Bacterial infections

Bacterial meningitis occurs in many clinical situations, including spontaneous (the most important category), post-traumatic, and device-associated (relating to cerebrospinal fluid shunts and drains). Each of these is associated with a particular pattern of infecting organisms, clinical presentation, and outcome, but overall there is high morbidity and mortality. Spontaneous meningitis is the most important category. It can be divided into neonatal meningitis and meningitis of childhood and adulthood. Post-traumatic meningitis follows neurosurgery or fractures of the skull. Device-associated meningitis complicates the use of cerebrospinal fluid shunts and drains. Infection may also be considered as community acquired or nosocomial (hospital acquired or physician associated).

Modular Redundancy for Cerebrospinal Fluid Shunts: Reducing Incidence of Failure due to Catheter Obstruction

Cerebrospinal fluid shunts for the treatment of hydrocephalus fail at a rate of 40% within the first year. The importance of this problem is supported by one institution’s analysis of neurosurgical 30-day readmissions with CSF shunt failure only second to brain tumor readmissions. Hospital shunt related costs have been estimated at $1.4 to $2 billion annually. The majority of these costs are attributable to shunt failures based on the number of revisions out of the total numbers of annual shunt procedures. The technical innovation of this project is a low cost, low risk and easy to implement CSF shunt design change compatible with current protocols. The proposed product is an innovative distal catheter to minimize the need for revision surgery due to obstruction (also referred to as occlusion). This is accomplished with a dual lumen catheter (current distal catheters are single lumen) consisting of a primary lumen and a secondary lumen providing redundant functionality in the event ofprimary lumen occlusion thereby eliminating the need for surgical shunt revision. 40% of shunts fail within the year after implant and distal catheter obstruction accounts for up to 24% of failures. Though less prevalent than proximal catheter occlusion, incidence of distal catheter occlusion is significant and improved reliability would reduce costs and improve patient outcomes by lowering the number of revisions.

Cerebrospinal Fluid Shunts

Placement and revision of ventricular shunts has saved more lives in Western society than any other neurosurgical procedure. Estimates of a total of 75,000 shunt procedures are done yearly in North America. The majority of these cerebrospinal fluid (CSF)-diverting shunts originate in the lateral ventricle, drain into the peritoneum and are described as ventriculoperitoneal (VP) shunts. Other less common CSF shunt variants include ventriculoatrial and ventriculopleural. VP shunts are the most common neurosurgical procedure performed in both adults and children. An understanding of CSF flow dynamics, intracranial pressure, and cerebral perfusion helps guide anesthetic management of these procedures.