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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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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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Kim E. The Shunt Slippage: A Complication of Pumping Test. Korean J Neurotrauma 2022; 18:110-115. [PMID: 35557644 PMCID: PMC9064754 DOI: 10.13004/kjnt.2022.18.e5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/09/2021] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
Abstract
Surgery for the placement of a ventriculoperitoneal shunt incurs numerous procedure-related complications. Distal dislodgment of the device from the cranial insertion site after pumping of the shunt chamber has rarely occurred and it has not been evaluated to date. Herein, we report an interesting case of a 20-year-old man who underwent shunt revision for ventricular catheter migration after a manual pumping test. We reviewed previously reported cases related to such rare conditions and described a simple method of valve fixation for preventing disconnection and migration of the proximal shunt system.
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Affiliation(s)
- El Kim
- Department of Neurosurgery, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
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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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Management of Hydrocephalus in Children: Anatomic Imaging Appearances of CSF Shunts and Their Complications. AJR Am J Roentgenol 2020; 216:187-199. [PMID: 33112667 DOI: 10.2214/ajr.20.22888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. This article addresses the management of hydrocephalus and the CSF shunts used to treat this entity. CONCLUSION. CSF shunts have a high failure rate. Imaging plays a pivotal role in assessing CSF shunt failure and determining the need for surgical revision. An in-depth knowledge of CSF shunt components, their failure modes, and the corresponding findings on anatomic imaging studies is necessary to ensure timely diagnosis and prevent permanent neurologic damage.
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Iyer RR, Gorelick N, Carroll K, Blitz AM, Beck S, Garrett CM, Monroe A, Tyler B, Zuckerman ST, Capadona JR, von Recum HA, Luciano MG. Evaluation of an in vivo model for ventricular shunt infection: a pilot study using a novel antimicrobial-loaded polymer. J Neurosurg 2019; 131:587-595. [PMID: 30074457 PMCID: PMC6677638 DOI: 10.3171/2018.1.jns172523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 01/15/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Ventricular shunt infection remains an issue leading to high patient morbidity and cost, warranting further investigation. The authors sought to create an animal model of shunt infection that could be used to evaluate possible catheter modifications and innovations. METHODS Three dogs underwent bilateral ventricular catheter implantation and inoculation with methicillin-sensitive Staphylococcus aureus (S. aureus). In 2 experimental animals, the catheters were modified with a polymer containing chemical "pockets" loaded with vancomycin. In 1 control animal, the catheters were polymer coated but without antibiotics. Animals were monitored for 9 to 11 days, after which the shunts were explanted. MRI was performed after shunt implantation and prior to catheter harvest. The catheters were sonicated prior to microbiological culture and also evaluated by electron microscopy. The animals' brains were evaluated for histopathology. RESULTS All animals underwent successful catheter implantation. The animals developed superficial wound infections, but no neurological deficits. Imaging demonstrated ventriculitis and cerebral edema. Harvested catheters from the control animal demonstrated > 104 colony-forming units (CFUs) of S. aureus. In the first experimental animal, one shunt demonstrated > 104 CFUs of S. aureus, but the other demonstrated no growth. In the second experimental animal, one catheter demonstrated no growth, and the other grew trace S. aureus. Brain histopathology revealed acute inflammation and ventriculitis in all animals, which was more severe in the control. CONCLUSIONS The authors evaluated an animal model of ventricular shunting and reliably induced features of shunt infection that could be microbiologically quantified. With this model, investigation of pathophysiological and imaging correlates of infection and potentially beneficial shunt catheter modifications is possible.
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Affiliation(s)
- Rajiv R. Iyer
- Departments of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Noah Gorelick
- Departments of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Karen Carroll
- Departments of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ari M. Blitz
- Departments of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sarah Beck
- Departments of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Caroline M. Garrett
- Departments of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Audrey Monroe
- Departments of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Betty Tyler
- Departments of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sean T. Zuckerman
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland
| | - Jeffrey R. Capadona
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland
- Departments Advanced Platform Technology Center, Rehabilitation Research and Development, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Horst A. von Recum
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland
| | - Mark G. Luciano
- Departments of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Hanak BW, Bonow RH, Harris CA, Browd SR. Cerebrospinal Fluid Shunting Complications in Children. Pediatr Neurosurg 2017; 52:381-400. [PMID: 28249297 PMCID: PMC5915307 DOI: 10.1159/000452840] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/25/2016] [Indexed: 12/11/2022]
Abstract
Although cerebrospinal fluid (CSF) shunt placement is the most common procedure performed by pediatric neurosurgeons, shunts remain among the most failure-prone life-sustaining medical devices implanted in modern medical practice. This article provides an overview of the mechanisms of CSF shunt failure for the 3 most commonly employed definitive CSF shunts in the practice of pediatric neurosurgery: ventriculoperitoneal, ventriculopleural, and ventriculoatrial. The text has been partitioned into the broad modes of shunt failure: obstruction, infection, mechanical shunt failure, overdrainage, and distal catheter site-specific failures. Clinical management strategies for the various modes of shunt failure are discussed as are research efforts directed towards reducing shunt complication rates. As it is unlikely that CSF shunting will become an obsolete procedure in the foreseeable future, it is incumbent on the pediatric neurosurgery community to maintain focused efforts to improve our understanding of and management strategies for shunt failure and shunt-related morbidity.
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Affiliation(s)
- Brian W. Hanak
- Department of Neurological Surgery, University of Washington and Seattle Children’s Hospital, Seattle, WA
| | - Robert H. Bonow
- Department of Neurological Surgery, University of Washington and Seattle Children’s Hospital, Seattle, WA
| | - Carolyn A. Harris
- Department of Neurosurgery, Wayne State University and Children’s Hospital of Michigan, Detroit, MI, USA
| | - Samuel R. Browd
- Department of Neurological Surgery, University of Washington and Seattle Children’s Hospital, Seattle, WA
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Weisenberg SH, TerMaath SC, Seaver CE, Killeffer JA. Ventricular catheter development: past, present, and future. J Neurosurg 2016; 125:1504-1512. [DOI: 10.3171/2015.12.jns151181] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Cerebrospinal fluid diversion via ventricular shunting is the prevailing contemporary treatment for hydrocephalus. The CSF shunt appeared in its current form in the 1950s, and modern CSF shunts are the result of 6 decades of significant progress in neurosurgery and biomedical engineering. However, despite revolutionary advances in material science, computational design optimization, manufacturing, and sensors, the ventricular catheter (VC) component of CSF shunts today remains largely unchanged in its functionality and capabilities from its original design, even though VC obstruction remains a primary cause of shunt failure. The objective of this paper is to investigate the history of VCs, including successful and failed alterations in mechanical design and material composition, to better understand the challenges that hinder development of a more effective design.
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Affiliation(s)
| | | | | | - James A. Killeffer
- 2Division of Neurosurgery, Department of Surgery, Graduate School of Medicine, University of Tennessee, Knoxville, Tennessee
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