Patent Publication Number: US-10772759-B2

Title: Central nervous system treatment device and methodology

Description:
BACKGROUND OF THE INVENTION 
     The current invention relates to regulation of the temperature in the brain and spinal cord. The invention describes a method and apparatus for altering the temperature of the brain and/or the cerebrospinal fluid in the ventricles of the brain and surrounding the brain and spinal cord. Hypothermia has been shown to provide cerebral and spinal cord injury protection from either trauma, ischemia, or hypoxia. Ischemia may occur from cardiac arrest, cardiac failure, stroke, head or spinal cord injury, aneurysm surgery, cardiac surgery, and aortic or carotid surgery. Hypothermia is also effective in reducing increased intracranial pressure from cerebral swelling. The mechanisms involved in hypothermic cerebral protection are several-fold and include 1) reduction in cerebral glucose and oxygen metabolism and decreasing lactate content following injury, 2) preventing disruption of the blood brain barrier and consequently reducing cerebral edema, 3) reduction of endogenously toxic neurotransmitters like glutamate, glycine, aspartate, acetylcholine, and norepinephrine into the brain after injury, 4) inhibit excessive calcium entry and intracellular calcium overload into neurons, 5) protecting membrane structural proteins like microtubule-associated protein-2, and 6) preventing diffuse axonal injury following brain trauma. 
     In general, the human brain and spinal cord are maintained at a constant temperature of approximately 37 to 38 degrees celsius. Hypothermia is considered mild when the body temperature is 33 to 35 degrees celsius, moderate between the temperatures of 28 to 32 degrees, and severe in the temperature range of 24 to 28 degrees celsius. Most studies in humans have involved mild to moderate systemic hypothermia mainly because of the significant side effects that occur from induced systemic hypothermia. These include infection, cardiac arrhythmias, coagulopathy, renal failure, as well as rewarming shock. In order to avoid these complications the degree and duration of hypothermia has been shortened thereby limiting its effectiveness. 
     Generally, cooling of the brain has been accomplished through whole body cooling with use of a cooling blanket, immersing the patient in ice, or cooling the blood through a cardiopulmonary bypass machine. A few methods have been described regarding selective brain and spinal cord hypothermia. These involve cooling the arterial vessel or blood supply to the brain or external cooling helmets, each with its own significant limitations. 
     Several catheters have been developed to induce systemic hypothermia by inserting them into the bloodstream. More recently catheters have been developed that can be inserted into the arterial vessels to the brain to induce selective brain hypothermia. These catheters are limited in their size and functionality by the small vessel lumen as well the inability to cool all the four major arterial vessels supplying blood to the brain and are unable to cool the spinal cord via this methodology. They also carry the risk of ischemic and thromboembolic stroke by either impairing the blood flow to the brain or dislodging clots that can develop in intra-arterial catheters. 
     External cooling helmets have limited effectiveness since the blood to the cooled scalp does not circulate into the brain and returns systemically which along with the thick skull dilutes the hypothermic effect to the brain. 
     Selective brain and spinal cord cooling with insertion of closed loop system catheters into the ventricular, subdural or epidural space was first described in U.S. Pat. No. 6,699,269 to Khanna. It also describes a catheter that expands with circulation of a coolant without direct contact of the coolant with the central nervous system. This avoids the side effects and complications seen from other methods of cooling. It also circumvents infection and fluid overload with exacerbation of brain swelling that can be potentially encountered with cooling systems involving circulating the cerebrospinal fluid. This patent also relates a methodology for cerebrospinal fluid drainage to relieve an increase in ICP. U.S. application Ser. No. 11/418,849 by the applicant relates a method and apparatus for selective central nervous system cooling with a balloon catheter. Although the balloon is used to increase the surface area of cerebrospinal fluid contact to facilitate heat exchange, all of the prior art relates dilation of the balloon to a preset volume. Balloon dilation inside the central nervous system has a significant potential for raising the intracranial pressure especially when there is pathology and/or swelling in the brain and spinal cord. Dilating the balloon to a preset volume may not be the best methodology since different patients will tolerate different levels of central nervous system volume increase. Even a few milliliters of volume increase inside the head or spine with a swollen brain and spinal cord can risk severe further injury. Another limitation of the prior technique is cooling of the cerebrospinal fluid in a stagnant cerebrospinal fluid which limits the extent of selective central nervous system cooling. There remains a need for faster and more uniform methodology for selective central nervous hypothermia induction and central nervous system pathology treatment. 
