scholarly journals In situ clearance of a proximal shunt malfunction in a child with hydrocephalus post cerebral arteriovenous malformation rupture noted intraoperatively

2020 ◽  
Vol 11 ◽  
pp. 116
Author(s):  
Zachary Porter ◽  
George Yang ◽  
Shawn Vuong ◽  
Baher Hanna ◽  
Joseph Madsen ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Ventriculoperitoneal Shunt ◽  
External Ventricular Drain ◽  
Cerebral Arteriovenous Malformation ◽  
Csf Shunt ◽  
Ventricular Catheter ◽  
Csf Flow ◽  
Shunt System ◽  
Shunt Valve

Background: Hydrocephalus shunt malfunctions remain treated with surgical intervention only. Despite efforts at identifying or preventing CSF shunt obstruction, no evidence currently exists to restore CSF flow following proximal occlusion, non-invasively. Case Description: We present direct intraoperative evidence in the case of a 5-year-old male who developed hydrocephalus subsequent to hemorrhagic presentation post cerebral arteriovenous malformation rupture. After weeks of externalized CSF diversion for clearance of CSF red blood cells, he was taken to the operating room for removal of the external ventricular drain and placement of a ventriculoperitoneal shunt for hydrocephalus. At conclusion of placing his ventriculoperitoneal shunt with ReFlow flusher assist device, his shunt valve reservoir was noted to not refill. Following manual depression of the ReFlow flusher, we identified clearance of debris from the obstructed ventricular catheter allowing reestablished CSF flow through the shunt system under live intraoperative ultrasonography. Subsequently, there was return of brisk refill to the shunt valve reservoir. Conclusion: Observations here demonstrate a potentially useful technical strategy toward clearance of proximal shunt obstructions, in situ.

scholarly journals Subgaleal Migration of the Distal Catheter of a Ventriculoperitoneal Shunt

2009 ◽  
Vol 52 (2) ◽  
pp. 77-79 ◽  
Author(s):  
Fatih Serhat Erol ◽  
Bekir Akgun
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Ventricular Catheter ◽  
Peritoneal Catheter ◽  
Shunt Valve ◽  
Distal Catheter ◽  
X Ray ◽  
Proximal Migration ◽  
Shunt Dysfunction ◽  
Valve Placement ◽  
The Brain

Proximal migration of the distal end of a ventriculoperitoneal shunt has been observed much more rarely than other numerous shunt-related complications. Subgaleal migration of the peritoneal end is one of the samples. In the preset report we have discussed a case of subgaleal migration of the peritoneal end detected as a result of the examinations performed for shunt dysfunction. There was ventricular dilatation on CT scan of the brain. X-ray examinations confirmed proper ventricular catheter and shunt valve placement but a complete migration of distal (peritoneal) catheter into the subgaleal space. Then the patient’s shunt was revised. When our case and the literature were examined, we observed that this complication was frequently encountered during the first postoperative months, in the pediatric ages and in patients with advanced hydrocephalus. Besides, we have detected that the peritoneal catheters had tendency to migration into the subgaleal tissues similar to pre-insertion forms of the preoperatively original packages.

In vitro experiment for verification of the tandem shunt valve system: a novel method for treating hydrocephalus by flexibly controlling cerebrospinal fluid flow and intracranial pressure

2013 ◽  
Vol 11 (1) ◽  
pp. 43-47
Author(s):  
Yasuo Aihara ◽  
Ichiro Shoji ◽  
Yoshikazu Okada
Keyword(s):  
Intracranial Pressure ◽  
Flow Rate ◽  
Csf Shunt ◽  
Main Function ◽  
Csf Flow ◽  
Shunt Valve ◽  
Cerebrospinal Fluid Flow ◽  
Valve System ◽  
Programmable Valve

