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Patel A, Qi D, Boyle J, Morris M, Lin J. Dual catheter and double-lumen cerebrospinal fluid shunt systems with backflow mechanisms. Childs Nerv Syst 2024; 40:135-143. [PMID: 37515721 DOI: 10.1007/s00381-023-06101-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/21/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE We previously developed a novel functional benchtop apparatus to simulate catheter occlusion in vitro utilizing avian vitelline membrane and chalaza to test catheter designs and de-obstruction techniques. Here, we study the integration of double-lumen catheter-mediated backflow in the shunt system assembly and its potential for an in-line de-obstruction of an obstructed ventricular catheter. METHODS A double-lumen catheter was connected to a standard proximal shunt catheter for all trials. One limb of the double-lumen catheter was connected to the backflow mechanisms and allowed to loop back for fluid access. A micropump and a bi-corporal electromagnetic pump were utilized to provide various degrees of backflow at predetermined intervals. Flow rates were measured after initial occlusion and after implementation of the backflow mechanisms, and degrees of catheter blockage was calculated as a percentage of the unoccluded flow rate. Flow visualization was also used. RESULTS In baseline blockage of less than 50%, the average occluding agent weighed 0.3-0.6 g with baseline flow rates of 8.5-11.9 mL/min. After 5 min of backflow using a micropump, the degree of blockage was reduced in 50% of trials. Additional backflow for 5 min did not provide further improvements in flow rate. In baseline blockage of greater than 50%, the average occluding agent weighed 0.8-1.3 g with baseline flow rates of 1.1-4.2 mL/min. After 5 min of backflow, the system demonstrated a decreased blockage in 20% of trials; additional backflow for 5 min further improved the flow rate in 40% of the total trials. Only magnetic plates provided enough force to provide pulsatile backflow in the bi-corporal electromagnetic system. CONCLUSIONS The preliminary results of connecting a standard proximal catheter in series with a double-lumen catheter show a slight change in the percent occlusion from the baseline status several times when the retrograde flow occurred via one limb of the catheter. Additionally, the de-obstruction seems related to the length of the interval of the backflow and the initial percentage occlusion of the proximal catheter. The statistical analysis does not reveal a statistically significant reduction in occlusion in the proximal catheter with either backflow interval.
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Affiliation(s)
- Anup Patel
- Department of Neurosurgery, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - David Qi
- Department of Neurosurgery, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Jacqueline Boyle
- Department of Neurosurgery, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Martin Morris
- Department of Mechanical Engineering, Bradley University, Peoria, IL, USA
| | - Julian Lin
- Department of Neurosurgery, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
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Proximal ventricular shunt catheter occlusion model. Childs Nerv Syst 2023; 39:205-210. [PMID: 36169702 DOI: 10.1007/s00381-022-05689-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/20/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Proximal ventricular shunt catheter occlusion remains a problematic cause of shunt malfunction, and there is no consistent in vivo or in vitro model to help clinicians and researchers study this phenomenon. METHODS An in vitro model utilizing standard proximal ventricular catheter and biological occluding agents mimicking choroid plexus was designed, constructed, and calibrated to occlude consistently within a specified timeframe. Hydrostatic pressure differential of 100 cmH2O was used as a driving force to generate flow through the catheter. Chalaza and vitelline membranes were harvested from avian eggs and used as occluding agents. Successful occlusion was defined as a greater than 90% reduction in volumetric flow rate through distal outlet. Histological sections of occluded catheters were performed and interpreted by a neuropathologist. RESULTS Initial trials demonstrated successful standard catheter occlusion within 24 h using chalaza, vitelline membrane, and combination treatments. Repeat trials demonstrated consistency in successful occlusion within 5 min utilizing only vitelline membrane treatment. Histopathology demonstrated the vitelline membrane to consist of a thin, superficial layer of extraembryonic ectoderm; the chalaza was observed to consist of strands of mucin protein. CONCLUSIONS An in vitro model of proximal ventricular shunt catheter occlusion was developed and calibrated for successful occlusion within 5 min. Future studies may utilize this model to rapidly test occlusion-resistant shunt designs and de-obstruction techniques.