     SUMMARY OF THE INVENTION 
     The invention provides a method and apparatus for treatment of central nervous system pathology. This is achieved by performing selective hypothermia to the brain and/or the spinal cord for injury protection without the need for systemic cooling as well as drainage any excess cerebrospinal fluid or hemorrhage through the device. 
     For selective brain cooling, in one embodiment of the present invention, a flexible heat exchange catheter is inserted into the cerebrospinal fluid space. The catheter has an inflow and outflow lumen for circulation of a coolant by an external regulator. The portion of the catheter in contact with the cerebrospinal fluid can expand into a balloon in a peristaltic format. The peristaltic expansion and contraction creates pulsations in the cerebrospinal fluid and circulates the cooled cerebrospinal fluid, thereby uniformly cooling the brain and spinal. Cerebrospinal fluid is produced by the choroid plexus inside the brain lateral ventricles. The two lateral ventricles communicate with each other through the third ventricle which also opens into the fourth ventricle. The lateral ventricles also communicate with the cerebrospinal fluid in the basal cisterns surrounding the brain stem through the choroidal fissure. The fourth ventricle communicates with the subarachnoid space through the foramen of Magendie and Luschka. The subarachnoid space extends from around the brain, brainstem, and spinal cord. Essentially all of the central nervous system structures and in particular the brain and spinal cord either are surrounded by or contain cerebrospinal fluid. A methodology that not only cools the cerebrospinal fluid but also facilitates circulation of the cooled cerebrospinal fluid provides for a faster and more uniform selective central nervous system hypothermia induction. 
     In another embodiment, the catheter has three lumens with two lumens used for circulation of the coolant that communicate at the distal end of the catheter. The third lumen has holes at the distal end that allows for drainage of cerebrospinal fluid as well as intracranial pressure monitoring similar to a ventriculostomy. An external regulator controls the extent of balloon dilation and coolant rate circulation by maintaining the central nervous system pressure within a desirable range. In another embodiment of the catheter, a balloon located at the distal end of the catheter expands when the coolant fluid is circulated. The expansion also opens the third lumen distal holes further to maintain patency. 
     In other embodiments, the balloon expansion is controlled and can also conform to the space of the central nervous system location that it is placed in as long as the central nervous system pressure remains within a desirable range preferably within normal limits of less than 15 mm Hg. 
     The catheters are designed to allow an inert coolant to circulate in the lumens without direct exposure to the brain or spinal cord and thereby altering the brain or spinal cord temperature. This allows for selective cooling of the brain and spinal cord for treatment of injury from trauma, ischemia, hypoxia and/or cerebral swelling. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a schematic view of one embodiment the device in the brain lateral ventricle. 
         FIG. 2 a    is a schematic view of the central nervous system and cerebrospinal fluid. 
         FIG. 2 b    is a schematic view of the device in the spinal subarachnoid cerebrospinal fluid space. 
         FIG. 3 a    is a side view of the device. 
         FIG. 3 b    is a longitudinal cross-sectional view of the device. 
         FIG. 4  is a longitudinal cross-sectional view of the device with partially dilated balloon. 
         FIG. 5  is a longitudinal cross-sectional view of the device with fully dilated balloon. 
         FIG. 6  is a partial sectional view of the device. 
         FIG. 7  is a cross-sectional view of the device. 
         FIG. 8 a    is a longitudinal cross-sectional view of another embodiment of the device. 
         FIG. 8 b    is a longitudinal cross-sectional view of the device with the balloon in a contracted position. 
         FIG. 9 a    is a longitudinal cross-sectional view of the device with the balloon in a partially dilated position. 
         FIG. 9 b    is a longitudinal cross-sectional view of the device with the balloon in a fully dilated position. 
         FIG. 10  is a longitudinal cross-sectional view of another embodiment the device with the balloon in a contracted position. 
         FIG. 11  is a longitudinal cross-sectional view of the device with the balloon in a partially dilated position. 
         FIG. 12  is a longitudinal cross-sectional view of the device with the balloon in a fully dilated position. 
         FIG. 13  is a cross-sectional view of another embodiment the device depicting direction of coolant flow. 
         FIG. 14  is a longitudinal cross-sectional view of another embodiment the device with the balloon in a partially dilated position. 
         FIG. 15  is a longitudinal cross-sectional view of the device with the balloon in a partially dilated position. 
         FIG. 16  is a longitudinal cross-sectional view of the device with the balloon in a fully dilated position. 
