) to reduce neurologic deficits during cerebral hypoperfusion in patients with, e.g., stroke, cardiac failure, or cardiac surgery, (6) during aortic surgery, such as AAA repair, to lengthen the window for reattachment of the spinal arteries, and (7) to provide intrathecal administration of neuroprotective agents.
- Fig. 1 depicts blood supply and venous drainage of the spinal cord.
- Fig. 2 depicts the relation of spinal cord segments to an adult patient's vertebral column.
- Fig. 3 depicts an embodiment of the medical device for providing spinal cord cooling according to the present invention.
- Fig. 4 depicts another embodiment of the medical device for providing spinal cord cooling according to the present invention.
- Fig. 5A depicts a distal end of another embodiment of the device including a needle.
- Fig. 5B depicts the distal end of the needle of Fig. 5A entering the subarachnoid space.
- Fig. 5C depicts the distal end of the device of Fig. 5A entering the subarachnoid space.
- Fig. 6A depicts another embodiment of the needle carried at the distal end of a catheter.
- Fig. 6B depicts the needle of Fig. 6 A inserted in the subarachnoid space.
- Fig. 6C depicts the needle and the distal end of the catheter of Fig. 6A inserted in the subarachnoid space.
- Fig. 6D depicts the needle of Fig. 6A being removed from the catheter.
- Fig. 6E depicts the device of Fig. 6A inserted in the subarachnoid space without the needle.
- Fig. 7 depicts the catheters of the device of Fig. 4 inserted in the lumbar region.
- Fig. 8 depicts the catheters of another embodiment of the device inserted in the lumbar and cervical region.
- Fig. 9 depicts the device according to the present invention inserted in various cranial locations to provide cooling to the cerebral tissue.
- Fig. 10A depicts another embodiment of the catheter having a distal bendable region which assumes a linear configuration relative to the proximal end of the catheter.
- Fig. 10B depicts the catheter of Fig. 10A having the distal bendable region assuming an angled configuration relative to the proximal end of the catheter.
- Fig. 11 A depicts another embodiment of the catheter having a distal bendable region and a side port.
- Fig. 1 IB depicts the catheter of Fig. 11 A inserted in the subarachnoid space.
- Fig. 11C depicts a distal region of the catheter of Fig. 11B assuming an angled configuration relative to the proximal end of the catheter.
- Fig. 12A depicts one embodiment of a port protecting mechanism having a net mounted over the distal port of the catheter.
- Fig. 12B depicts another embodiment of the port protecting mechanism having a fence guard mounted over the distal port of the catheter.
- Fig. 12C depicts one embodiment of the port protecting mechanism mounted in the inner wall of the catheter.
- Fig. 12D depicts the port protecting mechanism of Fig. 12C after being activated by withdrawing the needle.
- Fig. 12E depicts another embodiment of the port protecting mechanism having a moveable hinge mounted in the inner wall of the catheter.
- Fig. 12F depicts the port protecting mechanism of Fig. 12E covering the distal port of the catheter.
- the spinal cord part of the central nervous system, is located in the vertebral canal (neural canal) which contains the spinal cord, its protective membranes, called spinal meninges, and associated vessels embedded in loose connective and fatty tissue.
- the spinal meninges include pia mater 5, arachnoid mater 6, and dura mater 7 as depicted in Fig. 1.
- the subarachnoid space is formed between the pia mater and arachnoid mater.
- the epidural (extradural) space is formed between the arachnoid mater and the dura mater.
- the spinal needle is inserted into the lumbar interspinous space, and penetrates the dura mater and arachnoid mater to reach the subarachnoid space.
- the spinal cord is supplied by three longitudinal arteries, i.e., an anterior spinal artery and two posterior spinal arteries, which are reinforced by segmental vessels called radicular arteries. These vessels are derived from branches of the vertebral, deep cervical, intercostal, and lumbar arteries, all of which branch from the aorta.
- anterior spinal artery 1 formed by two small branches from the vertebral arteries, supplies the anterior two-third of the spinal cord.
- Posterior spinal arteries 2 arise as small branches of either the vertebral or the posterior inferior cerebellar arteries, supply the posterior one- third of the spinal cord. Fracture and/or dislocations of the spinal column may interfere with blood supply to the spinal cord from the spinal arteries.
- the blood supply by the anterior and posterior spinal arteries is sufficient only for the superior cervical segments of the spinal cord.
- the remaining segments receive most of their blood supply from the radicular arteries, which supply the vertebrae, meninges, and the spinal arteries.
- Great anterior radicular artery 3 also known as artery of Adamkiewicz
- This artery is clinically important because it contributes to the anterior spinal artery, and therefore, when the intercostal or lumbar artery is severed, e.g., during aortic surgeries, the main blood supply to the inferior two- third of the spinal cord is compromised. These patients may lose all sensation and voluntary movement distal to the level of impaired blood supply to the spinal cord.
- the relation of spinal cord segments 20 to the adult vertebral column is illustrated in Fig. 2.
- the spinal cord lies in the spinal canal surrounded by vertebral bodies 22 anteriorly and spinous processes 23 posteriorly.
