scholarly journals Investigation of ventriculoperitoneal shunt disconnection for hydrocephalus treatment

2020 ◽  
pp. 1-6
Author(s):  
Sulmaz Zahedi ◽  
Miles Hudson ◽  
Xin Jin ◽  
Richard Justin Garling ◽  
Jacob Gluski ◽  
...  
Keyword(s):  
Standard Of Care ◽  
Complete Separation ◽  
Mechanical Failure ◽  
Shunt Failure ◽  
Shunt System ◽  
Parallel Displacement ◽  
Shunt Catheter ◽  
Cyclical Loading ◽  
Hydrocephalus Treatment ◽  
Catheter Fracture

OBJECTIVEThis investigation is aimed at gaining a better understanding of the factors that lead to mechanical failure of shunts used for the treatment of hydrocephalus, including shunt catheter-valve disconnection and shunt catheter fracture.METHODSTo determine the root cause of mechanical failure, the authors created a benchtop mechanical model to mimic mechanical stressors on a shunt system. To test shunt fracture, cyclical loading on the catheter-valve connection site was tested with the shunt catheter held perpendicular to the valve. Standard methods were used to secure the catheter and valves with Nurolon. These commercial systems were compared to integrated catheters and valves (manufactured as one unit). To test complete separation/disconnection of the shunt catheter and valve, a parallel displacement test was conducted using both Nurolon and silk sutures. Finally, the stiffness of the catheters was assessed. All mechanical investigations were conducted on shunts from two major shunt companies, assigned as either company A or company B.RESULTSCyclical loading experiments found that shunts from company B fractured after a mean of 4936 ± 1725 cycles (95% CI 2990–6890 cycles), while those of company A had not failed after 8000 cycles. The study of parallel displacement indicated complete disconnection of company B’s shunt catheter-valve combination using Nurolon sutures after being stretched an average 32 ± 5.68 mm (95% CI 25.6–38.4 mm), whereas company A’s did not separate using either silk or Nurolon sutures. During the stiffness experiments, the catheters of company B had statistically significantly higher stiffness of 13.23 ± 0.15 N compared to those of company A, with 6.16 ± 0.29 N (p < 0.001).CONCLUSIONSMechanical shunt failure from shunt catheter-valve disconnection or fracture is a significant cause of shunt failure. This study demonstrates, for the first time, a correlation between shunt catheters that are less mechanically stiff and those that are less likely to disconnect from the valve when outstretched and are also less likely to tear when held at an angle from the valve outlet. The authors propose an intervention to the standard of care wherein less stiff catheters are trialed to reduce disconnection.

Radiographic assessment of snap-shunt failure

2010 ◽  
Vol 6 (3) ◽  
pp. 299-302 ◽  
Author(s):  
Anand I. Rughani ◽  
Bruce I. Tranmer ◽  
Jeffrey E. Florman ◽  
James T. Wilson
Keyword(s):  
Normal Values ◽  
Clinical Symptoms ◽  
Type System ◽  
Shunt Malfunction ◽  
Ct Scans ◽  
Shunt Revision ◽  
Ventricular Catheter ◽  
Shunt Failure ◽  
Shunt System ◽  
Ct Finding

Accurate assessment of imaging studies in patients with ventriculoperitoneal shunts can be aided by empirical findings. The authors characterize an objective measurement easily performed on head CT scans with the goal of producing clear evidence of shunt fracture or disconnection in patients with a snap shunt–type system. The authors describe 2 cases of ventriculoperitoneal shunt failure involving a fracture and a disconnection associated with a snap-shunt assembly. In both cases the initial clinical symptoms were not convincing for shunt malfunction, and the interpretation of the CT finding failed to immediately identify the abnormality. As the clinical picture became more convincing for shunt malfunction, each patient subsequently underwent successful shunt revision. The authors reviewed the CT scans of 10 patients with an intact and functioning snap-shunt system to characterize the normal appearance of the snap-shunt connection. On CT scans the distance between the radiopaque portion of the ventricular catheter and the radiopaque portion of the reservoir dome measures an average of 4.72 mm (range 4.6–4.9 mm, 95% CI 4.63–4.81 mm). In the authors' patient with a fractured ventricular catheter, this interval measured 7.8 mm, and in the patient with a disconnection it measured 7.7 mm. In comparison with the range of normal values, a radiolucent interval significantly greater than 4.9 mm should promptly raise concern for a disconnected or fractured shunt in this system. This measurement may prove particularly useful when serial imaging is not readily available.