Object The CSF shunt valve is a medical device whose main function is to regulate intracranial pressure and drain excess CSF. The authors have developed a new therapeutic method for treating hydrocephalus, namely the tandem shunt valve system, which has the potential of flexibly controlling the CSF flow rate and intracranial pressure in patients. Methods The properties of the tandem system were verified by performing in vitro experiments. An in vitro system with a manometer was built to measure pressure and flow rates of water in open systems using the Codman Hakim Programmable Valve and the Strata adjustable pressure programmable valve. A single valve and 2 single shunt valves connected in series (the tandem shunt valve system) were connected to the manometer to check the final pressure. Results Conventional single shunt valve systems require valve pressures to be set higher to slow down the CSF flow rate, which inevitably results in a higher final pressure. On the other hand, the tandem shunt valve system uses the combination of 2 valves to slow the CSF flow rate without increasing the final pressure. Conclusions The authors succeeded in experimentally demonstrating in vitro results of tandem systems and their effectiveness by applying a model to show that the valve with the higher pressure setting determined the final pressure of the entire system and the flow rate became slower than single shunt valve systems.

Arteriovenous fistula around the ventriculoperitoneal shunt system in a patient with a dural arteriovenous malformation of the posterior fossa

1995 ◽  
Vol 82 (2) ◽  
pp. 288-290 ◽  
Author(s):  
Shin-ichi Yoshimura ◽  
Nobuo Hashimoto ◽  
Kiyoshi Kazekawa ◽  
Atsushi Obata ◽  
Chikao Yutani ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Posterior Fossa ◽  
Ventriculoperitoneal Shunt ◽  
Rare Complication ◽  
Therapeutic Embolization ◽  
Dural Arteriovenous Malformation ◽  
Shunt System ◽  
Content Type ◽  
Underlying Mechanisms ◽  
Dural Avm

✓ A dural arteriovenous malformation (AVM) of the posterior fossa can produce persistent tinnitus, convulsions, and dementia. Successful therapeutic embolization may result in a complete cure, but in some cases, patients do not respond to the treatment. The authors report a patient with a dural AVM of the posterior fossa that did not respond to repeated intravascular treatments, but resulted in an arteriovenous shunt in the scalp around the ventriculoperitoneal shunt system. Although several hypotheses have been proposed on the pathogenesis of dural AVMs, the underlying mechanisms remain unknown. The rare complication we encountered may shed some light on the pathogenesis of dural AVMs.

scholarly journals Modelling fluid and particulate flow through a ventriculoperitoneal shunt in a variable temperature environment

2021 ◽  
Vol 347 ◽  
pp. 00035
Author(s):  
Tshiamo Ramokoka ◽  
Muaaz Bhamjee
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Volume Flow Rate ◽  
Variable Temperature ◽  
White Blood Cells ◽  
Experimental Results ◽  
Average Error ◽  
Cfd Model ◽  
Shunt System ◽  
Shunt Valve ◽  
Shunt Occlusion

One of the most prevalent causes of failure for a ventriculoperitoneal shunt is blockage, the other being infection. This study looks at the blockage of the shunt valve, and whether the occlusion of a shunt valve is accelerated by the presence of an infection. This study assumes that an infection will raise the number of white blood cells contained in the cerebrospinal fluid to fight it and will thus accelerate shunt occlusion. The experiment simulates a shunt system by suspending a shunt valve in a water bath that has a temperature that varies between 37°C and 41°C. A computational fluid dynamics model of the shunt system is used to gain further insight into the flow behaviour under these conditions. The results of the CFD model were validated using the experimental results. There was an average error of 15% between the readings that were obtained in the experiment and the CFD model. The experimental results showed that there was a decrease in the volume flow rate at the outlet of the shunt system, which was not large enough to point towards any blockage. Both the model predictions and the experimental results show that increased temperature and particulate concentration alone do not result in shunt occlusion, particularly at the shunt valve. This result effectively excluded the shunt valve as a region of shunt occlusion due to infection, as an infection occurs due to the growth of bacteria along the surfaces of the shunt system and this bacterial growth is more likely to occur at the proximal and distal ends of the shunt system.

A flow-regulating device to control differential pressure in CSF shunt systems

1982 ◽  
Vol 57 (4) ◽  
pp. 570-573 ◽  
Author(s):  
Hiroshi Yamada
Keyword(s):  
Experimental Study ◽  
Flow Rate ◽  
Csf Shunt ◽  
Csf Flow ◽  
Csf Shunts ◽  
Shunt System ◽  
Distal Catheter ◽  
Content Type ◽  
Teflon Tube ◽  
Fine Print

✓ A method of regulating flow rate through cerebrospinal fluid (CSF) shunts with the addition of a flow-regulating device (FRD) is reported. The FRD consists of a small-caliber (0.4 mm) Teflon tube placed in the usual connector. This device has the advantage of converting the original shunt valves to valves for higher-resistance flow without replacing the entire distal catheter. An experimental study revealed that this device reduced the CSF flow rate in the shunt system by approximately 30%. The author has found it reliable in 32 patients, without causing CSF obstruction. The device is easily installed and removed.

