Home India Ministry of Health and Family Welfare Classification of Medical Device pertaining to Neurological ...
Date: 2021-09-28 Category: Not Applicable State: Union Government Country: India

Classification of Medical Device pertaining to Neurological under the provisions of Medical Devices Rules, 2017

Issued by Ministry of Health and Family Welfare · Central Drugs Standard Control Organization

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Executive Summary & Key Takeaways

**Executive Summary:** This document classifies medical devices pertaining to neurological applications based on risk, as determined by the Central Drugs Standard Control Organization (CDSCO), a body of the Directorate General of Health Services, Government of India. The notice categorizes devices by intended use and assigns a risk class (A, B, C, or D). This classification guides regulatory requirements for these devices. **Key Points / Main Content:** * **Classification of Medical Devices:** * The document classifies various medical devices used in neurology. * Classification is based on the risk associated with the device's intended use. * Devices are assigned to one of four risk classes: A, B, C, or D. * **Device Categories and Risk Classes:** * **Class A:** Includes devices like analytical non-scalp cutaneous electrodes and cranial trephines, skull plate anvils, skull punches and skullplate screwdrivers, nonpowered neurosurgical instruments, esthesiometers, percussion hammers, pinwheels, tuning forks, ultrasonic scanner calibration test blocks, electroencephalograph testers * **Class B:** Includes devices like analgesic TENS systems, analytical scalp electrodes and leads, diagnostic somatosensory tactile stimulation systems, electroencephalogram EEG signal spectrum analyzers and electrode lead testers and test signal generators, electromyographs, electronystagmographs, facial nerve locating systems, gait enhancement electrical stimulation systems(external), leukotomes, manual surgical saws, neurosurgical head holder skull clamps and microscopes and ultrasound navigation systems, neuromuscular transmission motion sensors, stereotactic neuronavigation planning systems and transcranial electrical stimulation systems(continuous current and pulsedcurrent) * **Class C:** Includes devices like autonomic neuropathy heart rate meters, behavioural therapy electrical stimulation systems, brain injury adjunctive interpretive electroencephalograph assessment aids, cerebrospinal fluid manometer, programmer and shunt valve, craniotomy systems, depth electrodes, diagnostic peripheral nerve electrical stimulation systems, diagnostic EEG, ejaculation electrical stimulation systems, electroconvulsive therapy systems, electroencephalograph, epicranial brain electrical stimulation systems, home seizure monitoring systems, intramuscular diaphragmphrenic nerve electrical stimulation system programmer, intranasal cooling systems, invasive physiological monitor devices, nasopharyngeal electrodes, needle electrodes, nerve conduction velocity measurement equipment, neurological endoscope, neurological stereotactic surgery system, neuromuscular transmission electrical skin sensors, neuropsychiatric interpretive electroencephalograph assessment aids, olfactometry systems, photodiode subretinal prosthesis system, scalp clips, vagus nerve electrical stimulation system programmer, cerebro spinal fluid manometers and dura mater sealants * **Class D:** Includes devices like aneurysm clips, antiseizure psychiatric therapy vagus nerve electrical stimulation systems, atrial cerebrospinal fluid catheter, baremetal intracranial vascular stent, bladderbowel evacuation implantable electrical stimulation systems, brain-responsive electrical stimulation systems, cardiac therapy vagus nerve electrical stimulation systems, cerebral perfusion catheter, comaarousal vagus nerve electrical stimulation systems, cortical electrodes, cranial electrotherapy stimulator, cryogenic surgical device, deep brain electrical stimulation systems, diskectomy system, percutaneous, automatic, extramuscular diaphragmphrenic nerve electrical stimulation system, gait enhancement electrical stimulation system(implantable), human dura mater, implantable pulse generator mesh bag, implantable cerebellar stimulator, implantable diaphragmaticphrenic nerve stimulator, implantable intracerebralsubcortical stimulator for pain relief, implantable neuromuscular stimulator, implantable spinal cord stimulator for bladder evacuation, intracranial pressure monitor device, intramuscular diaphragmphrenic nerve electrical stimulation system, meningeal prosthesis, nerve guide, bioabsorbable(animal derived and synthetic), nonbioabsorbable, rheoencephalograph, scoliosis treatment electrical stimulation system, stereotactic radiosurgical system, tibial nerve percutaneous incontinence control electrical stimulation system, transvenous phrenic nerve electrical stimulation control unit **Impact Analysis:** * **Medical Device Manufacturers:** * *Impact:* Manufacturers need to be aware of the classification of their neurological devices to comply with Indian regulations. * *Action Required:* Review the classification of their devices and ensure compliance with the corresponding regulatory requirements for that risk class in India. * **Healthcare Providers:** * *Impact:* Classification affects device procurement and usage protocols. * *Action Required:* Understand the risk classifications to inform device selection and usage within their facilities. * **Regulatory Bodies (e.g., CDSCO):** * *Impact:* The classification informs regulatory oversight and enforcement activities. * *Action Required:* Utilize the classifications for device registration, approval, and post-market surveillance.