         FIG. 17  is a longitudinal cross-sectional view of another embodiment the device with the balloon in a partially dilated position. 
         FIG. 18  is a partial sectional view of the device. 
         FIG. 19  is a cross-sectional view of the device. 
         FIG. 20  is a longitudinal cross-sectional view of another embodiment the device with the balloon in a contracted position. 
         FIG. 21  is a longitudinal cross-sectional view of the device with the balloon in a dilated position. 
         FIG. 22  is a cross-sectional view of the device with the balloon in a contracted position. 
         FIG. 23  is a cross-sectional view of the device with the balloon in a dilated position. 
         FIG. 24  is a side view of another embodiment of the device. 
         FIG. 25  is a side view of another embodiment of the device. 
         FIG. 26  is a side view of another embodiment of the device. 
         FIG. 27  is a longitudinal cross-sectional view of another embodiment the device with the balloon in a contracted position. 
         FIG. 28  is a longitudinal cross-sectional view of the device with the balloon in a partially dilated position. 
         FIG. 29  is a longitudinal cross-sectional view of the device with the balloon in a fully dilated position. 
         FIG. 30  is a side view of another embodiment the device with the balloon in a contracted position. 
         FIG. 31  is a side view of the device with the balloon in a dilated position. 
         FIG. 32  is a cross-sectional view of another embodiment the device with the balloon in a contracted position. 
         FIG. 33  is a cross-sectional view of the device with the balloon in a dilated position. 
         FIG. 34  is a cross-sectional view of another embodiment the device with the balloon in a contracted position. 
         FIG. 35  is a cross-sectional view of the device with the balloon in a dilated position. 
         FIG. 36  is a cross-sectional view of another embodiment the device with the balloon in a contracted position. 
         FIG. 37  is a cross-sectional view of the device with the balloon in a dilated position. 
         FIG. 38  is a cross-sectional view of another embodiment the device with the balloon in a contracted position. 
         FIG. 39  is a cross-sectional view of the device with the balloon in a dilated position. 
         FIG. 40  is a side view of another embodiment the device with the balloon in a dilated position. 
         FIG. 41  is a side view of another embodiment the device with the balloon in a dilated position. 
     
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     In one method of central nervous system pathology treatment, the device as shown in  FIG. 1 , is placed into the ventricle of the brain or the subarachnoid space of the spine. This allows for cooling of the cerebrospinal fluid and hence the brain and/or spinal cord selectively. The effects of the cooling provide for treatment of swelling, traumatic, hypoxic, and ischemic injuries. These devices can be placed in the lateral ventricles using the standard landmarks or can be precisely placed with stereotactic guidance or use of an endoscope or ultrasound. The device  1  is placed into the cerebrospinal fluid in the ventricle  2  of the brain  3 . Typically a hole is drilled into the skull  4  to access the brain and the ventricles through a standard ventriculostomy approach. The device  1  distal end comprises a balloon placed in the cerebrospinal fluid that allows a greater surface area for heat exchange. The proximal end  5  of the device  1  is connected to a regulator that controls the extent of balloon dilation and circulation of the coolant through the device  1  closed loop cooling system. The regulator also monitors ICP and temperature through sensors positioned near the balloon end of the device  1 . As shown in  FIGS. 2 a    &amp;  2   b , the brain  6  contains cerebrospinal fluid inside the ventricles  8  and is also surrounded by cerebrospinal fluid  9  which is in communication with the cerebrospinal fluid  10  around the spinal cord. Cooling of the cerebrospinal provides for selective hypothermia of the brain and spinal cord. Facilitating circulation of the cooled cerebrospinal fluid provides for a faster brain and spinal cord cooling. The cerebrospinal fluid circulation can be facilitated by a device  1  placed in the cerebrospinal fluid  10  with a balloon that dilates and contracts in an alternating sequence or a peristaltic format as described in the current invention. This sequential dilation and contraction circulates the cerebrospinal fluid inside and outside the brain and spinal cord. It is also very prudent that the extent of the device balloon dilation placed inside the central nervous system be controlled so that the ICP is not increased in this process and also avoid compressive forces on the brain or spinal cord. A balloon that conforms to the shape of the space it has been placed inside the central nervous system allows for the best possible likelihood of not increasing the ICP with balloon dilation. The balloon shape can be round, oval, cylindrical or conform to the shape of the portion of the lateral ventricle it is placed in to avoid compression against the ventricle wall. The preferred spinal cerebrospinal fluid space location of the device is in the lumbar location but can also include cervical or thoracic spine. The device can be placed post-operatively after either a laminectomy, discectomy, or corpectomy. The device can also be placed through a percutaneous technique similar to placement of a spinal drain or lumbar puncture. X-ray or fluoroscopy can also be used to locate the correct spinal placement of the device. 