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Abstract
PURPOSE Prove the concept of high-resistance proximal catheters for valve-independent treatment of hydrocephalus. METHODS A preliminary design process yielded optimal high-resistance proximal ventricular catheters with a "scaled" design and parallel-oriented, U-shaped inlets. Prototypes were manually constructed using carving tools to stamp through silicone tubings. A testing apparatus was developed to simulate cerebrospinal fluid flow through a catheter, and the prototypes were tested against a control catheter for exhibition of an "on/off" phenomenon whereby no flow occurs at low pressures, and flow begins beyond a pressure threshold. Flow distribution was visualized with India ink. Regression analysis was performed to determine linearity. RESULTS The new designs showed varying amounts of improved flow control with the "scaled" design showing the most practical flow rate control across various pressures, compared to the standard catheter; however, no true "on/off" phenomenon was observed. The "scaled" design showed various degrees of dynamism; its flow rate can be time dependent, and certain maneuvers such as flushing and bending increased flow rate temporarily. Variation in the number of inlets within each "scaled" prototype also affected flow rate. Contrastingly, the flow rate of standard catheters was found to be independent of the number of inlet holes. Ink flow showed even flow distribution in "scaled" prototypes. CONCLUSIONS This initial feasibility study showed that high-resistance ventricular catheters can be designed to mimic the current/valved system. The "scaled" design demonstrated the best flow control, and its unique features were characterized.
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Aghayev K, Iqbal SM, Asghar W, Shahmurzada B, Vrionis FD. Advances in CSF shunt devices and their assessment for the treatment of hydrocephalus. Expert Rev Med Devices 2021; 18:865-873. [PMID: 34319823 DOI: 10.1080/17434440.2021.1962289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Hydrocephalus is a neurological disorder caused by excessive accumulation of the cerebrospinal fluid (CSF) in the ventricles of the brain. It can be treated by diverting the extra fluid to different parts of the body using a device called a shunt. This paper reviews different shunt devices that are used for this purpose. AREAS COVERED Shunts have high failure rates either due to infection or mechanical failure, therefore there is still ongoing work to address these two main handicaps. They require additional devices for performance assessment. Here, the paper also reviews different approaches for assessing shunt limitations. Moreover, future prospects are also discussed. EXPERT OPINION This study shows that shunt devices still remain an important treatment option for hydrocephalus. However, further efforts are required to design more advanced shunts, to eliminate high failure rates in clinical use. Sophisticated sensor systems that can accurately detect and regulate changes in CSF drainage to optimize drainage for individual needs. Moreover, shunt infection problem is still present despite recent improvements such as antibiotic impregnated catheters.
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Affiliation(s)
- Kamran Aghayev
- Department of Neurosurgery, Esencan Hospital, Esenyurt, Turkey
| | - Sheikh Ma Iqbal
- Department of Computer & Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL, USA.,Asghar-Lab, Micro and Nanotechnology in Medicine, College of Engineering and Computer Science, Boca Raton, FL, USA
| | - Waseem Asghar
- Department of Computer & Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL, USA.,Asghar-Lab, Micro and Nanotechnology in Medicine, College of Engineering and Computer Science, Boca Raton, FL, USA.,Department of Biological Sciences (Courtesy Appointment), Florida Atlantic University, Boca Raton, FL, USA
| | | | - Frank D Vrionis
- Department of Neurosurgery, Marcus Neuroscience Institute, Boca Raton Regional Hospital, Boca Raton, FL, USA
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Srinivas D, Tyagi G, Singh G. Shunt Implants – Past, Present and Future. Neurol India 2021; 69:S463-S470. [DOI: 10.4103/0028-3886.332263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Al-Saloum S, Zaranek M, Horbatiuk J, Gopalakrishnan P, Dumitrescu A, McAllister JP, Harris CA. Analysis of N-acetyl cysteine modified polydimethylsiloxane shunt for improved treatment of hydrocephalus. J Biomed Mater Res B Appl Biomater 2020; 109:1177-1187. [PMID: 33331125 DOI: 10.1002/jbm.b.34780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/17/2020] [Accepted: 12/02/2020] [Indexed: 11/06/2022]
Abstract
A major cause of hydrocephalus shunt failure is cell adhesion and obstruction of shunt catheter holes. An estimated 50% of pediatric shunts fail in the first 2 years of insertion, decreasing cell attachment and catheter obstruction can prolong the lifetime and effectiveness of the device. From previous studies, it was shown that treatment of the polydimethylsiloxane (PDMS) surface of a standard catheter with an N-acetyl-cysteine (NAC/1-ethyl-3-(3-dimethylanimopropyl)carbodiimide hydrochloride/N-hydroxysuccinimide) layer increases the wettability of the surface and has been shown to decrease cell adhesion. Other studies indicate that NAC's antioxidant behavior induces glutathione and in turn modulates cell inflammatory pathways. The current study explores the longevity of the NAC coating from the surface of the catheter over time and shows its effect on valve function. Using SEM imaging, contact angle testing, and nanodrop spectrophotometry, this release was quantified for shunt samples incubated for 0, 10, 30, 60, and 90 days. Contact angle showed a significant increase in wettability of the surface when shunts were treated with NAC, confirming successful surface modification. Pressure assays determined that if the coating is release it had no detrimental downstream effects, such as on the shunt valve mechanism. SEM imaging revealed slight deformations in surface coating indicative of salt deposition on the modified shunt samples, while nanodrop spectrophotometry and contact angle data trends suggested some discharge of the NAC coating from the catheter surfaces. The effects of NAC on cell activity may transform the way hydrocephalus is treated in the future by increasing the longevity of the shunt to protect from obstruction.