Key Entities Referenced

Directorate General of Health Services: A government organization under the Government of India. Central Drugs Standard Control Organization: A national regulatory body for pharmaceuticals and medical devices in India. FDA, Bhawan, new Delhi110002: Address of Central Drugs Standard Control Organization, New Delhi, India. Neurological: Pertaining to the study and treatment of disorders of the nervous system. vagus nerve: A cranial nerve that interfaces with parasympathetic control of the heart, lungs, and digestive tract. spinal cord: The main nerve pathway carrying signals between the brain and the body. cerebrospinal fluid CSF: A clear, colorless body fluid found in the brain and spinal cord. epilepsy: A neurological disorder characterized by recurrent seizures.
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Appendix A File.No.29/Misc/03/2020-DC (201) Government of India Directorate General of Health Services Central Drugs Standard Control Organization FDA, Bhawan, new Delhi-110002 Notice Classification of Medical Devices Pertaining to Neurological Sr. Risk Device Name Intended Use No. Class Intended to deliver controlled electrical impulses directly to Analgesic PENS 1 the subcutaneous tissue (i.e., invasively) in the vicinity of a B system peripheral nerve as relief of chronic neuropathic pain. Analgesic TENS Intended to treat pain by transcutaneous electrical 2 B system simulation on peripheral nerves. Electrical conductor designed to be attached to the skin Analytical non- surface of a patient outside of the hair line (i.e., non-scalp) 3 scalp cutaneous A to conduct electrical signals to a parent device for electrode electrophysiological recording/monitoring. Intended to conduct electrical signals between a skin Analytical non- electrode(s) or needle electrode(s) [electrode not included] 4 scalp cutaneous and a device designed for electrophysiological A lead recording/monitoring [e.g., electromyography (EMG), evoked potentials (EP), bioelectrical impedance]. Intended to be attached to the scalp surface of a patient to transmit changes in the electrical potential of various areas Analytical scalp 5 of the brain for recording/monitoring by a connected parent B electrode device [i.e., an electroencephalograph (EEG), sleep, or evoked potential recording device]. Intended to connect an electroencephalographic Analytical scalp electrode(s) to an electroencephalographic system to 6 B lead facilitate the transmission of the electrical signals during encephalography (EEG). An aneurysm clip is a device used to occlude an intracranial 7 Aneurysm clip. aneurysm (a balloonlike sac formed on a blood vessel) to D prevent it from bleeding or bursting Antiseizure/psych iatric-therapy Implantable device intended to apply periodic electrical vagus nerve 8 stimuli to the vagus nerve to help control seizures and/or to D electrical help treat psychiatric disorder symptoms (e.g., depression). stimulation system Atrial Intended to be implanted as the distal component of a 9 cerebrospinal ventriculoatrial shunt to channel cerebrospinal fluid (CSF) to D fluid catheter the right atrium where it can be absorbed into the body. Autonomic Intended to diagnose autonomic nervous system 10 neuropathy heart C dysfunction (autonomic neuropathy). rate meterBare-metal Intended to be implanted into the base or parent artery of an 11 intracranial D intracranial aneurysm. vascular stent Behavioural Intended in the treatment of obsessive/compulsive therapy electrical 12 behaviour and drug abuse, by applying electrical C stimulation impulse(aversion therapy). system Bladder/bowel- evacuation Intended to empty the urinary bladder and/or the bowels by implantable 13 applying electrical stimuli typically to the cone-shaped end D electrical of the spinal cord (conus medularis). stimulation system A brain injury adjunctive interpretive electroencephalograph Brain injury assessment aid is a prescription device that uses a patient's adjunctive electroencephalograph (EEG) to provide an interpretation of interpretive the structural condition of the patient's brain in the setting of 14 C electroencephalo trauma. A brain injury adjunctive interpretive EEG graph assessment aid is for use as an adjunct to standard clinical assessment aid. practice only as an assessment aid for a medical condition for which there exists other valid methods of diagnosis Brain-responsive Intended to continuously