Anti-siphon and reversible occlusion valves for shunting in hydrocephalus and preventing post-shunt subdural hematomas

Portnoy, Harold D.; R, Schulte; Fox, John L.; Croissant, Paul D.; Tripp, Lucius

doi:10.3171/jns.1973.38.6.0729

Cited by 260 publications

(99 citation statements)

References 25 publications

(1 reference statement)

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“…Following ventricular drainage, the intracranial dural-arachnoid separates, increasing tension on the bridging veins and increasing the chance of rupture with mild trauma, as well as providing a space for blood and CSF to mix. 10,11 The presence of air within the intracranial subdural space was observed in up to 64% of all pneumoencephalograms shortly after the spinal air injection. 9,12 This supported previous reports that the intracranial and spinal subdural spaces are continuous.…”

Section: Discussionmentioning

confidence: 99%

Spinal chronic subdural hematoma in a patient with ventriculo-peritoneal shunting after a minor trauma

et al. 2004

Spinal Cord

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Study design: Case report and review of literature. Objectives: Intracranial chronic subdural hematoma (SDH) is a well-recognized complication of ventriculoperitoneal (VP) shunt. Spinal chronic SDH is very rarely associated with VP shunt. Setting: Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. Case report: We describe a spinal chronic SDH, developing after a minor trauma, in a patient who underwent a VP shunt surgery for hydrocephalus 6 months previously. A good outcome was achieved after decompressive surgery. Conclusion: Spinal chronic SDH should be considered in the diagnosis of progressive spinal compression, especially in the patients with VP shunt after minor trauma.

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Section: Discussionmentioning

confidence: 99%

Spinal chronic subdural hematoma in a patient with ventriculo-peritoneal shunting after a minor trauma

et al. 2004

Spinal Cord

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“…The flow rates obtained within the usual range of operating pressures are in agreement with those reported in the literature. [7,11] Figure 3 shows the effect of 50 cm of outflow tubing (siphon pressure) on flow rate. The ratio between inlet diameter and the diameter of the SCD diaphragm is approximately 20:1, so that each 20 cm of outflow tubing adds 1 cm to the opening pressure.…”

Section: Resultsmentioning

confidence: 99%

“…Overdrainage of cerebrospinal fluid (CSF) is a serious complication in patients in whom shunts have been placed. [2,5,7,10,11] Since the development of the antisiphon device (ASD) by Portnoy and Schulte in 1971, technology has advanced to the point at which many shunt valves have an integral siphon-control device (SCD). Such devices were intended to prevent overdrainage of the CSF compartment.…”

mentioning

confidence: 99%

The importance of shunt valve position in flow characteristics of the Medtronic PS Medical Delta valve

Francel¹,

Stevens²,

Tompkins³

et al. 1999

FOC

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This study was conducted to document the extent to which flow depends on valve position in relation to head-pressure reference. Medtronic PS Medical Delta valves (contour model, performance levels 0.5, 1.0, 1.5, and 2.0) were studied in a bench test designed to evaluate flow rates with respect to valve position in relation to the head-pressure reference postion. The valves were connected to an “infinite” reservoir by the standard inlet catheter. An initial head (proximal) pressure was selected for each valve based on package insert data. The position of the inlet catheter tip was fixed at this starting head pressure, thus making the inlet catheter tip position the reference for relative head pressures on the valve assembly. When the valve body is positioned above this level, the effective head pressure is lowered, and when the valve body is positioned below this level, the effective head pressure is raised. Flow was established with the siphon control portion of the valve body located on the same horizontal level as the inlet catheter tip (the reference head pressure or “0” position). A standard silastic catheter was attached to the outlet of the valve, and its length was fixed at 50 cm for all valves (-50 cm H20). The distal end of the outlet catheter was connected to a fraction collector, and 1-minute samples (five replicates) were collected for gravimetric determination of flow rate. The valve assembly was then moved in 1-cm increments through the range of 4 cm above to 8 cm below the head-pressure reference position. Samples were collected from each position (4 cm to -8 cm) relative to the inlet catheter tip. Flow rate, in milliliters/hour, was plotted against both relative position (4 cm to -8 cm) and absolute head pressure (in centimeters of water). Each of the valves tested was shown to have a linear relationship between flow and position relative to the inlet catheter tip (or absolute head pressure). The average increase in flow per centimeter of displacement of valve from catheter tip was 16.5 ml/hr/cm (range 14.4-17.6 ml/hr/cm). Once the inlet catheter tip is fixed in position, it serves as a pressure reference. Movement of the valve above this level results in a net decrease in effective head pressure, and movement below this position results in a net increase in effective head pressure. Thus, the positioning of shunt valves in locations different from this pressure reference position should be performed only with the knowledge that significant increases in outflow rate may occur when the valve body is positioned lower than the inlet catheter tip. This increase in outflow rate is not the result of siphoning or a defect in the antisiphon device but instead the result of a net increase in effective head pressure.

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“…Thus, alternatives are needed to treat hydrocephalus in these patients efficiently and safely. Retrograde-ventricular sinus shunt (RVSS), developed by El-Shafei, shunts lateral ventricle to superior sagittal sinus (SSS) in the opposite direction of venous blood flow and is a feasible and rational alternative for the treatment of hydrocephalus, minimizing siphon effect 12,13,14,15,16,17,18,19,20,21,22,23,24,25,26 . This study aims to describe initial clinical results of RVSS in hydrocephalus after surgical repair of myelomeningocele.…”

mentioning

confidence: 99%

Surgical technique of retrograde ventricle-sinus shunt is an option for the treatment of hydrocephalus in infants after surgical repair of myelomeningocele

Oliveira

Teixeira

Norremose

et al. 2015

Arq. Neuro-Psiquiatr.

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Introduction Treatment of hydrocephalus is accomplished primarily through a ventricular-peritoneal shunt (VPS). This study aims to describe the application of retrograde ventricle-sinus shunt (RVSS) in patients with hydrocephalus after surgical treatment of myelomeningocele. Method A prospective, randomized and controlled pilot study. We consecutively enrolled 9 patients with hydrocephalus after surgical repair of myelomeningocele from January 2010 to January 2012. These patients underwent elective RVSS or VPS. Five underwent RVSS and 4 underwent VPS. Patients were followed for one year with quarterly evaluations and application of transcranial Doppler. Results RVSS group showed outcomes similar to those of VPS group. Doppler revealed significant improvement when comparing preoperative to postoperative period. RVSS group had significantly higher cephalic perimeter than VPS group. Neuropsychomotor development, complications and subjective outcomes did not differ between groups. Conclusion RVSS shunt is viable; it is an alternative option for the treatment of hydrocephalus.

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Anti-siphon and reversible occlusion valves for shunting in hydrocephalus and preventing post-shunt subdural hematomas

Cited by 260 publications

References 25 publications

Spinal chronic subdural hematoma in a patient with ventriculo-peritoneal shunting after a minor trauma

Spinal chronic subdural hematoma in a patient with ventriculo-peritoneal shunting after a minor trauma

The importance of shunt valve position in flow characteristics of the Medtronic PS Medical Delta valve

Surgical technique of retrograde ventricle-sinus shunt is an option for the treatment of hydrocephalus in infants after surgical repair of myelomeningocele

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