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Lee S, Ledbetter J, Davies J, Romero B, Muhonen M, Castaneyra-Ruiz L. Polyvinylpyrrolidone-coated catheters decrease choroid plexus adhesion and improve flow/pressure performance in an in vitro model of hydrocephalus. Childs Nerv Syst 2024; 40:115-121. [PMID: 37417983 DOI: 10.1007/s00381-023-06058-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE Proximal catheter obstruction is the leading cause of ventricular shunt failure in pediatric patients. Our aim is to evaluate various types of shunt catheters to assess in vitro cellular adhesion and obstruction. METHODS Four catheter types were tested: (1) antibiotic and impregnated, (2) barium-stripe polyvinylpyrrolidone coated (PVP), (3) barium-stripe, and (4) barium-impregnated. Catheters were seeded with choroid plexus epithelial cells to test cellular adhesion and inoculated with the same cells to test flow/pressure performance under choroid plexus growth conditions. Ventricular catheters were placed into a three-dimensional printed phantom ventricular replicating system through which artificial cerebrospinal fluid (CSF) was pumped. Differential pressure sensors were used to measure catheter performance. RESULTS PVP catheters had the lowest median cell attachment (10 cells) compared to antibiotic-impregnated (230 cells), barium stripe (513 cells), and barium-impregnated (146 cells) catheters after culture (p < 0.01). In addition, PVP catheters (- 0.247 cm H2O) and antibiotic-impregnated (- 1.15 cm H2O) catheters had significantly lower pressure in the phantom ventricular system compared to the barium stripe (0.167 cm H2O) and barium-impregnated (0.618 cm H2O; p < 0.01) catheters. CONCLUSIONS PVP catheters showed less cellular adhesion and, together with antibiotic-impregnated catheters, required less differential pressure to maintain a consistent flow. Our findings suggest clinical relevance for using PVP ventricular catheters in patients with recurrent catheter obstruction by choroid plexus.
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Affiliation(s)
- Seunghyun Lee
- CHOC Children's Research Institute, CHOC Neuroscience Institute, 1201 W. La Veta Avenue, Orange, CA, 92868, USA
| | - Jenna Ledbetter
- CHOC Children's Research Institute, CHOC Neuroscience Institute, 1201 W. La Veta Avenue, Orange, CA, 92868, USA
| | - Jordan Davies
- University of California, CA, Irvine, Orange, CA 92868 USA, USA
| | - Bianca Romero
- Neurosurgery Department, CHOC Children's Hospital, 505 S Main St., Orange, CA, 92868, USA
| | - Michael Muhonen
- Neurosurgery Department, CHOC Children's Hospital, 505 S Main St., Orange, CA, 92868, USA
| | - Leandro Castaneyra-Ruiz
- CHOC Children's Research Institute, CHOC Neuroscience Institute, 1201 W. La Veta Avenue, Orange, CA, 92868, USA.
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Gopalakrishnan P, Faryami A, Harris CA. A novel, benchtop model for quantitative analysis of resistance in ventricular catheters. PLoS One 2023; 18:e0294811. [PMID: 38032895 PMCID: PMC10688624 DOI: 10.1371/journal.pone.0294811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/09/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION The mechanisms of catheter obstruction are still poorly understood, but the literature suggests that resistance to fluid flow plays a significant role. We developed and assessed a gravity-driven device that measures flow through ventricular catheters. We used this device to quantitatively analyze the resistances of unused ventricular catheters used in the treatment of hydrocephalus; failed hydrocephalus catheters from our catheter biorepository were also evaluated quantitatively. METHODS Catheters of three manufacturing companies were inserted into the benchtop model, which records time, flow rate, and pressure data using sensors. The relative resistances of catheters across six design models were evaluated. Experiments were performed to evaluate changes in the relative resistance of a catheter when the catheter's holes were progressively closed. The relative resistance of explanted catheters from our catheter biorepository was also measured. RESULTS Experimental results showed significant differences (P<0.05) between the relative resistances of different catheter models just after being removed from their packaging. A non-linear trend of increasing resistance was observed in experiments on catheters with artificially obstructed holes. Data from five individual benchtop models were compared, and the differences in measured data between the models were found to be negligible. A significant increase (P < 0.05) in relative resistance was observed in explanted catheters. CONCLUSION The current study sought to propose a novel in-vitro model and use it to examine data on differences in relative resistance among catheter models. From these experiments, we can rapidly correlate clinical patient cohorts to identify mechanisms of luminal shunt obstruction.