monitor brain activity and deliver electrical 15 electrical stimuli to seizure foci in response to neurological D stimulation disorders (e.g., epilepsy). system Cardiac-therapy vagus nerve Intended to apply periodic stimuli to the vagus nerve as a 16 electrical D treatment for cardiac failure. stimulation system Cerebral Intended for brain protection during profound hypothermic 17 perfusion D circulatory arrest during aortic surgery. catheter Cerebrospinal Intended to measure the cerebrospinal fluid (CSF) 18 C fluid manometer, pressure/intracranial pressure via lumbar puncture. Cerebrospinal Intended to noninvasively modify the operating pressure of 19 fluid shunt valve a programmable, non-active, implanted cerebrospinal fluid C programmer (CSF) shunt valve that is part of a CSF shunt. Coma-arousal vagus nerve Intended to apply periodic stimuli to the vagus nerve for the 20 electrical purpose of exciting the patient to arousal from a vegetative D stimulation state (i.e., a deep coma). system A cortical electrode is an electrode which is temporarily Cortical 21 placed on the surface of the brain for stimulating the brain D electrode. or recording the brain's electrical activityIntended to fit into an appropriate powered handpiece that 22 Cranial bur, provides the rotation allowing the user to excavate soft or A hard skull tissue. Cranial A cranial electrotherapy stimulator is a device that applies 23 electrotherapy electrical current to a patient's head to treat insomnia, D stimulator. depression, or anxiety Metallic rotary endpiece designed to cut a hole(s) or a 24 Cranial perforator circular section(s) of the skull vault (calvarium) by attaching B to powered drill/handpiece. Intende as a neurosurgical blade used to cut/remove 25 Cranial trephine, circular sections of the skull vault (calvarium) to provide A access to the interior Craniotomy Intended to be used to rotate a cranial cutting tool (i.e., a power tool 26 drill bit, bur, trephine or perforator) in order to produce a C system hole or holes in the skull vault (calvarium). handpiece A cryogenic surgical device is a device used to destroy Cryogenic 27 nervous tissue or produce lesions in nervous tissue by the D surgical device. application of extreme cold to the selected site A cutaneous electrode is an electrode that is applied directly Cutaneous 28 to a patient's skin either to record physiological signals (e.g., B electrode. the electroencephalogram) or to apply electrical stimulation Deep brain Designed to apply electrical stimuli to specific areas of the electrical deep brain for the treatment of movement disorders, 29 D stimulation psychiatric disorders and/or to treat chronic, severe, system intractable pain. Deep brain electrical Intended to be implanted in specific areas of the deep brain 30 C stimulation and used along with deep brain electrical simulation system. system lead A depth electrode is an electrode used for temporary 31 Depth electrode. stimulation of, or recording electrical signals at, subsurface C levels of the brain Diagnostic peripheral nerve Intended to apply electrical stimuli in one peripheral region 32 electrical of the body while the response is monitored in another C stimulation peripheral region. system Diagnostic Intended to be used to apply tactile stimuli to the body (e.g., somatosensory pneumatic activation of a membrane to the fingers and lips) 33 B tactile stimulation typically for evoked response procedures to investigate the system function and potential disorders of the brain. Diskectomy system, Intended for the percutaneous (through the skin) removal of 34 D percutaneous, the nucleus pulposus from the lumbar disc. automatic Dura mater Intended to be applied to sutured dura mater to prevent 35 C sealant cerebrospinal fluid (CSF) leakage during healing.An echoencephalograph is an ultrasonic scanning device Echoencephalogr (including A-scan, B-scan, and doppler systems) that uses 36 C aph. noninvasive transducers for measuring intracranial interfaces and blood flow velocity to and in the head Ejaculation electrical Intended to apply electrical stimuli to the nerves that control 37 C stimulation ejaculation. system Intended to apply strong electrical stimuli to a patient's Electroconvulsive 38 brain to induce convulsions and loss of consciousness, C therapy system typically to treat major depression, schizophrenia, or mania. Electroencephalo An electroencephalogram (EEG) signal