- the spinal cord begins as a continuation of the inferior part of the brain stem. In adults the spinal cord usually ends opposite the intervertebral disc between LI and L2 vertebrae.
- the bundle of nerve roots in the subarachnoid space caudal to the termination of the spinal cord is cauda equina 25.
- the cerebral spinal fluid is usually obtained from the lumbar subarachnoid space between the spinous processes of L3 and L4 or L4 and L5 vertebrae because the spinal cord ends above these levels and is not likely to be damaged by a lumbar puncture needle or catheter.
- Fig 3 depicts a first embodiment of the device for cooling the spinal cord to prevent neurologic damage during inadequate spinal perfusion.
- the device includes two elongate catheters.
- First catheter 30 has lumen 33, proximal end 31, and distal end 32. The lumen communicates with port 35 at the distal end.
- Second catheter 40 has lumen 43, proximal end 41, and distal end 42. Lumen 43 communicates with port 45 at the distal end.
- Distal ends 32 and 42 are adapted for attachment to a lumbar puncture needle.
- Pump 50 is connected to proximal end 31 and 41 of the respective first and second catheters.
- Cooling system 52 is connected to pump 50 to provide variable cooling of the CSF.
- Proximal end 31 of the first catheter also includes manometer 55 for measuring CSF pressure in the circuit.
- Fig. 4 depicts another embodiment of the spinal cooling device.
- the device includes first and second catheter 30 and 40, each having, respectively, proximal end 31 and 41, distal end 32 and 42, and lumen 33 and 43.
- the proximal ends of the catheters are connected to pump and cooling unit 51, capable of providing circulation and cooling of the CSF in the circuit.
- the proximal end of the first catheter also includes manometer 55 and thermometer 60 for measuring, respectively, CSF pressure and temperature exiting or entering the first catheter.
- the proximal end of the second catheter also includes second thermometer 61 for measuring CSF temperature exiting or entering the second catheter. When the CSF pressure exceeds a desired threshold, the CSF can be drained from release valve 65 included in the first catheter or port 64 included in the second catheter.
- Port 64 can also be used to administer fluid or pharmaceutical agents into the subarachnoid space.
- Each distal end of the catheters carries needle 66, which facilitates introduction of the catheter into the subarachnoid space.
- Figs. 5 A, 5B, and 5C depict distal ends of an embodiment of the device carrying a needle.
- needle 66 is carried in lumen 33 of distal end 32 of the catheter.
- Distal end 67 of the needle protrudes distally from port 35.
- the needle is movable within the lumen of the catheter by operating mechanism 68, capable of reversibly locking and releasing the needle in the lumen.
- distal end 67 of the needle is inserted through soft tissue 71 between the spinous processes of two vertebrae into subarachnoid space 70 as depicted in Fig. 5B.
- mechanism 68 is operated to release the needle in the lumen.
- Distal end 32 of the catheter is advanced distally over the needle to insert in the subarachnoid space as depicted in Fig. 5C.
- the CSF is then circulated through port 35 and lumen 33 of the catheter.
- Another embodiment of the catheter carrying a needle at its distal end is depicted in Figs. 6A, 6B, 6C, 6D, and 6E.
- Figs. 6A, 6B, 6C, 6D, and 6E Another embodiment of the catheter carrying a needle at its distal end is depicted in Figs. 6A, 6B, 6C, 6D, and 6E.
- distal end 32 of the catheter includes second lumen 34 for housing needle 66.
- Lumen 34 communicates with lumen 33 of the catheter, distally with port 35, and proximally with port 36.
- Needle 66 which has distal end 67 and proximal end 68, is slidably movable in lumen 34. Distal end 67 protrudes distally from port 35, and proximal end 68 protrudes proximally from port 36.
- Suture flange 69 is slidably mounted on distal end 32 of the catheter.
- distal end 67 of the needle is inserted through soft tissue 71 between spinous processes of two vertebrae into subarachnoid space 70 as depicted in Fig. 6B.
- proximal end 68 of the needle While holding proximal end 68 of the needle, the distal end of the catheter is advanced distally over the needle to insert in the subarachnoid space as depicted in Fig. 6C.
- Needle 66 is removed from subarachnoid space 70 by pulling on end 68 proximally as depicted in Fig. 6D.
- Sutures can be placed between suture flange 69 and soft tissue 71 to secure the catheter.
- the needle can remain in lumen 34 or be removed completely from lumen 34.
- Port 36 can also be used as a release valve for draining the CSF when the CSF pressure exceeds a desired threshold or as an infusion port for administering fluid, such as Ringer's lactate solution, or pharmaceutical agents into the subarachnoid space.
- fluid such as Ringer's lactate solution, or pharmaceutical agents into the subarachnoid space.
- the devices disclosed herein are useful in reducing neurologic injury to the spinal cord following spinal trauma or aortic surgery by providing cooling of the CSF surrounding the spinal cord.
- Fig. 7 the device of Fig. 4 is shown inserted in a patient's lumbar region. Under sterile condition, two lumbar punctures are performed. Needle 66, preferably 14 Gauge, carried in distal end 32 of first catheter 30 is inserted between spinous processes 23 of L4 and L5 into subarachnoid space 70. Needle 66 carried in distal end 42 of second catheter 40 is inserted between the spinous processes of L3 and L4 into subarachnoid space 70. In alternative methods, the needle and catheter may be inserted between L5 and SI, L2 and L3, or LI and L2.