Flow characteristics of cerebrospinal fluid shunt tubing

2012 ◽  
Vol 9 (2) ◽  
pp. 191-197 ◽  
Author(s):  
Joseph T. Cheatle ◽  
Alexis N. Bowder ◽  
Sandeep K. Agrawal ◽  
Michael D. Sather ◽  
Leslie C. Hellbusch
Keyword(s):  
Cerebrospinal Fluid ◽  
Flow Characteristics ◽  
Hydrodynamic Resistance ◽  
Csf Shunt ◽  
Effective Diameter ◽  
Cerebrospinal Fluid Shunt ◽  
Shunt System ◽  
Shunt Valve ◽  
Cross Sectional ◽  
Distal Catheter

Object Cerebrospinal fluid shunt systems malfunction for a multitude of reasons, including malpostitioning, obstruction of the ventricular or distal catheter, obstruction of the shunt valve, and catheter disruptions or disconnections. The goal of this study was to examine the hydrodynamic resistance and flow in new and explanted catheters and also in catheters with 1 or 2 straight connectors. Methods Explanted catheters of multiple lengths, 2-piece catheters, 3-piece catheters, and new catheters were attached to a proximal and distal manometer. A flask with artificial CSF attached to the proximal end provided flow. The flow was allowed to stabilize over 1 hour; then the change in pressure between the proximal and distal end of the catheter was measured. Results The resistance to flow was calculated for new, never-implanted catheters and compared with the resistance of explanted distal shunt catheters. The resistance of the new catheters was examined after the addition of 1 and 2 straight connectors. Explanted catheters exhibited a slight increase in the resistance to flow of artificial CSF compared with new catheters. Two-piece and 3-piece catheters had a significant increase in resistance to flow compared with new catheters. For all catheters, resistance to flow increased as length increased (new, p = 0.01; explanted, p = 0.009; 1 connector, p = 0.01; 2 connectors, p = 0.03). In this paper, effective diameter is defined as the available cross-sectional area of catheter contacted by the artificial CSF. For new and explanted catheters, a decrease in the effective diameter of the catheter was associated with an increase in the resistance to flow of artificial CSF (new, p = 0.1083; explanted, p = 0.0091). However, after the addition of 1 or 2 connectors, an inverse trend was observed: resistance to flow increased with effective diameter. Conclusions There appears to be some increase in resistance of CSF shunt catheters as they age, altering flow dynamics. In addition, the use of straight connectors within a CSF shunt system increases the resistance to flow of artificial CSF within the shunt system. The increase in resistance appears to be related to the duration of implantation and the length of the catheter and inversely related to the diameter of the catheter. This increase in resistance may be related to sterile shunt malfunction. The addition of straight connectors is associated with a significant increase in resistance in comparison with catheters without connectors (p = 0.005).

Ventriculoperitoneal shunt with a rare twist: small-bowel ischemia and necrosis secondary to knotting of peritoneal catheter

2014 ◽  
Vol 14 (3) ◽  
pp. 234-237 ◽  
Author(s):  
Lee A. Tan ◽  
Manish K. Kasliwal ◽  
Roham Moftakhar ◽  
Lorenzo F. Munoz
Keyword(s):  
Small Bowel ◽  
Ventriculoperitoneal Shunt ◽  
Rare Complication ◽  
External Ventricular Drain ◽  
Bowel Ischemia ◽  
Shunt Revision ◽  
Peritoneal Catheter ◽  
High Grade Fever ◽  
Shunt System ◽  
Distal Catheter