     In one embodiment as shown in  FIGS. 3-7 , the device is in the contracted position of the balloon  16  as shown in  FIGS. 3 a    &amp;  3   b  and dilated balloon positions as shown in  FIGS. 4 &amp; 5 . The device comprises an outside wall  11  and an inside wall  12 . The inside wall divides the lumen of the device into two parts  15  that communicate at the distal end  14 . The lumens circulate a coolant through a regulator/coolant placed external to the body. The device distal end is placed inside the desired central nervous system location. The distal end also comprises of one or more sensors  13  (pressure, temperature, etc).  FIG. 4  shows the distal end  16  of the device in a partially dilated balloon position and  FIG. 5  shows the distal balloon  16  completely dilated. The pulsating dilation and contraction of the balloon  16  circulates the cerebrospinal fluid outside the balloon and the circulating coolant in the lumens cools the cerebrospinal fluid. The increased surface area provided by the balloon expansion allows for a greater degree of heat exchange. 
     In another embodiment as shown in  FIGS. 8 &amp; 9 , the device comprises a catheter with a wall  17  and a central lumen  20  surrounded by a lumen  18  and  19 . The lumen  20  communicates with the lumen  18  and  19  through holes  21  at the distal end of the catheter and circulates a coolant with the arrows in  FIG. 8 a    depicting the direction of the coolant flow. The catheter also contains sensors  22  at the distal portion. The contracted shape of the balloon is shown in  FIGS. 8 a    &amp;  8   b  and the expanded shape of the balloon  23  is shown in  FIGS. 9 a    &amp;  9   b . The balloon  23  is partially dilated in  FIG. 9 a    and completely dilated in  FIG. 9 b   . The balloon  23  expands and contracts in a pulsating format with circulation of the coolant by an external coolant pump regulator. This pulsating expansion and contraction of the balloon creates a wave in the cerebrospinal fluid where the balloon tip is placed and facilitates circulation of the cooled cerebrospinal fluid throughout the central nervous system. 
     In another embodiment of the device as shown in  FIGS. 10-12 , the catheter comprises a wall  24  with a central lumen  27  that communicates with the lumen  25  and  26  surrounding the central lumen  27  through holes  28  and  29 . The holes in the distal portion of the central lumen  27  are larger in diameter proximally  28  and decrease in diameter sequentially distally  29 . The coolant is circulated through the lumen  27  and exits into lumen  25  and  26  through the holes  28  and  29  in a closed loop system. The distal catheter wall  31  can dilate if the pressure in the lumen is increased by an external coolant regulator. The larger holes  28  proximally and smaller holes  29  distally in the central lumen  27  allow larger coolant flow more proximally into lumen  25  and  26  thereby dilating the balloon in a peristaltic format as shown in  FIGS. 11 &amp; 12 . In  FIG. 11 , the top portion of the balloon  31  is dilated more proximally and the dilation wave progresses more distally as seen with the bottom portion of the balloon  32 . This peristaltic format of balloon dilation with circulation of the coolant moves the cooled cerebrospinal surrounding the balloon and facilitates central nervous system cooling. 
     In another embodiment of the catheter as shown in  FIG. 13 , the central lumen  27  is surrounded by lumen  25  with an outer wall  24 . The central lumen  27  communicates with surrounding lumen  25  at the distal catheter end through holes  34  and  35  which enlarge circumferentially. This enables the wall  24  to dilate into a balloon in a peristaltic and spiraling format with circulation of the coolant  33  (arrows depicting flow direction). This balloon dilation format further facilitates circulation of the cooled cerebrospinal fluid surrounding the balloon. 
     In another embodiment of the catheter as shown in  FIGS. 14-19 , the central lumen  37  is surrounded by a lumen  39  and catheter wall  36 . The central lumen is attached to the outer wall by a membrane  47 . The central lumen  37  comprises holes  40  and  41  at the distal end. The holes are larger proximally  41  and taper to a smaller size  40  distally. The holes  41  and  40  also taper from a larger to smaller size in a spiraling format. With circulation of the coolant the outer catheter wall expands into a balloon from proximally to distally in a spiraling and peristaltic format.  FIG. 14  shows the balloon  38  dilation in the initial phase,  FIG. 15  shows circumferential balloon dilation  38 , and  FIG. 16  shows the peristaltic balloon dilation  38  moving from proximal to the distal end. 