- the catheters are advanced distally over the needle so that port 35 and 45 receive the CSF.
- Port 35 of the first catheter is positioned in the lumbar subarachnoid space
- distal end 42 of the second catheter is advanced rostrally in the subarachnoid space until it is positioned in the low cervical or high thoracic region.
- Port 45 is shown positioned between the spinous processes of C7 and Tl.
- Radiopaque markers may be mounted on the distal ends of the catheters so that the position of the distal ends can be confirmed radiologically. Insertion of the two catheters in the lumbar region is preferred because spinal cord 75 usually terminates about L2, and damage to the spinal cord due to instrumentation is not likely.
- the device Prior to the aortic surgeries, such as abdominal aneurysm repair, the device may be inserted by an anesthesiologist, so that the surgeon would not be inconvenienced.
- the CSF from the lumbar region may be drained through release valve 65 to reduce the CSF pressure to approximately zero, which is measured by second manometer 56, optionally included in the distal end of the catheter.
- the CSF is normally collected in a bag and may be discarded or reintroduced after the procedure.
- Large bore catheters e.g., 3 or 4 French, may be used to rapidly drain the CSF (at approximately 100-150 cc in 3-4 minutes), thereby eliminating the need of using suction, which may cause the arachnoid to obstruct the distal ports or inadvertent damage by suction on a nerve root.
- Fluid such as Ringer's lactate
- this CSF and Ringer's lactate mixture is withdrawn from the first catheter in the lumbar region, cooled by pump and cooling unit 51 , and passed into the second catheter in the low cervical /high thoracic region.
- the CSF is withdrawn from the second catheter and passed into the first catheter.
- any cooling of the CSF is beneficial in protecting the spinal cord from ischemic injury.
- the temperature of the CSF exiting and entering the subarachnoid space in the lumbar region is measured by thermometers 60 and 61, respectively. Using this method, the CSF temperature can be reduced rapidly.
- the flow rate of the recirculated CSF mixture can be adjusted to keep the CSF temperature and pressure at a desired level. It is desirable to keep the CSF pressure at a minimum, at approximately zero, to maximize any remaining perfusion in the spinal cord after injury.
- the cooling of the spinal cord and/or can be maintained during and/or several hours after aortic surgery, and be maintained several hours following spinal cord trauma or stroke. At the end of the cooling period, the CSF temperature is allowed to rise slowly. The catheters are then removed from the lumbar region.
- the second catheter can be inserted in the low cervical or high thoracic region.
- distal end 32 of first catheter 30 is inserted in the lumbar subarachnoid space between L4 and L5
- distal end 42 of second catheter 40 is inserted in the cervical subarachnoid space between C6 and C7.
- the distal ends of the catheters may be advanced over a needle into the subarachnoid space as described in Figs. 5A, 5B, and 5C. This method may be preferred in situations where spinal cord 75 is very swollen and rostral advancement of the second catheter through the lumbar region is difficult.
- the second catheter may be inserted in the cervical region by a radiologist under fluoroscopy.
- the CSF is aspirated through either catheter to the pump, cooled to below body temperature through a refrigeration system, and passed to the other catheter.
- the CSF is aspirated from the first catheter in the lumbar region, and the cooled CSF or CSF/Ringer's lactate mixture is returned to the second catheter in the cervical region, closer to the site of spinal injury.
- Circulation of hypothermic CSF by inserting the distal ends of the first and second catheters in the spinal region may be sufficient to protect the brain in patients suffering from focal or hemispherical ischemia, since the spinal CSF communicates with the cerebral CSF.
- cooling of the cerebral CSF can be achieved by inserting the distal end of the first catheter between the spinous processes of two cervical vertebrae, and inserting the distal end of the second catheter in the cervical region 90 into spinal subarachnoid space 91, through foramen magnum 92 into cerebellomedullary cistern 93, or through skull burr hole 94 into the subarachnoid space 95 as depicted in Fig. 9.
- the second catheter can be inserted through a burr hole into the lateral ventricle (not shown).
- the CSF is preferably aspirated from the first catheter in the cervical region, cooled to below body temperature, and returned to the second catheter.
- the patient may be gently tilted back and forth to improve circulation of the CSF.
- This method is useful in situations where neurologic complications arise as a result of inadequate cerebral perfusion, such as cardiac arrest, cardiac failure, low cardiac output states, stroke, head injury, cerebral aneurysm surgery, open and closed cardiac surgery and aortic surgery.
- Selective cerebral cooling is advantageous over systemic cooling in that complications due to systemic cooling, such as cardiac arrhythmia, disseminated intravascular coagulopathy, and poor healing, can be avoided.
- cooling of the brain and the spinal cord by intrathecal circulation of hypothermic CSF or CSF/Ringer's lactate mixture can be achieved by inserting the first catheter in the lumbar region and the second catheter in any spinal level or through skull burr hole in the ventricle.