Shunt Failure—The First 30 Days

Neurosurgery ◽  
2019 ◽  
Vol 87 (1) ◽  
pp. 123-129
Author(s):  
Ryan P Lee ◽  
Sonia Ajmera ◽  
Fridtjof Thomas ◽  
Pooja Dave ◽  
Jock C Lillard ◽  
...  
Keyword(s):  
Selection Procedure ◽  
Research Database ◽  
Shunt Failure ◽  
Shunt Surgery ◽  
Forward Selection ◽  
Multivariable Logistic Regression Model ◽  
Shunt System ◽  
Index Model ◽  
Surgery Research ◽  
Significant Covariates

Abstract BACKGROUND Incontrovertible predictors of shunt malfunction remain elusive. OBJECTIVE To determine predictors of shunt failure within 30 d of index surgery. METHODS This was a single-center retrospective cohort study from January 2010 through November 2016. Using a ventricular shunt surgery research database, clinical and procedural variables were procured. An “index surgery” was defined as implantation of a new shunt or revision or augmentation of an existing shunt system. The primary outcome was shunt failure of any kind within the first 30 days of index surgery. Bivariate models were created, followed by a final multivariable logistic regression model using a backward-forward selection procedure. RESULTS Our dataset contained 655 unique patients with a total of 1206 operations. The median age for the cohort at the time of first shunt surgery was 4.6 yr (range, 0-28; first and third quartile, .37 and 11.8, respectively). The 30-day failure rates were 12.4% when analyzing the first-index operation only (81/655), and 15.7% when analyzing all-index operations (189/1206). Small or slit ventricles at the time of index surgery and prior ventricular shunt operations were found to be significant covariates in both the “first-index” (P &lt; .01 and P = .05, respectively) and “all-index” (P = .02 and P &lt; .01, respectively) multivariable models. Intraventricular hemorrhage at the time of index surgery was an additional predictor in the all-index model (P = .01). CONCLUSION This study demonstrates that only 3 variables are predictive of 30-day shunt failure when following established variable selection procedures, 2 of which are potentially under direct control of the surgeon.

scholarly journals Acute Hydrocephalus Following a Spontaneous Ventriculoperitoneal Shunt Catheter Fracture With Scrotal Migration

Cureus ◽  
2021 ◽  
Author(s):  
Caio Perret ◽  
Raphael Bertani ◽  
Barbara Pilon ◽  
Stefan W Koester ◽  
Hugo C Schiavini
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Acute Hydrocephalus ◽  
Shunt Catheter ◽  
Catheter Fracture

Distal ventriculoperitoneal shunt failure caused by silicone allergy

2005 ◽  
Vol 102 (3) ◽  
pp. 536-539 ◽  
Author(s):  
Namath S. Hussain ◽  
Paul P. Wang ◽  
Carol James ◽  
Benjamin S. Carson ◽  
Anthony M. Avellino
Keyword(s):  
Allergic Reaction ◽  
Allergic Reactions ◽  
Shunt Failure ◽  
Valve Mechanism ◽  
Shunt System ◽  
Content Type ◽  
Vp Shunt ◽  
Shunt Tubing ◽  
Fine Print

✓ The placement of a ventriculoperitoneal (VP) shunt is the most common form of treatment for hydrocephalus. Although allergic reactions to the silicone in shunt hardware are very rare, the authors describe a case of silicone allergy causing multiple ventricular shunt revisions. A 24-year-old man, who had undergone multiple VP shunt revisions, presented with shunt malfunction caused by allergic reaction of the tissues surrounding the shunt tubing. The patient's existing silicone-based shunt was replaced with a new polyurethane system, including the proximal and distal catheters as well as the valve mechanism. Contrary to recommendations in previous studies of silicone shunt allergies, long-term immunosuppression was not initiated. The patient was followed up for more than 8 years without recurrence of an allergic reaction to the shunt. This outcome indicates that replacing the original silicone-based shunt system with a polyurethane-based system alone is sufficient in the treatment of a silicone shunt allergy.