       FIG. 17  illustrates another embodiment of the spiral peristaltic balloon dilation catheter. The central lumen  42  comprises holes  43  and  44  at the distal end surrounded by a lumen  46  and balloon wall  45 . The lumen  42  holes enlarge from a smaller  43  to larger  44  sizes from proximal to distal end in a spiraling format. Circulation of the coolant dilates the balloon  45  in a spiral peristaltic manner from distally to proximally. 
     In another embodiment of the device as shown in  FIGS. 20-23 , the catheter also comprises a drainage lumen with ports at the distal end. The lumen  49  and  54  is contained between the catheter outer wall  48  and the inner wall  56 . The inner lumen  50  is used for drainage of cerebrospinal fluid and/or hemorrhage through ports  51 . This lumen can also be used to monitor intracranial pressure similar to a ventriculostomy drain. The lumen wall  56  is attached to the lumen wall  48  with membrane  55 . A coolant is circulated in the lumens  49  and  54  which communicate at the distal end  53  with a closed loop system. A temperature and/or pressure sensor  52  is positioned at the tip or any other location on the catheter to monitor central nervous system temperature and/or pressure. The distal portion of the catheter is capable of dilating into a balloon with circulation of the coolant under controlled pressure with dilation of the lumen  49  and  54  spaces as shown in  FIGS. 21 and 23 . 
     The balloons located at the distal catheter ends can conform to the shape of the central nervous system space that they are placed in. The balloon walls are compliant and conform to the shape most amenable to not increasing the intracranial pressure.  FIGS. 24-26  illustrate the various embodiments with different balloon shapes including but not limited to the shapes illustrated.  FIG. 24  shows an inflow and outflow coolant circulation lumen  57  with a round balloon  58 ,  FIG. 25  shows an inflow and outflow lumen  59  with an oval balloon  60 , and  FIG. 26  illustrates an inflow and outflow lumen  61  with a cylindrical balloon  62 . Other balloon shapes can comprise of a shape of the lateral ventricle, post-surgical brain cavity, cisterna magna, subdural, epidural or subarachnoid space in the head or spine. The balloons can dilate parallel to the longitudinal catheter axis or at any other angle from 0 to 360 degrees. 
     In another embodiment of the device as shown in  FIGS. 27-29 , the catheter comprises double balloons at the distal heat exchange end. The catheter wall  63  encloses lumens  64  and  69  with a central lumen  70  and a temperature and ICP sensor  68 . The central coolant inlet lumen comprises of holes  65  and  67  with a portion in between without holes  66 . Pumping of the coolant through the inlet lumen  70  circulates the coolant through holes  65  and  67  with the coolant entering outlet lumens  64  and  69 . The balloons  71  and  72  dilate depending on the pressure under which the coolant is pumped.  FIG. 28  illustrates the partial dilation of balloon  71  and complete dilation of balloon  72 . As more of the coolant is circulated under higher pressure, both the balloons dilate as shown in  FIG. 29 . This sequential balloon dilation creates a wave in the cerebrospinal fluid surrounding the balloons and facilitates circulation of the cooled cerebrospinal fluid. 
     In another embodiment of the device as shown in  FIGS. 30 &amp; 31 , the catheter distal end comprises of thermal heat conductors  74  in the wall  75 . The proximal portion  73  contains and inlet and outlet lumen for coolant circulation and the distal heat conductor portion of the wall  75  can dilate into a balloon as shown in  FIG. 31  with the flow of the coolant under pressure. The thermal heat conductors  74  can also comprise of pressure sensors which gauge the extent of balloon dilation by maintaining the central nervous system pressure within a desired range and avoid undue pressure on the surrounding brain. 
     In another embodiment of the device as shown in  FIGS. 32 and 33 , the distal balloon end of the catheter wall  80  comprises of pressure sensors  75 . The multiple balloons are arranged in a circumferential format and have an individual inlet  76  and  79  and outlet  77  and  78  ports for coolant circulation. The extent of each balloon  77 ,  78  dilation is dictated by the pressure on each balloon sensor  75  with the attempt to avoid pressure against the ventricle wall or central nervous system as would normally be undertaken with blind dilation in the prior art. In alternative embodiments, the pressure sensor  75  can also comprise a dual function as a thermal conductor to facilitate heat exchange.  FIG. 32  shows the contracted position of the balloons  77  &amp;  78  and  FIG. 33  shows the dilated position of the balloons  77  &amp;  78 . 