Small-bowel ischemia and necrosis due to knotting of the peritoneal catheter is an extremely rare complication related to a ventriculoperitoneal shunt (VPS). A 3-month-old girl, with a history of Chiari II malformation and myelomeningocele (MM) after undergoing right occipital VPS insertion and MM repair at birth, presented to the emergency department with a high-grade fever. Examination of a CSF sample obtained via shunt tap raised suspicion for the presence of infection. Antibiotic therapy was initiated, and subsequently the VPS was removed and an external ventricular drain was placed. Intraoperatively, as attempts at pulling the distal catheter from the scalp incision were met with resistance, the distal catheter was cut and left in the abdomen while the remainder of the shunt system was successfully removed. While the patient was awaiting definitive shunt revision surgery to replace the VPS, she developed abdominal distension due to small-bowel obstruction. An emergency exploratory laparotomy revealed a knot in the distal catheter looping around and strangulating the distal ileum, causing small-bowel ischemia and necrosis in addition to the obstruction. A small-bowel resection with ileostomy was performed, with subsequent placement of ventriculoatrial shunt for treatment of hydrocephalus. The authors report this exceedingly rare clinical scenario to highlight the fact that any retained distal catheter must be carefully managed with immediate abdominal exploration to remove the distal catheter to avoid bowel necrosis as pulling of a knotted peritoneal catheter may strangulate the bowel and cause ischemia, with significant clinical morbidity and possible mortality.

A 12-year single-center retrospective analysis of antisiphon devices to prevent proximal ventricular shunt obstruction for hydrocephalus

2019 ◽  
Vol 24 (6) ◽  
pp. 642-651
Author(s):  
Joyce Koueik ◽  
Mark R. Kraemer ◽  
David Hsu ◽  
Elias Rizk ◽  
Ryan Zea ◽  
...  
Keyword(s):  
Shunt Revision ◽  
Ventricular Catheter ◽  
Shunt Failure ◽  
Shunt System ◽  
Shunt Valve ◽  
Catheter Obstruction ◽  
Before And After ◽  
Observational Cohort ◽  
Shunt Obstruction

OBJECTIVERecent evidence points to gravity-dependent chronic shunt overdrainage as a significant, if not leading, cause of proximal shunt failure. Yet, shunt overdrainage or siphoning persists despite innovations in valve technology. The authors examined the effectiveness of adding resistance to flow in shunt systems via antisiphon devices (ASDs) in preventing proximal shunt obstruction.METHODSA retrospective observational cohort study was completed on patients who had an ASD (or additional valve) added to their shunt system between 2004 and 2016. Detailed clinical, radiographic, and surgical findings were examined. Shunt failure rates were compared before and after ASD addition.RESULTSSeventy-eight patients with shunted hydrocephalus were treated with placement of an ASD several centimeters distal to the primary valve. The records of 12 of these patients were analyzed separately due to a complex shunt revision history (i.e., > 10 lifetime shunt revisions). The authors found that adding an ASD decreased the 1-year ventricular catheter obstruction rates in the “simple” and “complex” groups by 67.3% and 75.8%, respectively, and the 5-year rates by 43.3% and 65.6%, respectively. The main long-term ASD complication was ASD removal for presumed valve pressure intolerance in 5 patients.CONCLUSIONSUsing an ASD may result in significant reductions in ventricular catheter shunt obstruction rates. If confirmed with prospective studies, this observation would lend further evidence that chronic shunt overdrainage is a central cause of shunt malfunction, and provide pilot data to establish clinical and laboratory studies that assess optimal ASD type, number, and position, and eventually develop shunt valve systems that are altogether resistant to siphoning.

scholarly journals Reconsidering Ventriculoperitoneal Shunt Surgery and Postoperative Shunt Valve Pressure Adjustment: Our Approaches Learned From Past Challenges and Failures

2022 ◽  
Vol 12 ◽  
Author(s):  
Shigeki Yamada ◽  
Masatsune Ishikawa ◽  
Madoka Nakajima ◽  
Kazuhiko Nozaki
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Early Period ◽  
Csf Shunt ◽  
Symptom Improvement ◽  
Shunt Surgery ◽  
Shunt Valve ◽  
Improvement Rate ◽  
Shunt Implantation ◽  
Csf Drainage ◽  
Valve Pressure