spectrum analyzer gram (EEG) 39 is a device used to display the frequency content or power B signal spectrum spectral density of the electroencephalogram (EEG) signal analyzer. An electroencephalograph electrode/lead tester is a device Electroencephalo used for testing the impedance (resistance to alternating graph 40 current) of the electrode and lead system of an B electrode/lead electroencephalograph to assure that an adequate contact tester. is made between the electrode and the skin Electroencephalo An electroencephalograph test signal generator is a device 41 graph test signal B used to test or calibrate an electroencephalograph generator. Intended to perform quality control procedures on an Electroencephalo 42 electroencephalograph (EEG) machine and/or a sleep A graph tester recording machine. An electroencephalograph is a device used to measure and Electroencephalo 43 record the electrical activity of the patient's brain obtained C graph. by placing two or more electrodes on the head Electroencephalo Analytical scalp electrodes preconfigured within a head- 44 graphic electrode B worn device to use with electroencephalography (EEG). cap Electroencephalo Intended to continuously record electroencephalographic graphic long-term signals in ambulatory patients for periods usually from 24 to 45 B ambulatory 72 hours to assess a variety of neurological conditions (e.g., recorder epilepsy) and psychiatric disorders. Intended to continuously measure the electrical signals produced by a patient's brain and display/record them as an Electroencephalo electroencephalogram (EEG) to evaluate brain function. graphic Alongwith which measuring of other physiological 46 C monitoring parameters such as electromyogram (EMG), respiration system wave forms, blood pressure, ocular motility, and/or haemoglobin oxygen saturation (SpO2) and carbon dioxide (CO2) in relation to EEG. Intended in clinical diagnosis of muscular disorders to evaluate muscle weakness and to determine if the 47 Electromyograph B weakness is related to the muscles themselves or a problem with the nerves that supply the muscles. Electronystagmo Intended for detecting the electrical potential caused by eye 48 B graph movements.Epicranial brain Intended to apply weak, pulsed (not continuous) electrical electrical 49 stimuli from beneath the scalp to specific areas of the brain C stimulation for the treatment of focal epilepsy. system An esthesiometer is a mechanical device which usually consists of a single rod or fiber which is held in the fingers of 50 Esthesiometer. A the physician or other examiner and which is used to determine whether a patient has tactile sensitivity Intended to provide ventilatory support to a patient with Extramuscular diaphragm dysfunction of neuromuscular origin through diaphragm/phreni electrical stimulation of the phrenic nerve, to contract the 51 c nerve electrical D diaphragm rhythmically (using extramuscular electrodes) stimulation and cause the patient to draw breath in a manner similar to system natural breathing. Facial nerve Intended to locate a facial nerve by applying an electrical 52 B locating system stimulus. Gait- Intended to improve the gait in a patient suffering from enhancement partial paralysis of the lower extremities or other 53 electrical B neuromuscular disorders by applying external electrical stimulation simulation. system, external Gait- enhancement Intended to improve the gait in a patient suffering from electrical partial paralysis of the lower extremities or other 54 D stimulation neuromuscular disorders by applying internal electrical system, simulation. implantable Intended to detect and record a seizure by continuous measurement of one or more physical/physiological Home seizure parameters (e.g., body motion, electrical activity of the heart 55 monitoring C or skeletal muscles) in a patient with epilepsy during daily system activities and/or sleep in the home; some types may also be used in clinical settings. Human dura Human dura mater is human pachymeninx tissue intended 56 D mater. to repair defects in human dura mater Implantable pulse Intended to envelop an implantable pulse generator (IPG) generator mesh (e.g., cardiac pacemaker/defibrillator, neurostimulator) to 57 D bag, stabilize the implant in the subcutaneous pocket in which it bioabsorbable is implanted. Implantable spinal cord Device designed to change, telemetrically, one or more of electrical the