Cerebrospinal fluid shunt

Abstract

A method including: introducing a shunt into a vascular system, wherein the shunt includes an inlet aperture in an inlet region and an outlet aperture in an outlet region; positioning the inlet region into an epidural or intervertebral vein; with a stylet, puncturing a wall of the epidural or intervertebral vein, traversing an interstitial space, and puncturing a thecal sac, wherein the stylet includes a wire extending through the shunt; moving the shunt to cause the inlet region to extend through a wall of the epidural or intervertebral vein; moving the shunt to cause the inlet region to extend into an interstitial space; and moving the shunt to cause the inlet region to extend through the thecal sac, such that the inlet region is positioned in an intradural space, and such that the outlet region is positioned in a venous pathway.

Description

Abstract This invention relates to a method comprising: introducing a shunt into a vascular system, wherein the shunt includes an inlet orifice in an inlet region and an outlet orifice in an outlet region; positioning the inlet region into an epidural vein or intervertebral vein; puncturing the wall of the epidural vein or intervertebral vein with a catheter, passing through the interstitial space, and puncturing the sheath, wherein the catheter includes a wire extending through the shunt; moving the shunt such that the inlet region extends through the wall of the epidural vein or intervertebral vein; moving the shunt such that the inlet region extends into the interstitial space; and moving the shunt such that the inlet region extends through the sheath, thereby positioning the inlet region within the dural lumen and positioning the outlet region within the venous pathway.

Claims

CLAIMS1. A method for endovenously positioning a cerebrospinal fluid shunt in a patient, the method comprising: introducing the cerebrospinal fluid shunt into a vascular system of the patient, wherein the cerebrospinal fluid shunt includes an inlet aperture in an inlet region and an outlet aperture in an outlet region, wherein the inlet aperture and the outlet aperture are in fluid communication with each other; positioning the inlet region of the cerebrospinal fluid shunt into an epidural vein or an intervertebral vein; with a stylet, puncturing a wall of the epidural vein or the intervertebral vein, traversing an interstitial space, and puncturing a thecal sac, wherein the stylet includes a wire extending through the cerebrospinal fluid shunt; moving the cerebrospinal fluid shunt to cause the inlet region to extend through a wall of the epidural vein or the intervertebral vein; subsequent to moving the cerebrospinal fluid shunt to cause the inlet region to extend through a wall of the epidural vein or the intervertebral vein, moving the cerebrospinal fluid shunt to cause the inlet region to extend into an interstitial space; and subsequent to moving the cerebrospinal fluid shunt to cause the inlet region to extend into the interstitial space, moving the cerebrospinal fluid shunt to cause the inlet region to extend through the thecal sac, such that the inlet region of the cerebrospinal fluid shunt is positioned in an intradural space, and such that the outlet region of the cerebrospinal fluid shunt is positioned in a venous pathway.

2. The method of claim 1 , wherein the epidural vein or the intervertebral vein is located in a lumbar region of the patient.

3. The method of claim 1, wherein the epidural vein or the intervertebral vein is located in a thoracic region of the patient.

4. The method of claim 1, wherein the epidural vein or the intervertebral vein is located in a cervical region of the patient.

5. The method of claim 1, wherein the epidural vein or the intervertebral vein is located in a sacrum of the patient.

6. The method of claim 1, wherein the venous pathway where the outlet aperture of the cerebrospinal fluid shunt is located includes at least one of an epidural vein, an intervertebral vein, a paraspinal vein, a lumbar vein, an iliac vein, a femoral vein, an azygos vein, a hemiazygos vein, an inferior vena cava, a superior vena cava, a right atrium of a heart, or a vein tributary of the inferior vena cava or superior vena cava.

7. The method of claim 1 , further comprising, subsequent to puncturing the thecal sac, deploying an anchor within the intradural space to stabilize the inlet region of the cerebrospinal fluid shunt with respect to the thecal sac.

8. The method of claim 1, further comprising, prior to puncturing the thecal sac, deploying a limiter at least partially in the interstitial space, wherein the limiter determines a maximum length of the cerebrospinal fluid shunt that extends through the thecal sac and into the intradural space.

9. The method of claim 8, wherein said deploying a limiter comprises expanding the limiter such that an outer radius of the limiter is greater than an outer radius of a transverse region of the cerebrospinal fluid shunt between the inlet region and the outlet region.