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Affiliation(s)
- Pranav Gopalakrishnan
- Department of Medical Education, Wayne State University School of Medicine, Detroit, MI, United States of America
| | - Ahmad Faryami
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, United States of America
| | - Carolyn A. Harris
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, MI, United States of America
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Hariharan P, Gluski J, Sondheimer J, Petroj A, Jea A, Whitehead WE, Del Bigio MR, Marupudi NI, McAllister JP, Limbrick DD, Rocque BG, Harris CA. Exploration of clinical predictors of the degree of ventricular catheter obstruction: a multicenter retrospective study. J Neurosurg Pediatr 2023; 32:447-454. [PMID: 37503917 PMCID: PMC10416264 DOI: 10.3171/2023.5.peds22552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 05/30/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE The aim of this study was to explore how clinical factors, including the number of lifetime revision surgeries and the duration of implantation, affect the degree of obstruction and failure rates of ventricular catheters (VCs) used to manage hydrocephalus. METHODS A total of 343 VCs and their associated clinical data, including patient demographics, medical history, and surgical details, were collected from 5 centers and used for this analysis. Each VC was classified by the degree of obstruction after macroscopic analysis. Univariate, multivariate, and binned analyses were conducted to test for associations between clinical data and degree of VC obstruction. RESULTS VCs from patients with 0 to 2 lifetime revisions had a larger proportion of VC holes obstructed than VCs from patients with 10 or more revisions (p = 0.0484). VCs implanted for less than 3 months had fewer obstructed holes with protruding tissue aggregates than VCs implanted for 13 months or longer (p = 0.0225). Neither duration of implantation nor the number of lifetime revisions was a significant predictor of the degree of VC obstruction in the regression models. In the multinomial regression model, contact of the VCs with the ventricular wall robustly predicted the overall obstruction status of a VC (p = 0.005). In the mixed-effects model, the age of the patient at their first surgery emerged as a significant predictor of obstruction by protruding tissue aggregates (p = 0.002). VCs implanted through the parietal entry site were associated with more holes with nonobstructive growth and fewer empty holes than VCs implanted via other approaches (p = 0.001). CONCLUSIONS The number of lifetime revisions and duration of implantation are correlated with the degree of VC obstruction but do not predict it. Contact of the VC with the ventricular wall and the age of the patient at their first surgery are predictors of the degree of VC obstruction, while the entry site of the VC correlates with it.
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Affiliation(s)
| | - Jacob Gluski
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Jeffrey Sondheimer
- Chemical Engineering and Materials Science, Wayne State University, Detroit, Michigan
| | - Alexandra Petroj
- Chemical Engineering and Materials Science, Wayne State University, Detroit, Michigan
| | - Andrew Jea
- Department of Neurosurgery, The University of Oklahoma College of Medicine and Oklahoma Children’s Hospital, Oklahoma City, Oklahoma
| | - William E. Whitehead
- Department of Neurosurgery, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas
| | - Marc R. Del Bigio
- Department of Pathology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Neena I. Marupudi
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan
- Department of Neurosurgery, Children’s Hospital of Michigan, Detroit, Michigan
| | - James P. McAllister
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri; and
| | - David D. Limbrick
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri; and
| | - Brandon G. Rocque
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Carolyn A. Harris
- Chemical Engineering and Materials Science, Wayne State University, Detroit, Michigan