- intrathecal cooling of the cerebral tissue can be achieved by inserting the first catheter in the lumbar region and the second catheter one level immediately above or below the level of the first catheter insertion.
- Figs 10A and 10B depict another embodiment of the catheter having bendable region 80 at distal region 32. In Fig. 10A, the distal end of the catheter is inserted through soft tissue 71 into subarachnoid space 70.
- distal region 32 assumes a linear configuration relative to the proximal end of the catheter.
- mechanism 68 is operated to release the needle in the lumen.
- Distal region 32 of the catheter is advanced distally over the needle to insert in the subarachnoid space as depicted in Fig. 10B.
- bendable region 80 is advanced distally in the subarachnoid space over needle 66, distal region 32 assumes an angled configuration relative to the proximal end of the catheter.
- Distal port 35 can be positioned rostrally as shown in Fig. 10B or positioned caudally.
- Figs. 11 A, 11B, and 11C depict another embodiment of the device for intrathecal cooling of the CSF having bendable region 80 and side port 82 at distal region 32 of the catheter.
- the catheter has first lumen 33 and second lumen 84.
- the first lumen communicates with distal port 35, needle lumen 34, and proximal end 31, which includes thermometer 60 for measuring CSF temperature.
- the needle lumen communicates proximally with port 36, which can be used to drain CSF when the CSF pressure exceeds a desired threshold, or as an infusion port for administering fluid, such as Ringer's lactate solution, or pharmaceutical agents into the subarachnoid space.
- the second lumen communicates with side port 82 and proximal end 85, which includes manometer 55 for measuring CSF pressure.
- Cooling system 52 is connected to proximal ends 31 and 85 to provide variable cooling of the CSF.
- Slidable suture flange 69 is mounted on the catheter proximal to side port 82.
- Lumens 33 and 84 may be joined distally and separated proximally. Distal region 32 assumes a linear configuration relative to a proximal end of needle lumen 34.
- needle 66 which protrudes distal to port 35, is inserted in the subarachnoid space.
- Distal region 32 of the catheter in a linear configuration with the proximal end of lumen 34, is advanced over the needle to insert in subarachnoid space 70 as shown in Fig. 11B.
- bendable region 80 and side port 82 are advanced distally to position in subarachnoid space 70 as depicted in Fig. 11C, distal region 32 assumes an angled configuration relative to the proximal end of lumen 34 and distal port 35 is positioned rostrally in the subarachnoid space.
- Position of side port 82 is verified by back-flow of the CSF in lumen 84.
- the needle may be removed from lumen 34, leaving port 36 available to drain the CSF or infuse Ringer's lactate solution.
- Sutures can be placed on suture flange 69 to secure the catheter onto soft tissue 71.
- the CSF is drained by gravity or by a pump from port 82, passed through lumen 84, cooled by the cooling system, and returned to port 35 through lumen 33 and 34. In this way, circulation of hypothermic CSF for protecting the brain and the spinal cord is achieved by inserting the device through a single spinal level, thereby eliminating the need for two spinal punctures.
- the distal end of the catheter may include a port protecting mechanism to protect the arachnoid from folding over or a nerve root from being sucked into the distal port of the catheter, especially when the pump is used.
- net 86 which is mounted over port 35 at the distal end of the catheter, allows needle 66 to protrude distal to port 35 and prevents soft tissue from entering the port.
- fence guard 87 another embodiment of the port protecting mechanism, is mounted at the distal end of the catheter. Needle 66 is inserted through the center of the fence guard. Both the fence guard and the needle protrude distal to port 35.
- Fig. 12A net 86, which is mounted over port 35 at the distal end of the catheter, allows needle 66 to protrude distal to port 35 and prevents soft tissue from entering the port.
- fence guard 87 another embodiment of the port protecting mechanism, is mounted at the distal end of the catheter. Needle 66 is inserted through the center of the fence guard. Both the fence guard and the needle protrude distal to port 35
- releasable protecting mechanism 88 operably associated with needle 66, is mounted in the inner wall of the distal end of the catheter.
- protecting mechanism 88 is released distally overlying port 35, thereby preventing the arachnoid or a nerve root from entering the port during suction.
- net 90 having a dome-like frame, is mounted on the distal end of the catheter by hinge 89. The hinge allows net 90 to open and close, thereby covering the distal port of the catheter.
- net 90 is positioned adjacent the inner wall of the catheter, needle 66 is advanced distal to the open distal port, as depicted in Fig.
- the length of the catheter will generally be between 20 to 100 centimeters, preferably approximately between 30 and 60 centimeters.
- the inner diameter of the catheter will generally be between 0.1 and 0.6 centimeters, preferably approximately 0.3 centimeters.