operating parameters (the programs) of an implanted 58 C stimulation spinal cord electrical stimulation system pulse generator system (EPG). programmer An implanted cerebellar stimulator is a device used to stimulate electrically a patient's cerebellar cortex for the treatment of intractable epilepsy, spasticity, and some Implanted movement disorders. The stimulator consists of an 59 cerebellar D implanted receiver with electrodes that are placed on the stimulator. patient's cerebellum and an external transmitter for transmitting the stimulating pulses across the patient's skin to the implanted receiverAn implanted diaphragmatic/phrenic nerve stimulator is a device that provides electrical stimulation of a patient's phrenic nerve to contract the diaphragm rhythmically and produce breathing in patients who have hypoventilation (a Implanted state in which an abnormally low amount of air enters the diaphragmatic/ph 60 lungs) caused by brain stem disease, high cervical spinal D renic nerve cord injury, or chronic lung disease. The stimulator consists stimulator. of an implanted receiver with electrodes that are placed around the patient's phrenic nerve and an external transmitter for transmitting the stimulating pulses across the patient's skin to the implanted receiver An implanted intracerebral/subcortical stimulator for pain relief is a device that applies electrical current to subsurface Implanted areas of a patient's brain to treat severe intractable pain. intracerebral/sub 61 The stimulator consists of an implanted receiver with D cortical stimulator electrodes that are placed within a patient's brain and an for pain relief. external transmitter for transmitting the stimulating pulses across the patient's skin to the implanted receiver An implanted neuromuscular stimulator is a device that provides electrical stimulation to a patient's peroneal or femoral nerve to cause muscles in the leg to contract, thus improving the gait in a patient with a paralyzed leg. The Implanted stimulator consists of an implanted receiver with electrodes 62 neuromuscular D that are placed around a patient's nerve and an external stimulator. transmitter for transmitting the stimulating pulses across the patient's skin to the implanted receiver. The external transmitter is activated by a switch in the heel in the patient's shoe An implanted spinal cord stimulator for bladder evacuation is an electrical stimulator used to empty the bladder of a paraplegic patient who has a complete transection of the Implanted spinal spinal cord and who is unable to empty his or her bladder by cord stimulator reflex means or by the intermittent use of catheters. The 63 D for bladder stimulator consists of an implanted receiver with electrodes evacuation. that are placed on the conus medullaris portion of the patient's spinal cord and an external transmitter for transmitting the stimulating pulses across the patient's skin to the implanted receiver Intracranial Intended for intermittent or continuous measurement and 64 pressure monitor display of intracranial pressure (ICP). It is used in D device conjunction with an invasive intracranial device. Intended to provide ventilatory support to a patient with Intramuscular diaphragm dysfunction of neuromuscular origin through diaphragm/phreni electrical stimulation of the phrenic nerve to contract the 65 c nerve electrical D diaphragm rhythmically (using intramuscular electrodes) and stimulation cause the patient to draw breath in a manner similar to system natural breathing.Intramuscular diaphragm/phreni Intended to change, telemetrically, one or more of the c nerve electrical operating parameters (the programs) of an intramuscular 66 C stimulation diaphragm/phrenic nerve electrical stimulation system system external pulse generator (EPG). programmer Intended for rapid cooling induction in patients where Intranasal cooling temperature reduction is clinically indicated (e.g., following a 67 C system cerebral ischemic event, during cardiac arrest) to help mimimize damage to the brain and heart. Invasive- Intended for continuous or intermittent measurement, detection display and/or recording of several invasively-detected 68 C physiological physiological parameters [e.g., intracranial pressure (ICP), monitor compartmental pressure]. Intended to cut brain tissue (i.e., cutting white matter, 69 Leukotome B leukotomy). Intended to non-invasively detect, measure, and display