K Number
K042198
Device Name
PS MEDICAL NEUROSURGICAL IMPLANTS
Date Cleared
2004-09-24

(42 days)

Product Code
Regulation Number
882.5550
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
CSF Shunt components are designed to provide controlled Cerebrospinal Fluid (CSF) flow from the ventricles of the brain to the right atrium of the heart or the peritoneal cavity.
Device Description
The PS Medical Neurosurgical Implants are manufactured with silicone adhesive. The devices are used as shunt components.
More Information

Not Found

No
The summary describes a mechanical device (CSF shunt components) and makes no mention of AI, ML, image processing, or any software-driven analytical capabilities.

Yes
The device is designed to manage cerebrospinal fluid flow, which is a therapeutic intervention for conditions requiring CSF shunting.

No
The device is described as a CSF shunt component designed to provide controlled fluid flow, not to diagnose a condition.

No

The device description explicitly states it is manufactured with silicone adhesive and used as shunt components, indicating it is a physical implant, not software.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use describes a device designed to manage the flow of cerebrospinal fluid within the body (from the brain ventricles to the heart or peritoneal cavity). This is a therapeutic or physiological function, not a diagnostic one performed in vitro (outside the body).
  • Device Description: The description mentions silicone adhesive and use as shunt components, which are consistent with an implantable medical device used for fluid management.
  • Lack of IVD Indicators: There is no mention of analyzing samples (blood, urine, tissue, etc.), detecting analytes, or providing diagnostic information based on laboratory tests.

IVD devices are used to examine specimens derived from the human body to provide information for diagnostic, monitoring, or compatibility purposes. This device's function is purely mechanical and physiological.

N/A

Intended Use / Indications for Use

CSF Shunt components are designed to provide controlled Cerebrospinal Fluid (CSF) flow from the ventricles of the brain to the right atrium of the heart or the peritoneal cavity.

Product codes (comma separated list FDA assigned to the subject device)

JXG

Device Description

The PS Medical Neurosurgical Implants are manufactured with silicone adhesive. The devices are used as shunt components.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

ventricles of the brain, right atrium of the heart, peritoneal cavity

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Not Found

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K803257, K831678, K841442, K833822, K873247, K874468, K874498, K900676, K902783, K911410, K913412, K934545, K951258, K991502, K012052, K033850

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 882.5550 Central nervous system fluid shunt and components.

(a)
Identification. A central nervous system fluid shunt is a device or combination of devices used to divert fluid from the brain or other part of the central nervous system to an internal delivery site or an external receptacle for the purpose of relieving elevated intracranial pressure or fluid volume (e.g., due to hydrocephalus). Components of a central nervous system shunt include catheters, valved catheters, valves, connectors, and other accessory components intended to facilitate use of the shunt or evaluation of a patient with a shunt.(b)
Classification. Class II (performance standards).

0

K042198

510k Summary 4.

This summary of safety and effectiveness is submitted in accordance with the requirements of SMDA 1990 and 21 CFR 807.87.

Establishment Registration Number:2021898
Address of Manufacturer:Medtronic Neurosurgery
125 Cremona Drive
Goleta CA, 93117
(805) 968-1546 ext. 1773
Fax: (805) 968-9336
Contact Person:Jeffrey Henderson
Date:August 11, 2004
Trade or Proprietary Name:Medtronic PS Medical® Neurosurgical implants
Common usual or Classification Name:Central Nervous System Flow Control Shunts and
Accessories ( 882.5550)
Predicate Device Identification:PS Medical® Neurosurgical implants (K803257,
K831678, K841442, K833822, K873247, K874468,
K874498, K900676, K902783, K911410, K913412,
K934545, K951258, K991502, K012052, K033850.)

The PS Medical Neurosurgical Implants are manufactured with silicone adhesive. The Description: devices are used as shunt components.

Intended Use: CSF Shunt components are designed to provide controlled Cerebrospinal Fluid (CSF) flow from the ventricles of the brain to the right atrium of the heart or the peritoneal cavity.

Intended Use of predicate device(s): CSF Shunt components are designed to provide controlled Cerebrospinal Fluid (CSF) flow from the ventricles of the right atrium of the heart or the peritoneal cavity.

Technological comparison:_Medtronic Neurosurgery submits that the materials of fabrication, intended use, performance characteristics and design specifications of the CSF-Flow Control Shunt components are equivalent to the previously reviewed and cleared products. Based upon the summary above, Medtronic Neurosurgery determines substantial equivalence, safety, and efficacy of the products based upon the predicate and currently marketed devices.

1

DEPARTMENT OF HEALTH & HUMAN SERVICES

Public Health Service

Image /page/1/Picture/2 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized depiction of an eagle or bird with three curved lines representing its wings or feathers. The bird is positioned within a circular border that contains the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" in a sans-serif font. The text is arranged around the circumference of the circle.

SEP 2 4 2004

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Mr. Jeffrey Henderson Vice President, Quality and Regulatory Affairs Medtronic Neurosurgery 125 Cremona Drive Goleta, California 93117

Re: K042198

Trade/Device Name: Medtronic Neurosurgical Implants Regulation Number: 21 CFR 882.5550 Regulation Name: Central nervous system fluid shunt and components. Regulatory Class: II Product Code: JXG Dated: August 11, 2004 Received: August 27, 2004

Dear Mr. Henderson:

We have reviewed your Section 510(k) premarket notification of intent to market the device wfo neve ro rowed your and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate for use surfed in the encreases)77 the enactment date of the Medical Device Amendments, or to commerce price that have been reclassified in accordance with the provisions of the Federal Food, Drug, do noos mat have e e e e e equire approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it If your de roo to such additional controls. Existing major regulations affecting your device can may be babyer is been Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

2

Page 2 - Mr. Jeffrey Henderson

This letter will allow you to begin marketing your device as described in your Section 510(k) I ms lotter will and in your e FDA finding of substantial equivalence of your device to a legally premated notineted in " results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please If you a the Office of Compliance at (301) 594-4659. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act from the Division of Small other general international and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely yours,

Miriam C. Provost
for

Celia M. Witten, Ph.D., M.D. Director Division of General, Restorative and Neurological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

3

K042198 510(k) Number (if known):

Device Name: Medtronic Neurosurgical implants

Indications For Use:

CSF Shunt components are designed to provide controlled Cerebrospinal Fluid (CSF) flow from the ventricles of the brain to the right atrium of the heart or the peritoneal cavity.

X Prescription Use _ (Part 21 CFR 801 Subpart D) AND/OR

Over-The-Counter Use (21 CFR 807 Subpart C)

..

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Page 1 of __ 1__

Miriam C. Provost

(Division Sign-Off) Division of General, Restorative, and Neurological Devices

K042198 510(k) Number_