Abstract
Description
Claims
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US09/287,969 | 1999-04-07 | ||
US09/287,969 US6217552B1 (en) | 1999-03-01 | 1999-04-07 | Medical device for selective intrathecal spinal cooling in aortic surgery and spinal trauma |
Publications (2)
Publication Number | Publication Date |
---|---|
WO2000059419A1 WO2000059419A1 (en) | 2000-10-12 |
WO2000059419A9 true WO2000059419A9 (en) | 2002-04-11 |
Family
ID=23105169
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/US2000/007511 WO2000059419A1 (en) | 1999-04-07 | 2000-03-21 | A medical device for selective intrathecal spinal cooling in aortic surgery and spinal trauma |
Country Status (2)
Country | Link |
---|---|
US (4) | US6217552B1 (en) |
WO (1) | WO2000059419A1 (en) |
Families Citing this family (85)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6736790B2 (en) * | 1998-02-25 | 2004-05-18 | Denise R. Barbut | Method and system for selective or isolated integrate cerebral perfusion and cooling |
US6217552B1 (en) * | 1999-03-01 | 2001-04-17 | Coaxia, Inc. | Medical device for selective intrathecal spinal cooling in aortic surgery and spinal trauma |
US6743196B2 (en) | 1999-03-01 | 2004-06-01 | Coaxia, Inc. | Partial aortic occlusion devices and methods for cerebral perfusion augmentation |
AU2002252713A1 (en) * | 2001-04-24 | 2002-11-05 | Neuron Therapeutics, Inc. | Method of delivering liquid through cerebral spinal pathway |
US6761715B2 (en) * | 2001-04-26 | 2004-07-13 | Ronald J. Carroll | Method and device for neurocryo analgesia and anesthesia |
US8123789B2 (en) * | 2002-04-29 | 2012-02-28 | Rohit Khanna | Central nervous system cooling catheter |
US6699269B2 (en) * | 2001-04-30 | 2004-03-02 | Rohit K. Khanna | Selective brain and spinal cord hypothermia method and apparatus |
US6830579B2 (en) | 2001-05-01 | 2004-12-14 | Coaxia, Inc. | Devices and methods for preventing distal embolization using flow reversal and perfusion augmentation within the cerebral vasculature |
US20030028137A1 (en) * | 2001-05-18 | 2003-02-06 | Levin Bruce H. | Novel hypothermic modalities and direct application of protective agents to neural structures or into CSF |
US7011647B2 (en) * | 2001-07-13 | 2006-03-14 | Scimed Life Systems, Inc. | Introducer sheath |
US20030093105A1 (en) * | 2001-07-13 | 2003-05-15 | Scimed Life Systems, Inc. | Guide catheter for introduction into the subarachnoid space and methods of use thereof |
US7455666B2 (en) | 2001-07-13 | 2008-11-25 | Board Of Regents, The University Of Texas System | Methods and apparatuses for navigating the subarachnoid space |
US7150737B2 (en) * | 2001-07-13 | 2006-12-19 | Sci/Med Life Systems, Inc. | Methods and apparatuses for navigating the subarachnoid space |
US6623514B1 (en) | 2001-08-01 | 2003-09-23 | Origin Medsystems, Inc. | Method of cooling an organ |
US6929656B1 (en) | 2001-09-14 | 2005-08-16 | Medcool, Inc. | Method and device for reducing secondary brain injury |
US7144418B1 (en) | 2001-11-02 | 2006-12-05 | Medcool, Inc. | Method, and system for selective cerebral hypothermia |
AU2002357805A1 (en) * | 2001-12-07 | 2003-06-23 | Neuron Therapeutics | Protection of neurological tissue by direct cns perfusion cooling |
US7156867B2 (en) * | 2001-12-31 | 2007-01-02 | Medcool, Inc. | Uniform selective cerebral hypothermia |
US7241307B2 (en) * | 2001-12-31 | 2007-07-10 | Medcool, Inc. | Method and apparatus for managing temperature in a patient |
US9694166B2 (en) | 2002-03-26 | 2017-07-04 | Medtronics Ps Medical, Inc. | Method of draining cerebrospinal fluid |
US20030220675A1 (en) * | 2002-05-21 | 2003-11-27 | Coin C. Gene | Method of cooling the central nervous system |
JP4474590B2 (en) * | 2002-06-17 | 2010-06-09 | 厚夫 森 | Local cooling catheter and local cooling device using the same |
CA2411569A1 (en) * | 2002-11-12 | 2004-05-12 | Ross E. Mantle | Medical device for the extravascular recirculation of fluid in body cavities at controlled temperature and pressure |
US7004961B2 (en) * | 2003-01-09 | 2006-02-28 | Edward Wong | Medical device and method for temperature control and treatment of the brain and spinal cord |
US20040167466A1 (en) * | 2003-02-21 | 2004-08-26 | Drasler William J. | Delivering cooled fluid to sites inside the body |
US7442372B2 (en) | 2003-08-29 | 2008-10-28 | Biomarin Pharmaceutical Inc. | Delivery of therapeutic compounds to the brain and other tissues |