bio- magnetic signals produced by electrically-active cortical Magnetoencepha 70 brain tissue, and that provide diagnostic information about B lography system the location of the active tissue responsible for cognitive brain functions relative to the surrounding brain anatomy Manual surgical Intended for cutting bone through a sawing action during 71 B saw, flexible neurological or orthopaedic surgery. Meningeal 72 Intended to repair the meningeal membrane (meninges). D prosthesis A nasopharyngeal electrode is an electrode which is Nasopharyngeal 73 temporarily placed in the nasopharyngeal region for the C electrode. purpose of recording electrical activity A needle electrode is a device which is placed 74 Needle electrode. C subcutaneously to stimulate or to record electrical signals A nerve conduction velocity measurement device is a Nerve conduction device which measures nerve conduction time by applying a velocity stimulus, usually to a patient's peripheral nerve. This device 75 C measurement includes the stimulator and the electronic processing device. equipment for measuring and displaying the nerve conduction time Nerve guide, Collagen matrix material intended to be used to create a 76 bioabsorbable, tunnel through which a discontinuous peripheral nerve can D animal-derived regenerate to bridge the proximal and distal nerve stumps. Nerve guide, Synthetic material intended to be used to create a tunnel 77 bioabsorbable, through which a discontinuous peripheral nerve can D synthetic regenerate to bridge the proximal and distal nerve stumps. Non-bioabsorbable material intended to be used to create a Nerve guide, non- 78 tunnel through which a discontinuous peripheral nerve can D bioabsorbable regenerate to bridge the proximal and distal nerve stumps. Neurological A neurological endoscope is an instrument with a light 79 C endoscope. source used to view the inside of the ventricles of the brainNeurological Intended to store diagnostic images used for image-guided 80 stereotactic C neurosurgery. surgery system Neuromuscular Intended to detect electrical neuromuscular transmission transmission 81 (NMT) signals, for assessing the degree of neuromuscular C electrical skin block in a patient. sensor Intended to be placed on the thumb and index finger of a Neuromuscular patient to detect movements and convert them into 82 transmission B electrical neuromuscular transmission (NMT) signals during motion sensor nerve stimulation. The neuropsychiatric interpretive electroencephalograph Neuropsychiatric assessment aid is a prescription device that uses a patient's interpretive electroencephalograph (EEG) to provide an interpretation of 83 electroencephalo the patient's neuropsychiatric condition. The C graph neuropsychiatric interpretive EEG assessment aid is used assessment aid. only as an assessment aid for a medical condition for which there exists other valid methods of diagnosis Neurosurgical Intended to support and position a patient in a sitting or 84 A chair reclined position during neurosurgery. Neurosurgical A neurosurgical head holder (skull clamp) is a device used 85 head holder (skull to clamp the patient's skull to hold head and neck in a B clamp). particular position during surgical procedures Neurosurgical A neurosurgical headrest is a device used to support the 86 A headrests. patient's head during a surgical procedure Designed to magnify minute structures within the neurological fields for surgery, typically the brain or spine or Neurosurgical 87 surroundings in the performance of neurological surgical B microscope procedures which require high magnification by transmitted light. Neurosurgical Intended for intraoperative imaging of the brain for precise ultrasound 88 navigation during brain surgery (e.g., resection of malignant B navigation brain tumours, treatment of vascular malformations). system Non- electroencephalo A non-electroencephalogram (non-EEG) physiological gram (EEG) signal based seizure monitoring system is a noninvasive physiological 89 prescription device that collects physiological signals other C signal based than EEG to identify physiological signals that may be seizure associated with a seizure monitoring system. A nonpowered neurosurgical instrument is a hand instrument or an accessory to a hand instrument used Nonpowered during neurosurgical procedures to cut, hold, or manipulate 90 neurosurgical tissue. It includes specialized