Peritoneography in the Assessment of Peritoneal Cerebrospinal Fluid Absorption Potential for Distal Ventriculoperitoneal Shunt Catheter Placement: Technical Case Report

Neurosurgery ◽  
2001 ◽  
Vol 49 (5) ◽  
pp. 1267-1269 ◽  
Author(s):  
David McAuley ◽  
Alistair C. Dick ◽  
Annie Paterson
Keyword(s):  
Cerebrospinal Fluid ◽  
Ventriculoperitoneal Shunt ◽  
Contrast Material ◽  
Water Soluble ◽  
Catheter Placement ◽  
Shunt Failure ◽  
Fluid Absorption ◽  
Shunt Catheter ◽  
Water Soluble Contrast ◽  
Cerebrospinal Fluid Absorption

ABSTRACT OBJECTIVE AND IMPORTANCE Distal ventriculoperitoneal shunt failure has been associated with absorption failure secondary to previous peritonitis. This assumption has caused surgeons to seek alternate sites for distal catheter placement. We propose that the absorptive potential of the peritoneal cavity should be assessed before that site is discounted for catheter placement. CLINICAL PRESENTATION The case of a 14-month-old male patient is presented, demonstrating multiple ventriculoperitoneal shunt placement procedures and a diagnostic dilemma with respect to distal shunt placement. Peritoneography was performed to demonstrate peritoneal fluid absorption, allowing subsequent placement of a new distal shunt catheter with good clinical results. TECHNIQUE Using aseptic technique, a 24-gauge spinal needle was inserted in the midline of the abdomen and water-soluble contrast material was instilled. Delayed radiographs delineated peritoneal adhesions and demonstrated renal excretion of the contrast material, confirming peritoneal absorption. CONCLUSION The peritoneal cavity remains the site of choice for distal shunt catheter placement. If failure of peritoneal cerebrospinal fluid absorption is suspected as a cause of shunt failure, then peritoneography with water-soluble contrast material may be safely used to demonstrate the adequacy of fluid absorption before a secondary site is chosen.

scholarly journals Multimodal Sensing Capabilities for the Detection of Shunt Failure

Sensors ◽  
2021 ◽  
Vol 21 (5) ◽  
pp. 1747
Author(s):  
Milenka Gamero ◽  
Woo Seok Kim ◽  
Sungcheol Hong ◽  
Daniel Vorobiev ◽  
Clinton D. Morgan ◽  
...  
Keyword(s):  
Flow Rate ◽  
Medical Condition ◽  
Primary Therapy ◽  
Shunt System ◽  
Multimodal Sensing ◽  
Abnormal Accumulation ◽  
Long Time ◽  
Adult Congenital ◽  
Wireless Device ◽  
Hydrocephalus Treatment

Hydrocephalus is a medical condition characterized by the abnormal accumulation of cerebrospinal fluid (CSF) within the cavities of the brain called ventricles. It frequently follows pediatric and adult congenital malformations, stroke, meningitis, aneurysmal rupture, brain tumors, and traumatic brain injury. CSF diversion devices, or shunts, have become the primary therapy for hydrocephalus treatment for nearly 60 years. However, routine treatment complications associated with a shunt device are infection, obstruction, and over drainage. Although some (regrettably, the minority) patients with shunts can go for years without complications, even those lucky few may potentially experience one shunt malfunction; a shunt complication can require emergency intervention. Here, we present a soft, wireless device that monitors distal terminal fluid flow and transmits measurements to a smartphone via a low-power Bluetooth communication when requested. The proposed multimodal sensing device enabled by flow sensors, for measurements of flow rate and electrodes for measurements of resistance in a fluidic chamber, allows precision measurement of CSF flow rate over a long time and under any circumstances caused by unexpected or abnormal events. A universal design compatible with any modern commercial spinal fluid shunt system would enable the widespread use of this technology.

Endoscope-assisted placement of a multiperforated shunt catheter into the fourth ventricle via a frontal transventricular approach

2007 ◽  
Vol 22 (4) ◽  
pp. 1-8 ◽  
Author(s):  
Kristen Upchurch ◽  
Murisiku Raifu ◽  
Marvin Bergsneider
Keyword(s):  
Fourth Ventricle ◽  
Third Ventricle ◽  
Flexible Endoscope ◽  
Catheter Placement ◽  
Cerebral Aqueduct ◽  
Frameless Stereotaxy ◽  
Ventricular Catheter ◽  
Shunt System ◽  
Shunt Catheter ◽  
Isolated Fourth Ventricle