WO2005034801A2 (en) * | 2003-10-08 | 2005-04-21 | The General Hospital Corporation D/B/A Massachusetts General Hospital | Pain management using localized hypothermia |
US6980466B2 (en) * | 2004-01-15 | 2005-12-27 | Hewlett-Packard Development Company, L.P. | Soft-reference four conductor magnetic memory storage device |
US20080214951A1 (en) * | 2004-02-03 | 2008-09-04 | Neuro Diagnostic Devices, Inc. | Cerebrospinal Fluid Evaluation Systems |
US7520862B2 (en) * | 2004-02-03 | 2009-04-21 | Neuro Diagnostic Devices, Inc. | Cerebral spinal fluid shunt evaluation system |
US7318834B2 (en) * | 2004-02-09 | 2008-01-15 | Philip Chidi Njemanze | Apparatus and method for hypothermia and rewarming by altering the temperature of the cerebrospinal fluid in the brain |
EP1773219A2 (en) * | 2004-06-24 | 2007-04-18 | BCU International | Method and medical device for rapid and accurate entry through soft tissue and bone |
US7789846B2 (en) * | 2005-01-25 | 2010-09-07 | Thermopeutix, Inc. | System and methods for selective thermal treatment |
US20060175543A1 (en) * | 2005-02-08 | 2006-08-10 | John Elefteriades | Intra-thecal catheter and method for cooling the spinal cord |
US7513883B2 (en) | 2005-04-05 | 2009-04-07 | Glenn Bradley J | Subarachnoid epidural shunt |
US7699799B2 (en) * | 2005-08-26 | 2010-04-20 | Ceeben Systems, Inc. | Ultrasonic material removal system for cardiopulmonary bypass and other applications |
US20180311071A1 (en) * | 2005-10-21 | 2018-11-01 | Daniel R. BURNETT | Method and apparatus for peritoneal oxygenation |
US20070093697A1 (en) * | 2005-10-21 | 2007-04-26 | Theranova, Llc | Method and apparatus for detection of right to left shunting in the cardiopulmonary vasculature |
US20070225781A1 (en) * | 2006-03-21 | 2007-09-27 | Nidus Medical, Llc | Apparatus and methods for altering temperature in a region within the body |
US7822485B2 (en) * | 2006-09-25 | 2010-10-26 | Zoll Circulation, Inc. | Method and apparatus for spinal cooling |
US10632237B2 (en) | 2006-10-09 | 2020-04-28 | Minnetronix, Inc. | Tangential flow filter system for the filtration of materials from biologic fluids |
ES2845146T3 (en) | 2006-10-09 | 2021-07-26 | Neurofluidics Inc | Cerebrospinal fluid purification system |
US10850235B2 (en) | 2006-10-09 | 2020-12-01 | Minnetronix, Inc. | Method for filtering cerebrospinal fluid (CSF) including monitoring CSF flow |
EP2155300A1 (en) | 2007-04-05 | 2010-02-24 | Velomedix, Inc | Automated therapy system and method |
WO2008124643A1 (en) * | 2007-04-05 | 2008-10-16 | Velomedix, Inc. | Device and method for safe access to a body cavity |
US20080249501A1 (en) * | 2007-04-09 | 2008-10-09 | Medtronic Vascular, Inc. | Methods for Simultaneous Injection and Aspiration of Fluids During a Medical Procedure |
CA2693774A1 (en) * | 2007-07-09 | 2009-01-15 | Velomedix, Inc. | Hypothermia devices and methods |
EP3964243A1 (en) * | 2008-01-28 | 2022-03-09 | Implantica Patent Ltd | Blood clot removal device, system, and method |
EP2092943A1 (en) * | 2008-02-21 | 2009-08-26 | Universität Bern | Implantable access for removal and/or return of fluids |
AU2009313320A1 (en) * | 2008-11-07 | 2010-05-14 | Velomedix, Inc. | Devices and methods for monitoring core temperature and an intraperitoneal parameter |
EP2393460A4 (en) * | 2009-02-06 | 2012-06-27 | Velomedix Inc | Method and apparatus for inducing therapeutic hypothermia |
US8608696B1 (en) | 2009-02-24 | 2013-12-17 | North Carolina State University | Rapid fluid cooling devices and methods for cooling fluids |
US8905968B2 (en) | 2009-04-29 | 2014-12-09 | Encephalon Technologies, Llc | System for cooling and pressurizing fluid |
US20110092955A1 (en) | 2009-10-07 | 2011-04-21 | Purdy Phillip D | Pressure-Sensing Medical Devices, Systems and Methods, and Methods of Forming Medical Devices |
CA2805448A1 (en) | 2010-06-25 | 2011-12-29 | Shire Human Genetic Therapies, Inc. | Methods and compositions for cns delivery of iduronate-2-sulfatase |
EP3875107A1 (en) * | 2010-06-25 | 2021-09-08 | Shire Human Genetic Therapies, Inc. | Pharmaceutical formulation comprising a replacement enzyme for a lysosomal enzyme for use in treating lysosomal storage disease intrathecally |
KR20140005842A (en) | 2010-06-25 | 2014-01-15 | 샤이어 휴먼 지네틱 테라피즈 인크. | Methods and compositions for cns delivery of heparan n-sulfatase |
PE20130578A1 (en) | 2010-06-25 | 2013-05-19 | Shire Human Genetic Therapies | COMPOSITIONS AND METHODS FOR SUPPLYING THE CENTRAL NERVOUS SYSTEM OF HEPARAN N-SULFATASE |