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Affiliation(s)
- Saja Al-Saloum
- Wayne State University Department of Chemical Engineering and Materials Science, Detroit, Michigan, USA
| | - Mira Zaranek
- Wayne State University Department of Chemical Engineering and Materials Science, Detroit, Michigan, USA
| | - Jeff Horbatiuk
- Wayne State University Department of Chemical Engineering and Materials Science, Detroit, Michigan, USA
| | - Pranav Gopalakrishnan
- Wayne State University Department of Chemical Engineering and Materials Science, Detroit, Michigan, USA
| | - Andrea Dumitrescu
- Wayne State University Department of Chemical Engineering and Materials Science, Detroit, Michigan, USA
| | | | - Carolyn A Harris
- Wayne State University Department of Chemical Engineering and Materials Science, Detroit, Michigan, USA
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Giménez Á, Galarza M, Thomale U, Schuhmann MU, Valero J, Amigó JM. Pulsatile flow in ventricular catheters for hydrocephalus. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2017; 375:rsta.2016.0294. [PMID: 28507239 PMCID: PMC5434084 DOI: 10.1098/rsta.2016.0294] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/06/2016] [Indexed: 05/24/2023]
Abstract
The obstruction of ventricular catheters (VCs) is a major problem in the standard treatment of hydrocephalus, the flow pattern of the cerebrospinal fluid (CSF) being one important factor thereof. As a first approach to this problem, some of the authors studied previously the CSF flow through VCs under time-independent boundary conditions by means of computational fluid dynamics in three-dimensional models. This allowed us to derive a few basic principles which led to designs with improved flow patterns regarding the obstruction problem. However, the flow of the CSF has actually a pulsatile nature because of the heart beating and blood flow. To address this fact, here we extend our previous computational study to models with oscillatory boundary conditions. The new results will be compared with the results for constant flows and discussed. It turns out that the corrections due to the pulsatility of the CSF are quantitatively small, which reinforces our previous findings and conclusions.This article is part of the themed issue 'Mathematical methods in medicine: neuroscience, cardiology and pathology'.
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Affiliation(s)
- Á Giménez
- Operations Research Center, Miguel Hernández University, Avda. Universidad s/n, 03202 Elche (Alicante), Spain
| | - M Galarza
- Regional Department of Neurosurgery, Virgen de la Arrixaca University Hospital, 30120 El Palmar (Murcia), Spain
| | - U Thomale
- Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - M U Schuhmann
- Department of Neurosurgery, University Hospital Tuebingen, Eberhard-Karls-University, Tuebingen, Germany
| | - J Valero
- Operations Research Center, Miguel Hernández University, Avda. Universidad s/n, 03202 Elche (Alicante), Spain
| | - J M Amigó
- Operations Research Center, Miguel Hernández University, Avda. Universidad s/n, 03202 Elche (Alicante), Spain
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Ortuño FM, Valenzuela O, Glösekötter P, Rojas I. Main findings and advances in biomedical engineering and bioinformatics from IWBBIO 2015. Biomed Eng Online 2016; 15 Suppl 1:79. [PMID: 27454414 PMCID: PMC4959334 DOI: 10.1186/s12938-016-0187-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Franscisco M. Ortuño
- Department of Computer Architecture and Computer Technology, CITIC-UGR, University of Granada, 18071 Granada, Spain
| | - Olga Valenzuela
- Department of Applied Mathematics, University of Granada, 18071 Granada, Spain
| | - Peter Glösekötter
- Department of Electrical Engineering and Computer Sciences, Muenster University of Applied Sciences, 48565 Steinfurt, Germany
| | - Ignacio Rojas
- Department of Computer Architecture and Computer Technology, CITIC-UGR, University of Granada, 18071 Granada, Spain
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