Object Patients with symptomatic isolated fourth ventricle and multicompartmentalized hydrocephalus benefit from operative treatment, but the optimal surgical approach and technique have yet to be established. The authors report on their experience with the treatment of symptomatic adult patients by endoscope-assisted placement of a fourth ventricle shunt catheter via a frontal transventricular approach. Methods The authors describe a retrospective series of four patients treated for isolated fourth ventricle. The surgical technique is described in detail: use of a flexible endoscope with dual-port intraventricular access for direct visualization and for mechanical manipulation of a multiperforated panventricular catheter guided by frameless stereotaxy. The transventricular approach allowed optimal catheter placement within the fourth ventricle. The use of the flexible endoscope permitted the neurosurgeon to use the endoscope as a tool to guide the ventricular catheter tip within the third ventricle and through the cerebral aqueduct. Clinical outcomes demonstrated neurological and radiographically verified improvement in all patients. Conclusions The endoscope-assisted dual-port technique provides a solution to the technical difficulties of fourth ventricle shunt placement. The multiple advantages of this technique include a single ventricular catheter shunt system that equalizes ventricular pressures, a frontal location for the ventricular catheter that facilitates valve placement and programming, and ventricular catheter placement within the fourth ventricle that does not allow the catheter to impinge on the fourth ventricle floor and makes the catheter less prone to obstruction.

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.

Epidermal electronics for noninvasive, wireless, quantitative assessment of ventricular shunt function in patients with hydrocephalus

2018 ◽  
Vol 10 (465) ◽  
pp. eaat8437 ◽  
Author(s):  
Siddharth R. Krishnan ◽  
Tyler R. Ray ◽  
Amit B. Ayer ◽  
Yinji Ma ◽  
Philipp Gutruf ◽  
...  
Keyword(s):  
High Performance ◽  
Standard Of Care ◽  
Rechargeable Batteries ◽  
Operating Conditions ◽  
Diagnostic Tools ◽  
Shunt Failure ◽  
Current Standard ◽  
Sensors And Actuators ◽  
Magnetic Resonance Imaging Mri ◽  
Wireless Architectures

Hydrocephalus is a common and costly neurological condition caused by the overproduction and/or impaired resorption of cerebrospinal fluid (CSF). The current standard of care, ventricular catheters (shunts), is prone to failure, which can result in nonspecific symptoms such as headaches, dizziness, and nausea. Current diagnostic tools for shunt failure such as computed tomography (CT), magnetic resonance imaging (MRI), radionuclide shunt patency studies (RSPSs), and ice pack–mediated thermodilution have disadvantages including high cost, poor accuracy, inconvenience, and safety concerns. Here, we developed and tested a noninvasive, skin-mounted, wearable measurement platform that incorporates arrays of thermal sensors and actuators for precise, continuous, or intermittent measurements of flow through subdermal shunts, without the drawbacks of other methods. Systematic theoretical and experimental benchtop studies demonstrate high performance across a range of practical operating conditions. Advanced electronics designs serve as the basis of a wireless embodiment for continuous monitoring based on rechargeable batteries and data transmission using Bluetooth protocols. Clinical studies involving five patients validate the sensor’s ability to detect the presence of CSF flow (P= 0.012) and further distinguish between baseline flow, diminished flow, and distal shunt failure. Last, we demonstrate processing algorithms to translate measured data into quantitative flow rate. The sensor designs, fabrication schemes, wireless architectures, and patient trials reported here represent an advance in hydrocephalus diagnostics with ability to visualize flow in a simple, user-friendly mode, accessible to the physician and patient alike.

scholarly journals Accidental guide catheter fracture in mechanical thrombectomy

2018 ◽  
Vol 25 (3) ◽  
pp. 297-300 ◽  
Author(s):  
Abdul Rahman Al-Schameri ◽  
Aviraj Deshmukh ◽  
Hadi Debaseh ◽  
Christoph Griessenauer ◽  
Monika Killer-Oberpfalzer
Keyword(s):  
Mechanical Thrombectomy ◽  
Standard Of Care ◽  
Unusual Complication ◽  
Histopathological Analysis ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Guide Catheter ◽  
Complete Recanalisation ◽  
Clinical Consequences ◽  
Catheter Fracture

Endovascular thrombectomy is now the standard of care for large vessel occlusion stroke. The aim is to achieve rapid and complete recanalisation while avoiding complications. Apart from the conventional complications of neurointerventional procedures, mechanical thrombectomy has its unique set of complications, inherent to the disease pathophysiology. We describe an unusual complication of catheter fracture and subsequent distal embolisation into the cerebral vasculature, which was noticed 24 hours after the procedure. Due to a lack of clinical consequences, we decided to manage it conservatively. The patient died within the following few days from respiratory complications unrelated to the stroke or the endovascular thrombectomy procedure. Consequently, we were able to retrieve the fractured segment and carry out histopathological analysis, which helped us to identify exactly its origin from the guide catheter. We believe that systematic reporting and database compilation of such device-related complications will aid in the design and development of neurointerventional devices in the future.

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