chisels, osteotomes, curettes, A instrument. dissectors, elevators, forceps, gouges, hooks, surgical knives, rasps, scissors, separators, spatulas, spoons, blades, blade holders, blade breakers, probes, etc Olfactometry Intended to determine the response of humans to odours 91 C system delivered through the nose, including irritants.Percussion Intended to be used by an examining physician to gently tap 92 A hammer, manual near a patient's joints to test reflexes. A percussor is a small hammerlike device used by a 93 Percussor. physician to provide light blows to a body part. A percussor A is used as a diagnostic aid during physical examinations Photodiode Designed to provide visual function to a patient with vision subretinal loss due to retinal degeneration by detecting light, 94 C prosthesis converting it into electrical signals, and relaying them to the system retina for neural stimulation. Physical therapy ultrasound/neuro Designed to produce a rhythmic contraction/release of 95 muscular injured muscles to promote the removal of metabolic by- B stimulation products while applying ultrasound treatments. system A pinwheel is a device with sharp points on a rotating wheel 96 Pinwheel. A used for testing pain sensation A rheoencephalograph is a device used to estimate a Rheoencephalogr patient's cerebral circulation (blood flow in the brain) by 97 D aph. electrical impedance methods with direct electrical connections to the scalp or neck area A scalp clip is a plastic or metal clip used to stop bleeding 98 Scalp clip. C during surgery on the scalp Scoliosis- treatment Intended to apply electrical stimuli to the spinal musculature 99 electrical to produce a force that stabilizes or limits the progression of D stimulation the spinal lateral curvature (i.e., scoliosis). system A skull plate anvil is a device used to form alterable skull 100 Skull plate anvil. plates in the proper shape to fit the curvature of a patient's A skull A skull punch is a device used to punch holes through a 101 Skull punch. patient's skull to allow fixation of cranioplasty plates or bone A flaps by wire or other means A skullplate screwdriver is a tool used by the surgeon to Skullplate 102 fasten cranioplasty plates or skullplates to a patient's skull A screwdriver. by screws Intended to receive and analyse patient magnetic resonance imaging (MRI) images and position landmarks on Stereotactic these images, then register the images by the mean of a 103 neuronavigation/ three-dimensional (3-D) optical positioning system B planning system (frameless stereotactic neuronavigation) to provide real-time relative positioning for the treatment probes and instruments. Intended to deliver a therapeutic radiation dose to an Stereotactic anatomical region from external beams produced from 104 radiosurgical multiple radionuclide sources arranged in a fixed focal point D system collimated array; typically used to treat brain, neck, breast and spinal tumours.Tibial nerve percutaneous Intended to treat urinary and/or faecal incontinence with incontinence- 105 electrical stimuli applied to the sacral nerve via D control electrical percutaneous tibial nerve stimulation (PTNS). stimulation system Transcranial Intended for one or more psychiatric\neurological therapy electrical types [e.g., transcranial direct current stimulation (tDCS), stimulation transcranial alternating current stimulation (tACS)]. And to 106 system, induce a state resembling that of chemically-induced B continuous- anaesthesia for treating one or more psychiatric disorders current and which may include anxiety, depression, insomnia, and/or pulsed-current addiction. Transvenous Intended to configure/deliver stimulation of the phrenic phrenic nerve nerve, via a transvenous electrode, to cause contraction of 107 electrical D the diaphragm in conjunction with mechanical ventilation to stimulation assist earlier ventilation weaning. control unit Intended to test the hearing acuity of a patient, to diagnose 108 Tuning fork A hearing disorders, and to test for vibratory sense. Ultrasonic An ultrasonic scanner calibration test block is a block of scanner 109 material with known properties used to calibrate ultrasonic A calibration test scanning devices (e.g., the echoencephalograph) block. Vagus nerve electrical The strength and duration of the electrical impulses are 110 stimulation C programmed system programmer

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