AU2011270672B2 (en) | 2010-06-25 | 2017-01-12 | Shire Human Genetic Therapies, Inc. | Treatment of Sanfilippo Syndrome type B |
CA2803003C (en) | 2010-06-25 | 2022-11-22 | Shire Human Genetic Therapies, Inc. | Methods and compositions for cns delivery of arylsulfatase a |
WO2012006625A2 (en) | 2010-07-09 | 2012-01-12 | Velomedix, Inc. | Method and apparatus for pressure measurement |
EP2736581A4 (en) | 2011-07-25 | 2015-11-04 | Neurosave Inc | Non-invasive systems, devices, and methods for selective brain cooling |
CA2852027A1 (en) | 2011-10-12 | 2013-04-18 | Synageva Biopharma Corp. | Recombinant human naglu protein and uses thereof |
EP2599465B1 (en) * | 2011-12-02 | 2015-08-19 | Schiller Medical S.A.S. | Device for intracorporally cooling a patient |
EA201792099A1 (en) | 2011-12-23 | 2018-05-31 | Шир Хьюман Дженетик Терапис, Инк. | TREATMENT OF COGNITIVE DISTURBANCES IN HANTER'S SYNDROME THROUGH INTRATECAL DELIVERY OF IURONAT-2-SULFATASE |
EP2793922B1 (en) | 2011-12-23 | 2019-10-30 | Shire Human Genetic Therapies, Inc. | Stable formulations for cns delivery of arylsulfatase a |
RU2475281C1 (en) * | 2012-02-16 | 2013-02-20 | Сергей Петрович Бажанов | Method of local hypothermia of spinal cord in case of complicated traumatic injuries of cervical spine |
AU2013204200B2 (en) | 2012-10-11 | 2016-10-20 | Brandeis University | Treatment of amyotrophic lateral sclerosis |
SI3115372T1 (en) | 2012-11-27 | 2019-08-30 | Biomarin Pharmaceutical Inc. | Targeted therapeutic lysosomal enzyme fusion proteins and uses thereof |
US20150313971A1 (en) | 2012-12-07 | 2015-11-05 | Shire Human Genetic Therapies | Methods and compositions for intrathecally administered treatment of mucupolysaccharidosis type iiia |
US9668741B2 (en) | 2013-08-14 | 2017-06-06 | Zoll Circulation, Inc. | Aortic occluder with tensioned balloons |
US9931490B2 (en) | 2013-12-17 | 2018-04-03 | Zoll Circulation, Incorporated | Control system for arterial catheter |
US9737693B2 (en) | 2013-12-17 | 2017-08-22 | Zoll Circulation, Inc. | Control system for arterial catheter |
WO2016005422A1 (en) | 2014-07-09 | 2016-01-14 | INSERM (Institut National de la Santé et de la Recherche Médicale) | Methods and compositions for treating neuropathic pain |
CA2916283A1 (en) | 2015-01-09 | 2016-07-09 | Pfizer Inc. | Dosage regimen for madcam antagonists |
CN104800965B (en) * | 2015-05-21 | 2018-02-13 | 中国人民解放军第二军医大学 | Spinal cord empty cavum subarachnoidale microinvasion part flow arrangement |
US11147540B2 (en) | 2015-07-01 | 2021-10-19 | Minnetronix, Inc. | Introducer sheath and puncture tool for the introduction and placement of a catheter in tissue |
US10639356B2 (en) | 2015-07-20 | 2020-05-05 | Shire Human Genetic Therapies, Inc. | Treatment of cognitive impairment of mucopolysaccharidosis type IIIA by intrathecal delivery of heparan N-sulfatase |
EP3359071A4 (en) * | 2015-10-06 | 2019-06-05 | Minnetronix Inc. | Devices and methods for providing focal cooling to the brain and spinal cord |
CN108778355B (en) | 2015-12-04 | 2021-04-30 | 米奈特朗尼克斯有限公司 | Systems and methods for regulating cerebrospinal fluid |
CN108883162A (en) | 2016-02-17 | 2018-11-23 | 夏尔人类遗传性治疗公司 | The method and composition that CNS for Arylsulfatase A is delivered |
AU2017222620B2 (en) | 2016-02-24 | 2022-06-16 | Biomarin Pharmaceutical Inc. | Targeted therapeutic lysosomal enzyme fusion proteins, associated formulations and uses thereof |
US10849787B2 (en) * | 2017-09-15 | 2020-12-01 | Rohit Khanna | Method and apparatus for treating the brain and/or spinal cord using a catheter |
WO2019099583A1 (en) * | 2017-11-15 | 2019-05-23 | Alcyone Lifesciences, Inc. | Therapy specific, pre-programmed auto injection device |
BR112020012637A2 (en) | 2017-12-19 | 2020-12-01 | Shire Human Genetic Therapies, Inc | purified arylsulfatase a and compositions thereof |
Family Cites Families (9)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4795423A (en) * | 1980-04-14 | 1989-01-03 | Thomas Jefferson University | Oxygenated perfluorinated perfusion of the ocular globe to treat ischemic retinopathy |
US4393863A (en) * | 1980-04-14 | 1983-07-19 | Thomas Jefferson University | Extravascular circulation of oxygenated synthetic nutrients to treat tissue hypoxic and ischemic disorders |
US5085630A (en) * | 1980-04-14 | 1992-02-04 | Thomas Jefferson University | Oxygenated fluorocarbon nutrient solution |