10. The method of claim 1, wherein the outlet region of the cerebrospinal fluid shunt is located in one of an epidural vein, an intervertebral vein, a lumbar vein, an iliac vein, or a perivertebral vein when the inlet region of the cerebrospinal fluid shunt is located in the intradural space.

11. The method of claim 1, wherein the cerebrospinal fluid shunt comprises silicone.1 . The method of claim 1 , wherein the cerebrospinal fluid shunt comprises polyurethane.

13. The method of claim 1, wherein the cerebrospinal fluid shunt comprises nitinol.

14. The method of claim 1, wherein the cerebrospinal fluid shunt comprises at least one radiopaque marker.

15. The method of claim 1, wherein the cerebrospinal fluid shunt comprises a material on at least one of an exterior of the cerebrospinal fluid shunt or an interior of the inlet region configured to reduce at least one of coagulation of blood, aggregation of proteins, or aggregation of cells.

16. The method of claim 1, wherein the cerebrospinal fluid shunt comprises an anti-reflux mechanism between the inlet aperture and the outlet aperture, wherein the anti-reflux mechanism is configured to reduce or prevent retrograde migration of blood.

17. The method of claim 1, wherein the cerebrospinal fluid shunt comprises a flow regulator between the inlet aperture and the outlet aperture, wherein the flow regulator is configured to regulate a flow of cerebrospinal fluid between the inlet aperture and the outlet aperture.

18. The method of claim 1, wherein said introducing the cerebrospinal fluid shunt into the vascular system of the patient comprises introducing the cerebrospinal fluid shunt into a vein of a leg, a vein of a neck, or a vein of an arm.

19. The method of claim 1, further comprising removing the cerebrospinal fluid shunt by engaging with a shunt removal feature on the cerebrospinal fluid shunt.

20. The method of claim 1, further comprising, temporarily enlarging at at least one enlargement location, at least one of the aperture through one of the epidural vein wall or the intervertebral vein wall, a region of interstitial space, or the aperture through the thecal sac by positioning a balloon at the at least one enlargement location and then inflating the balloon to perform enlarging before or during passage of the shunt through the at least one enlargement location.

21. A cerebrospinal fluid shunt for placement in a patient, the cerebrospinal fluid shunt comprising: an inlet region configured to pass through an aperture in an epidural vein wall or an intervertebral vein wall, to pass through an aperture in a thecal sac, and to pass through an interstitial space between one of the epidural vein wall or the intervertebral vein wall and the thecal sac; an inlet aperture in the inlet region, wherein the inlet aperture is configured to receive cerebrospinal fluid from an intradural space; an outlet region configured to be positioned in a venous pathway; an outlet aperture in the outlet region, wherein the outlet aperture is in fluid communication with the inlet aperture, wherein the outlet aperture is configured to permit flow the cerebrospinal fluid received by the inlet region out of the cerebrospinal fluid shunt;a transverse region between the inlet region and the outlet region, wherein the transverse region comprises a channel to enable fluid communication between the inlet aperture and the outlet aperture; and an insertion-limiting portion located in the transverse region, wherein the insertionlimiting portion configured to be positioned in the interstitial space between the epidural vein wall or the intervertebral vein wall and the thecal sac.

22. The cerebrospinal fluid shunt of claim 21, further comprising: at least one radio opaque marker at least partially located in the inlet region; at least one radio opaque marker located at least partially in the transverse region; and at least one radio opaque marker located at least partially in the outlet region.

23. The cerebrospinal fluid shunt of claim 22, wherein the inlet region comprises a bulbous head region.

24. The cerebrospinal fluid shunt of claim 23, wherein the insertion-limiting portion comprises a radially-protruding portion, and wherein the bulbous head region and the radially-protruding portion are integrated in one piece.

25. The cerebrospinal fluid shunt of claim 24, wherein the one piece is coupled to another portion of the cerebrospinal fluid shunt including the outlet region.

26. A system for positioning a cerebrospinal fluid shunt in a patient, the system comprising: a guide catheter configured to slide over a proximal region of a guidewire positioned in a venous system of the patient, wherein the guide catheter comprises a proximal region and a distal region, wherein the guide catheter comprises ananchor configured to anchor the distal region of the guide catheter at a location in the venous system of the patient; an adapter coupled with the proximal region of the guide catheter, wherein the adapter is configured to selectively prevent fluids from flowing from the patient and out of the adapter; a sheath including a proximal region and a distal region, wherein the sheath is at least partially positioned within the guide catheter; a shunt at least partially positioned between the guide catheter and the sheath, wherein the shunt comprises an inlet region including an inlet aperture, an outlet region including an outlet aperture, and a transverse region between the inlet region and the outlet region, wherein the transverse region comprises a channel such that the inlet aperture is in fluid communication with the outlet aperture, wherein the transverse region is configured to extend through a vein wall and through an interstitial space, wherein the inlet region is configured to extend through a thecal sac and into an intradural space, and wherein the outlet region is configured to be positioned in a venous pathway; and a wire configured to extend through the shunt and at least partially out of the inlet aperture, wherein the wire comprises a proximal region and a distal region, and wherein the distal region is configured to puncture the vein wall and the thecal sac.