     In another embodiment of the device as shown in  FIGS. 34 and 35 , the distal balloon end of the catheter comprises of balloons  85  and  86  each with a coolant inflow lumens  84  and  83  and outflow lumens  81  and  82 . The outflow lumens  81  and  82  dilate into balloons once the coolant is circulated as shown in  FIG. 35 . 
     In another embodiment of the balloon catheter as shown in  FIGS. 36 &amp; 37 , the central lumen  90  comprises a wall  91  and circulates a coolant into the multiple balloon lumens  87 ,  88 , and  89  which dilate depending on the pressure of the coolant circulation as shown in  FIG. 37 . The balloon wall is compliant and adapts to the shape of the path of least resistance in the central nervous system. In alternative embodiments, as shown in  FIGS. 38 and 39 , the balloons  92 ,  94 , and  96  have individual inflow  98 ,  95 ,  97  and outflow coolant lumens. The central lumen  93  communicates with cerebrospinal fluid through ports  99  for drainage and pressure monitoring.  FIG. 38  shows the contracted position of the balloons  92 ,  94 , and  96  and  FIG. 39  shows the expanded position. 
       FIG. 40  illustrates double balloons  100  and  102  with drainage ports  104  in the catheter wall  101  between the balloons. A coolant is circulated through a closed loop system through the catheter proximal portion  103  connected to a cooler.  FIG. 41  illustrates a balloon cooling catheter  108  with drainage ports  107 . The drainage ports  107  can also be incorporated into the balloon wall  105 . 
     The methodology and device described provides for treatment of any central nervous system pathology including but not limited to treatment of increased intracranial pressure, brain swelling or edema, spinal cord edema, trauma, brain injury, skull fracture, stroke, ischemia, hypoxia following respiratory or cardiac arrest, tumors, hemorrhage, infection, seizure, spinal cord injury, spine fractures, arteriovenous malformations, aneurysms, aortic artery surgery ischemia protection, spinal stenosis, herniated disc, and scoliosis surgery. The device can be placed intracranial following drilling of a hole in the skull via a twist drill, burr hole placement, or craniotomy/craniectomy. It can be placed inside the spinal canal in the epidural, subdural or subarachnoid space through a percutaneous technique or following a laminotomy/laminectomy. Placement of the device intracranially or intraspinally can be further facilitated by radiographic guidance (fluoroscopy), ventriculograms, cisternograms, ultrasound, frame based or frameless stereotactic navigation systems, or endoscopy. The preferred location of the device is in the cerebrospinal fluid space in the lateral ventricle, subarachnoid space of the brain surface, and lumbar intra-thecal space. Other locations include in the surgical resection bed following craniotomy for removal of brain tumor or hemorrhage and spinal epidural or intrathecal space following a laminectomy. The catheter device can also be secured to the skull by a hollow bolt. The closed loop cooling system selectively cools the central nervous system without serious side-effects of generalized body cooling and in some embodiments also provides for drainage of fluid (cerebrospinal fluid or hemorrhage). 
     Sensors can be placed in the distal portion of the device positioned inside the central nervous system. These sensors can either be in one location or in multiple locations on the catheter wall. In the preferred embodiment, the sensors monitor pressure and temperature. In other embodiments water sensors can also be positioned to detect cerebrospinal fluid location inside the ventricle to confirm correct catheter location since cerebrospinal fluid predominantly comprises of water. Similarly, impedance sensors can also provide for confirmation of location as the impedance changes from brain to a cerebrospinal fluid location as the catheter is advanced into the lateral ventricle during placement. Other sensors can comprise of cerebrospinal fluid marker sensors, osmolarity sensors, oxygenation sensors, carbonation sensors, metabolite sensors, and pH sensors. 
     The device with the capability of cooling and circulation of the cerebrospinal fluid provides for selective cooling of the brain and spinal cord. Since the cerebrospinal fluid is in communication from inside the brain to the outer surface of the brain and spinal cord, placement of the device intracranially not only cools the brain but also the spinal cord. Similarly, cooling of the brain can also be achieved by placement of the device inside the spinal canal. Alternatively, one device can be placed intracranially and another in the spinal canal to increase the extent of selective central nervous system cooling. 
     While the invention and methodology described herein along with the illustrations is specific, it is understood that the invention is not limited to the embodiments disclosed. Numerous modifications, rearrangements, and substitutions can be made with those skilled in the art without departing from the spirit of the invention as set forth and defined herein.