US4445887A (en) * | 1982-03-03 | 1984-05-01 | Thomas Jefferson University | Stroke treatment utilizing extravascular circulation of oxygenated synthetic nutrients to treat tissue hypoxic and ischemic disorders |
US4781672A (en) * | 1986-10-21 | 1988-11-01 | Cordis Corporation | Three stage implantable flow control valve with improved valve closure member |
US4904237A (en) * | 1988-05-16 | 1990-02-27 | Janese Woodrow W | Apparatus for the exchange of cerebrospinal fluid and a method of treating brain and spinal cord injuries |
US6217552B1 (en) * | 1999-03-01 | 2001-04-17 | Coaxia, Inc. | Medical device for selective intrathecal spinal cooling in aortic surgery and spinal trauma |
AU4713601A (en) * | 1999-12-07 | 2001-06-18 | Alsius Corporation | Method and system for treating stroke using hypothermia |
US7004961B2 (en) * | 2003-01-09 | 2006-02-28 | Edward Wong | Medical device and method for temperature control and treatment of the brain and spinal cord |
-
1999
- 1999-04-07 US US09/287,969 patent/US6217552B1/en not_active Expired - Lifetime
-
2000
- 2000-03-21 WO PCT/US2000/007511 patent/WO2000059419A1/en active Application Filing
-
2001
- 2001-03-29 US US09/823,168 patent/US6379331B2/en not_active Expired - Lifetime
-
2002
- 2002-03-05 US US10/092,743 patent/US6758832B2/en not_active Expired - Lifetime
-
2004
- 2004-07-02 US US10/884,124 patent/US20040243058A1/en not_active Abandoned
Also Published As
Publication number | Publication date |
---|---|
US20010020159A1 (en) | 2001-09-06 |
US20020091356A1 (en) | 2002-07-11 |
US20040243058A1 (en) | 2004-12-02 |
US6379331B2 (en) | 2002-04-30 |
US6758832B2 (en) | 2004-07-06 |
WO2000059419A1 (en) | 2000-10-12 |
US6217552B1 (en) | 2001-04-17 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
US6217552B1 (en) | Medical device for selective intrathecal spinal cooling in aortic surgery and spinal trauma | |
US10716921B2 (en) | Methods of using a dual-lumen sheath in intraluminal procedures | |
US7150737B2 (en) | Methods and apparatuses for navigating the subarachnoid space | |
Timofeev et al. | Decompressive craniectomy—operative technique and perioperative care | |
Trupp et al. | Vascular tumors of the brain and spinal cord and their treatment | |
US11690985B2 (en) | Systems and methods for single puncture percutaneous reverse blood flow | |
Guidetti | Removal of extramedullary benign spinal cord tumours | |
Fàbregas et al. | Anaesthesia for minimally invasive neurosurgery | |
Luyendijk | The operative approach to the posterior fossa | |
Mukherjee et al. | In-depth view: how to perform a lumboperitoneal CSF shunt | |
KR102076981B1 (en) | Sacral Hiatus Entering Drill for Percutaneous Epidural Neuroplasty | |
Chung et al. | Navigation-assisted minimally invasive bullet removal in the lumbar spine: a case report | |
Zucker et al. | The combined subcranial-pterional approach to the anterolateral skull base | |
Brown | Local hypothermia | |
Udekwu et al. | 1565: PREDICTORS OF POOR OUTCOMES IN NEAR-HANGING WITH AND WITHOUT THERAPEUTIC HYPOTHERMIA | |
Bruno et al. | 1566: CORRELATION OF NEAR-INFRARED SPECTROSCOPY WITH CEREBRAL BLOOD FLOW IN A TRAUMATIC BRAIN INJURY MODEL | |
Shafik | Hollow and fenestrated penile prosthesis: a new implant for treatment of impotence | |
Onesti et al. | The transparaspinal approach to dumbbell-shaped spinal tumors |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
AK | Designated states |
Kind code of ref document: A1 Designated state(s): CA JP |
|
AL | Designated countries for regional patents |
Kind code of ref document: A1 Designated state(s): AT BE CH CY DE DK ES FI FR GB GR IE IT LU MC NL PT SE |
|
121 | Ep: the epo has been informed by wipo that ep was designated in this application | ||
DFPE | Request for preliminary examination filed prior to expiration of 19th month from priority date (pct application filed before 20040101) | ||
AK | Designated states |
Kind code of ref document: C2 Designated state(s): CA JP |
|
AL | Designated countries for regional patents |
Kind code of ref document: C2 Designated state(s): AT BE CH CY DE DK ES FI FR GB GR IE IT LU MC NL PT SE |
|
COP | Corrected version of pamphlet |
Free format text: PAGES 1/14-14/14, DRAWINGS, REPLACED BY NEW PAGES 1/14-14/14; DUE TO LATE TRANSMITTAL BY THE RECEIVING OFFICE |
|
122 | Ep: pct application non-entry in european phase |