27. The system of claim 26, wherein the anchor of the guide catheter comprises a balloon.

28. The system of claim 26, wherein the inlet region of the shunt further comprises an anchor configured to stabilize the inlet region with respect to the thecal sac.

29. The system of claim 26, wherein the sheath comprises a retractable sheath.

30. The system of claim 26, wherein the transverse region comprises a limiter configured to limit a distance of insertion of the shunt into the patient.

31. A method for endovenously positioning a cerebrospinal fluid shunt in a patient, the method comprising: introducing the cerebrospinal fluid shunt into a vascular system of the patient, wherein the cerebrospinal fluid shunt includes an inlet aperture in an inlet region and an outlet aperture in an outlet region, wherein the inlet aperture and the outlet aperture are in fluid communication with each other; positioning the inlet region of the cerebrospinal fluid shunt into an epidural vein or an intervertebral vein; subsequent to positioning the inlet region of the cerebrospinal fluid shunt the epidural vein or the intervertebral vein, moving the cerebrospinal fluid shunt to cause the inlet region to extend into an interstitial space; and subsequent to moving the cerebrospinal fluid shunt to cause the inlet region to extend into an interstitial space, moving the cerebrospinal fluid shunt to cause the inlet region to pass through an aperture thecal sac, such that the inlet region of the cerebrospinal fluid shunt is positioned at least partially in an intradural space, and such that the outlet region of the cerebrospinal fluid shunt is positioned in a venous pathway.

32. A method for endovenously positioning a cerebrospinal fluid shunt in a patient, the method comprising: introducing the cerebrospinal fluid shunt into a vascular system of the patient, wherein the cerebrospinal fluid shunt includes an inlet aperture in an inlet region and an outlet aperture in an outlet region, wherein the inlet aperture and the outlet aperture are in fluid communication with each other;positioning the inlet region of the cerebrospinal fluid shunt into an epidural vein or an intervertebral vein; moving the cerebrospinal fluid shunt to cause the inlet region to pass through an aperture in a wall of the epidural vein or the intervertebral vein; and subsequent to moving the cerebrospinal fluid shunt to cause the inlet region to pass through a wall of the epidural vein or the intervertebral vein, moving the cerebrospinal fluid shunt to cause the inlet region to pass through an aperture in a thecal sac, such that the inlet region of the cerebrospinal fluid shunt is positioned at least partially within an intradural space, and such that the outlet region of the cerebrospinal fluid shunt is positioned in a venous pathway.

33. A method for endovenously positioning a cerebrospinal fluid shunt in a patient, the method comprising: introducing the cerebrospinal fluid shunt into a vascular system of the patient, wherein the cerebrospinal fluid shunt includes an inlet aperture in an inlet region and an outlet aperture in an outlet region, wherein the inlet aperture and the outlet aperture are in fluid communication with each other; positioning the inlet region of the cerebrospinal fluid shunt into an epidural vein or an intervertebral vein; moving the cerebrospinal fluid shunt to cause the inlet region to extend through a wall of the epidural vein or the intervertebral vein; subsequent to moving the cerebrospinal fluid shunt to cause the inlet region to extend through a wall of the epidural vein or the intervertebral vein, moving the cerebrospinal fluid shunt to cause the inlet region to extend into an interstitial space; and subsequent to moving the cerebrospinal fluid shunt to cause the inlet region to extend into the interstitial space, moving the cerebrospinal fluid shunt to cause the inlet region to extend through a thecal sac, such that the inlet region of thecerebrospinal fluid shunt is positioned in an intradural space, and such that the outlet region of the cerebrospinal fluid shunt is in fluid communication with at least one of a reservoir positioned at under a skin of the patient or a transdermal port.

34. The method of claim 33, wherein the transdermal port is configured to at least one of permit delivery of a drug to the patient, drain CSF, or facilitate measurement of CSF pressure.

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