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Vinzani M, Alshareef M, Eskandari R. Use of a Prophylactic Retrograde-Flushing Device in High-Risk Pediatric Patients with Ventriculoperitoneal Shunts: A Technical Note. Pediatr Neurosurg 2023; 58:136-141. [PMID: 37231887 DOI: 10.1159/000530869] [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: 09/10/2022] [Accepted: 04/11/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Ventriculoperitoneal shunt (VPS) malfunction rates are as high as 40% in the first year with posthemorrhagic hydrocephalus (PHH) patients having the highest proximal occlusion risk. Debris, protein, and cellular ingrowth most commonly obstruct the proximal ventricular catheter and/or valve. Historically, no preventative methods have demonstrated efficacy. We present a technical note and case series describing the use of a retrograde proximal flushing device and prophylactic flushing protocol to maintain ventricular catheter patency and reduce proximal shunt occlusions. METHODS We present our 2.8-4-year follow-up data on the first 9 pediatric cases of ReFlow (Anuncia Inc, Scottsdale, AZ) device implantation combined with routine prophylactic flushing. Rationale for device implantation, patient selection, surgical procedure details, postoperative follow-up, and prophylactic flushing protocol are discussed as well as pre- and postimplantation ventricular catheter obstruction rates. We include a technical note on the device setup and prophylactic flushing protocol. RESULTS Patient average age was 5.6 years and all patients had PHH. Minimal follow-up was 2.8 years (range 2.8-4 years). Prophylactic flushing was initiated between 2 and 14 days after ReFlow implantation and has continued as of the last follow-up. In 7 patients, ReFlow implantation occurred during the revision of an existing shunt and in two, implantation was coincident with initial VPS placement. In the 2 years preceding ReFlow and prophylactic flushing, 14 proximal shunt failures occurred in the 7 patients with existing VPS. This was reduced to only one proximal shunt failure in all 9 patients during the full follow-up period after ReFlow and prophylactic flushing. CONCLUSION Pediatric VPS placement carries high rates of proximal catheter occlusion, often leading to emergency surgery, morbidity, or even death. The ReFlow device along with routine prophylactic flushing may reduce proximal obstruction and need for revision surgery. Higher patient numbers and longer follow-up periods are necessary to further elucidate the safety and effect of such a device on longer term shunt failures and revision surgery.
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Affiliation(s)
- Michael Vinzani
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mohammed Alshareef
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ramin Eskandari
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Nasongkla N, Wongsuwan N, Meemai A, Apasuthirat A, Boongird A. Antibacterial and biocompatibility studies of triple antibiotics-impregnated external ventricular drainage: In vitro and in vivo evaluation. PLoS One 2023; 18:e0280020. [PMID: 36603010 DOI: 10.1371/journal.pone.0280020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023] Open
Abstract
Hydrocephalus is a neurological disease caused by an unusually high level of cerebrospinal fluid (CSF), which can be relieved by external ventricular drainage (EVD) insertion. However, the infection can lead to complications during the use of EVD. In this study, EVD was impregnated with three synergistic antibiotics, including rifampicin, clindamycin, and trimethoprim, to improve the antibacterial property. The impregnated drainage was studied for its characteristics in vitro and in vivo. Drug loading determination revealed that rifampicin had the highest concentration in the tube, followed by clindamycin and trimethoprim, respectively. In vitro cytotoxicity and hemolytic studies showed no toxic effects from antibiotics-impregnated EVD on fibroblast and red blood cells. For antibacterial testing, the impregnated EVD exhibited antibacterial activity against Staphylococcus aureus MRSA and Staphylococcus epidermidis up to 14 and 90 days, respectively. Moreover, biocompatibility and drug release into the bloodstream and surrounding tissues were investigated by implantation in rabbits for 30 days. Histology and morphology results showed that fibroblast cells began to adhere to the drainage surface and inflammatory cell numbers were noticeably small after the long-term implantation. In addition, there was no drug leakage to the bloodstream and surrounding tissues. Hence, this impregnated EVD can potentially be used for antibacterial application.