Treatment for idiopathic normal pressure hydrocephalus (iNPH) continues to develop. Although ventriculoperitoneal shunt surgery has a long history and is one of the most established neurosurgeries, in the 1970s, the improvement rate of iNPH triad symptoms was poor and the risks related to shunt implantation were high. This led experts to question the surgical indication for iNPH and, over the next 20 years, cerebrospinal fluid (CSF) shunt surgery for iNPH fell out of favor and was rarely performed. However, the development of programmable-pressure shunt valve devices has reduced the major complications associated with the CSF drainage volume and appears to have increased shunt effectiveness. In addition, the development of support devices for the placement of ventricular catheters including preoperative virtual simulation and navigation systems has increased the certainty of ventriculoperitoneal shunt surgery. Secure shunt implantation is the most important prognostic indicator, but ensuring optimal initial valve pressure is also important. Since over-drainage is most likely to occur in the month after shunting, it is generally believed that a high initial setting of shunt valve pressure is the safest option. However, this does not always result in sufficient improvement of the symptoms in the early period after shunting. In fact, evidence suggests that setting the optimal valve pressure early after shunting may cause symptoms to improve earlier. This leads to improved quality of life and better long-term independent living expectations. However, in iNPH patients, the remaining symptoms may worsen again after several years, even when there is initial improvement due to setting the optimal valve pressure early after shunting. Because of the possibility of insufficient CSF drainage, the valve pressure should be reduced by one step (2–4 cmH2O) after 6 months to a year after shunting to maximize symptom improvement. After the valve pressure is reduced, a head CT scan is advised a month later.

scholarly journals Comparison of the accuracy and proximal shunt failure rate of freehand placement versus intraoperative guidance in parietooccipital ventricular catheter placement

2016 ◽  
Vol 41 (3) ◽  
pp. E10 ◽  
Author(s):  
Thomas J. Wilson ◽  
Kathleen E. McCoy ◽  
Wajd N. Al-Holou ◽  
Sergio L. Molina ◽  
Matthew D. Smyth ◽  
...  
Keyword(s):  
Catheter Placement ◽  
Csf Shunt ◽  
Frameless Stereotaxy ◽  
Ventricular Catheter ◽  
Shunt Failure ◽  
Shunt System ◽  
Distal Catheter ◽  
Freehand Technique ◽  
The University ◽  
Intraoperative Guidance

OBJECTIVE The aim of this paper is to compare the accuracy of the freehand technique versus the use of intraoperative guidance (either ultrasound guidance or frameless stereotaxy) for placement of parietooccipital ventricular catheters and to determine factors associated with reduced proximal shunt failure. METHODS This retrospective cohort study included all patients from 2 institutions who underwent a ventricular cerebrospinal fluid (CSF) shunting procedure in which a new parietooccipital ventricular catheter was placed between January 2005 and December 2013. Data abstracted for each patient included age, sex, method of ventricular catheter placement, side of ventricular catheter placement, Evans ratio, and bifrontal ventricular span. Postoperative radiographic studies were reviewed for accuracy of ventricular catheter placement. Medical records were also reviewed for evidence of shunt failure requiring revision. Standard statistical methods were used for analysis. RESULTS A total of 257 patients were included in the study: 134 from the University of Michigan and 123 from Washington University in St. Louis. Accurate ventricular catheter placement was achieved in 81.2% of cases in which intraoperative guidance was used versus 67.3% when the freehand technique was used. Increasing age reduced the likelihood of accurate catheter placement (OR 0.983, 95% CI 0.971–0.995; p = 0.005), while the use of intraoperative guidance significantly increased the likelihood (OR 2.809, 95% CI 1.406–5.618; p = 0.016). During the study period, 108 patients (42.0%) experienced shunt failure, 79 patients (30.7%) had failure involving the proximal catheter, and 53 patients (20.6%) had distal failure (valve or distal catheter). Increasing age reduced the likelihood of being free from proximal shunt failure (OR 0.983, 95% CI 0.970–0.995; p = 0.008), while both the use of intraoperative guidance (OR 2.385, 95% CI 1.227–5.032; p = 0.011), and accurate ventricular catheter placement (OR 3.424, 95% CI 1.796–6.524; p = 0.009) increased the likelihood. CONCLUSIONS The use of intraoperative guidance during parietooccipital ventricular catheter placement as part of a CSF shunt system significantly increases the likelihood of accurate catheter placement and subsequently reduces the rate of proximal shunt failure.

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