Device and method for neuromodulation
View Patent ↗The present invention relates to a preoperative test method, to an implantation system ( 20 ) and to an implantation method for implanting a neuroprosthesis in the area of the pubic bone ( 31 ), wherein implantation is ultimately simplified and made more effective directly or indirectly by the subject-matters of the invention.
1. An implantation method for a wire electrode means ( 8 ) into the pelvic area of a human body ( 13 ), the implantation method comprising the method steps of:
producing a first temporary implantation channel ( 7 ) running from the genital area ( 12 ) behind the pubic bone ( 31 ) to the abdominal wall ( 5 ) for receiving the wire electrode means ( 8 );
introducing the wire electrode means ( 8 ) into the first temporary implantation channel ( 7 ) from the abdominal wall ( 5 ) in such a manner that a contact portion ( 9 ) of the wire electrode means ( 8 ) protrudes from the human body ( 13 );
producing a second temporary implantation channel ( 17 ) which runs under the pubic bone ( 31 ) in the genital area ( 12 ) and whose exit area ( 15 ) from the human body ( 13 ) coincides with an entry area ( 16 ) of the first temporary implantation channel ( 7 ) located in the genital area ( 12 ), the contact portion ( 9 ) of the wire electrode means ( 8 ) thus being introducible into the second temporary implantation channel ( 17 ),
transferring the contact portion ( 9 ) of the wire electrode means ( 8 ) protruding from the human body ( 13 ) into the second temporary implantation channel in such a manner that electrodes ( 24 ) disposed in the contact portion ( 9 ), are placed in an area of the roots of the nerves ( 19 ) in the genital area ( 12 ).
2. The method according to claim 1 , wherein the introducing step is carried out in such a manner that the contact portion ( 9 ) protrudes from the first temporary implantation channel ( 7 ), in the genital area.
3. The method according to claim 1 , wherein the second temporary implantation channel ( 17 ) is produced in an area of the pelvic floor.
4. The method according to claim 1 , wherein the electrodes ( 24 ) are circumferential electrode means.
5. The method according to claim 1 , wherein the wire electrode means ( 8 ) is anchored to a cartilage and/or bone structure.
6. The method according to claim 5 , wherein the cartilage and/or bone structure is the pubic bone ( 31 ).
7. The method according to claim 5 , wherein the wire electrode means ( 8 ) has a fixing means on the contact portion ( 9 ), the fixing means allowing the wire electrode means ( 8 ) to be fixed to the cartilage and/or bone structure.
8. The method according to claim 5 , wherein the wire electrode means ( 8 ) has a mobile fixing means in a shaft portion, the mobile fixing means allowing the wire electrode means ( 8 ) to be fixed to the cartilage and/or bone structure.
9. The method according to claim 1 , wherein the first and/or the second temporary implantation channel ( 17 ) is/are produced using a curved hollow needle applicator ( 1 ) which comprises a hollow needle channel enclosed by a shaft ( 6 ) and forming the respective first and/or second temporary implantation channel.
10. The method according to claim 9 , wherein, in the first and/or the second temporary implantation channel ( 17 ), a tip ( 4 ) is disposed on and can be removed from the hollow needle applicator ( 1 ) at a front end, and wherein the tip ( 4 ) blocks access to the hollow needle channel and fills part of the hollow needle channel.
11. The method according to claim 10 , wherein the tip ( 4 ) is extracorporeally removed from the hollow needle applicator ( 1 ) at the front end after production of the first and/or second temporary implantation channel.
12. The method according to claim 9 , wherein in the production of the first temporary implantation channel ( 7 ), the curved hollow needle applicator ( 1 ) is introduced while being in contact with a lower edge of the pubic ramus until it penetrates the urogenital diaphragm, the retropubic space and the abdominal wall ( 5 ), exit from the abdominal wall ( 5 ) being performed in such a manner that exit occurs above the pubic bone ( 31 ) and a shaft ( 6 ) of the hollow needle applicator ( 1 ) surrounding the hollow needle channel is in contact with the pubic bone ( 31 ).
13. The method according to claim 9 , the wire electrode means ( 8 ) is introduced into the hollow needle channel, and then the hollow needle applicator ( 1 ) is removed from the human body ( 13 ) by being retracted.
14. The method according to claim 13 , wherein the hollow needle applicator ( 1 ) is retracted in a direction of a puncture or in a direction of an entry point.
15. The method according to claim 1 , wherein producing the first temporary implantation channel ( 7 ) comprises making an incision, the incision being made in the genital area ( 12 ) of the human body ( 13 ), 0.5 cm to 1.5 cm below the external urethral meatus or 0.5 cm to 1.5 cm below the infrapubic parapenile.
16. The method according to claim 15 , wherein producing the second temporary implantation channel ( 17 ) comprises making a second incision, the second incision, on a median axis of the human body, being made below the caudal border of the inferior pubic ramus, just above the root of the penis or the clitoral glands and laterally offset therefrom by 3 mm to 5 mm.
17. The method according to claim 1 , wherein a connecting end of the wire electrode means ( 8 ) that faces away from the contact portion ( 9 ) is connected to a pacemaker ( 21 ) which is placed behind the pubic bone ( 31 ), opposite the contact portion ( 9 ) of the wire electrode means ( 8 ).
18. The method according to claim 1 , wherein the surgical method steps are performed under general anesthesia, spinal anesthesia or epidural anesthesia.