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Affiliation(s)
- Norased Nasongkla
- Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Nakhon Pathom, Thailand
| | - Nattarat Wongsuwan
- Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Nakhon Pathom, Thailand
| | - Aniroot Meemai
- Novatec Healthcare Company Limited, Samrong-Nua, Muang, Samutprakarn, Thailand
| | - Adisorn Apasuthirat
- Novatec Healthcare Company Limited, Samrong-Nua, Muang, Samutprakarn, Thailand
| | - Atthaporn Boongird
- Department of Surgery, Neurosurgical Unit, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Castañeyra-Ruiz L, Lee S, Chan AY, Shah V, Romero B, Ledbetter J, Muhonen M. Polyvinylpyrrolidone-Coated Catheters Decrease Astrocyte Adhesion and Improve Flow/Pressure Performance in an Invitro Model of Hydrocephalus. CHILDREN (BASEL, SWITZERLAND) 2022; 10:children10010018. [PMID: 36670569 PMCID: PMC9856269 DOI: 10.3390/children10010018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/13/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
The leading cause of ventricular shunt failure in pediatric patients is proximal catheter occlusion. Here, we evaluate various types of shunt catheters to assess in vitro cellular adhesion and obstruction. The following four types of catheters were tested: (1) antibiotic- and barium-impregnated, (2) polyvinylpyrrolidone, (3) barium stripe, and (4) barium impregnated. Catheters were either seeded superficially with astrocyte cells to test cellular adhesion or inoculated with cultured astrocytes into the catheters to test catheter performance under obstruction conditions. Ventricular catheters were placed into a three-dimensional printed phantom ventricular replicating system through which artificial CSF was pumped. Differential pressure sensors were used to measure catheter performance. Polyvinylpyrrolidone catheters had the lowest median cell attachment compared to antibiotic-impregnated (18 cells), barium stripe (17 cells), and barium-impregnated (21.5 cells) catheters after culture (p < 0.01). In addition, polyvinylpyrrolidone catheters had significantly higher flow in the phantom ventricular system (0.12 mL/min) compared to the antibiotic coated (0.10 mL/min), barium stripe (0.02 mL/min) and barium-impregnated (0.08 mL/min; p < 0.01) catheters. Polyvinylpyrrolidone catheters showed less cellular adhesion and were least likely to be occluded by astrocyte cells. Our findings can help suggest patient-appropriate proximal ventricular catheters for clinical use.
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Affiliation(s)
- Leandro Castañeyra-Ruiz
- CHOC Children’s Research Institute, and CHOC Neuroscience Institute, 1201 W. La Veta Avenue, Orange, CA 92868, USA
- Correspondence:
| | - Seunghyun Lee
- CHOC Children’s Research Institute, and CHOC Neuroscience Institute, 1201 W. La Veta Avenue, Orange, CA 92868, USA
| | - Alvin Y. Chan
- Neurosurgery Department, CHOC Children’s Hospital, 505 S Main St., Orange, CA 92868, USA
| | - Vaibhavi Shah
- Neurosurgery Department, CHOC Children’s Hospital, 505 S Main St., Orange, CA 92868, USA
| | - Bianca Romero
- CHOC Children’s Research Institute, and CHOC Neuroscience Institute, 1201 W. La Veta Avenue, Orange, CA 92868, USA
| | - Jenna Ledbetter
- CHOC Children’s Research Institute, and CHOC Neuroscience Institute, 1201 W. La Veta Avenue, Orange, CA 92868, USA
| | - Michael Muhonen
- Neurosurgery Department, CHOC Children’s Hospital, 505 S Main St., Orange, CA 92868, USA
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Whitehead WE, Weiner HL. Infantile and Childhood Hydrocephalus. N Engl J Med 2022; 387:2067-2073. [PMID: 36449422 DOI: 10.1056/nejmra2116504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- William E Whitehead
- From the Department of Neurosurgery, Baylor College of Medicine, and the Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital - both in Houston (W.E.W., H.L.W.)
| | - Howard L Weiner
- From the Department of Neurosurgery, Baylor College of Medicine, and the Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital - both in Houston (W.E.W., H.L.W.)
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Khodadadei F, Arshad R, Morales DM, Gluski J, Marupudi NI, McAllister JP, Limbrick DD, Harris CA. The effect of A1 and A2 reactive astrocyte expression on hydrocephalus shunt failure. Fluids Barriers CNS 2022; 19:78. [PMID: 36171630 PMCID: PMC9516791 DOI: 10.1186/s12987-022-00367-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background The composition of tissue obstructing neuroprosthetic devices is largely composed of inflammatory cells with a significant astrocyte component. In a first-of-its-kind study, we profile the astrocyte phenotypes present on hydrocephalus shunts. Methods qPCR and RNA in-situ hybridization were used to quantify pro-inflammatory (A1) and anti-inflammatory (A2) reactive astrocyte phenotypes by analyzing C3 and EMP1 genes, respectively. Additionally, CSF cytokine levels were quantified using ELISA. In an in vitro model of astrocyte growth on shunts, different cytokines were used to prevent the activation of resting astrocytes into the A1 and A2 phenotypes. Obstructed and non-obstructed shunts were characterized based on the degree of actual tissue blockage on the shunt surface instead of clinical diagnosis. Results The results showed a heterogeneous population of A1 and A2 reactive astrocytes on the shunts with obstructed shunts having a significantly higher proportion of A2 astrocytes compared to non-obstructed shunts. In addition, the pro-A2 cytokine IL-6 inducing proliferation of astrocytes was found at higher concentrations among CSF from obstructed samples. Consequently, in the in vitro model of astrocyte growth on shunts, cytokine neutralizing antibodies were used to prevent activation of resting astrocytes into the A1 and A2 phenotypes which resulted in a significant reduction in both A1 and A2 growth. Conclusions Therefore, targeting cytokines involved with astrocyte A1 and A2 activation is a promising intervention aimed to prevent shunt obstruction. Supplementary Information The online version contains supplementary material available at 10.1186/s12987-022-00367-3.
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Affiliation(s)
- Fatemeh Khodadadei
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, MI, USA.
| | - Rooshan Arshad
- School of Medicine, Wayne State University, Detroit, MI, USA
| | - Diego M Morales
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jacob Gluski
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Neena I Marupudi
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - James P McAllister
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - David D Limbrick
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Carolyn A Harris
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, MI, USA. .,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA. .,Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA.
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Lee S, Vinzani M, Romero B, Chan AY, Castañeyra-Ruiz L, Muhonen M. Partial Obstruction of Ventricular Catheters Affects Performance in a New Catheter Obstruction Model of Hydrocephalus. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1453. [PMID: 36291388 PMCID: PMC9601154 DOI: 10.3390/children9101453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/24/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE One of the major causes of cerebral ventricular shunt failure is proximal catheter occlusion. We describe a novel ventricular cerebrospinal fluid (CSF) flow replicating system that assesses pressure and flow responses to varying degrees of catheter occlusion. METHODS Ventricular catheter performance was assessed during conditions of partial and complete occlusion. The catheters were placed into a three-dimensionally-printed phantom ventricular replicating system. Artificial CSF was pumped through the ventricular system at a constant rate of 1 mL/min to mimic CSF flow, with the proximal end of the catheter in the phantom ventricle. Pressure transducer and flow rate sensors were used to measure intra-phantom pressure, outflow pressure, and CSF flow rates. The catheters were also inserted into silicone tubing and pressure was measured in the same manner for comparison with the phantom. RESULTS Pressure measured in the ventricle phantom did not change when the outflow of the ventricular catheter was partially occluded. However, the intraventricular phantom pressure significantly increased when the outflow catheter was 100% occluded. The flow through the catheter showed no significant difference in rate with any degree of partial occlusion of the catheter. At the distal end of the partially occluded catheters, there was less pressure compared with the nonoccluded catheters. This difference in pressure in partially occluded catheters correlated with the percentage of catheter hole occlusion. CONCLUSIONS Our model mimics the physiological dynamics of the CSF flow in partially and completely obstructed ventricular catheters. We found that partial occlusion of the catheter had no effect on the CSF flow rate, but did reduce outflow pressure from the catheter.
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Affiliation(s)
- Seunghyun Lee
- CHOC Children’s Research Institute, 1201 W. La Veta Avenue, Orange, CA 92868, USA
| | - Michael Vinzani
- College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Bianca Romero
- CHOC Children’s Neuroscience Institute, 1201 W. La Veta Avenue, Orange, CA 92868, USA
| | - Alvin Y. Chan
- Department of Pediatric Neurosurgery, CHOC Children’s Hospital, 505 S Main St., Orange, CA 92868, USA
| | | | - Michael Muhonen
- Department of Pediatric Neurosurgery, CHOC Children’s Hospital, 505 S Main St., Orange, CA 92868, USA
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Juhler M, Hansen TS, Novrup HVG, MacAulay N, Munch TN. Hydrocephalus Study Design: Testing New Hypotheses in Clinical Studies and Bench-to-Bedside Research. World Neurosurg 2022; 161:424-431. [PMID: 35505563 DOI: 10.1016/j.wneu.2021.12.100] [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: 09/13/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 10/18/2022]
Abstract
In this article, we aimed to describe some of the currently most challenging problems in neurosurgical management of hydrocephalus and how these can be reasons for inspiration for and development of research. We chose 4 areas of focus: 2 dedicated to improvement of current treatments (shunt implant surgery and endoscopic hydrocephalus surgery) and 2 dedicated to emerging future treatment principles (molecular mechanisms of cerebrospinal fluid secretion and hydrocephalus genetics).
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Affiliation(s)
- Marianne Juhler
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | | | - Hans V G Novrup
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | - Nanna MacAulay
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Tina Nørgaard Munch
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
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