Continuous-flow shunt for treatment of hydrocephalus due to lesions of the posterior fossa

Arriada, Nicasio; Sotelo, Julio

doi:10.3171/jns.2004.101.5.0762

Cited by 11 publications

(13 citation statements)

References 31 publications

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“…A flow-regulated versus a pressure-regulated external drainage may have a lower incidence of complications involved with over-drainage and abrupt decompression, such as nausea, vomiting, diplopia, alteration of consciousness and tension pneumocephalus [4][5][6][7]. It has also been proposed that a continuous flow may help maintain the system patency [7] with a high viscosity CSF, as blood clots, protein and cellular debris are not permitted to settle inside the drain tubing.…”

Section: Discussionmentioning

confidence: 96%

Flow-regulated external lumbar drain: applications and complications

2014

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The FRED system offered better patient compliance and comfort, providing them with greater mobility, while maintaining a safer steady removal of a set amount of CSF. In opposition to the pressure-regulated systems, we describe the possible indications, advantages and disadvantages of a flow regulated device. Extensive clinical trials are needed to study the use of FRED in patients with different CSF circulation physiology, pressure and composition.

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Section: Discussionmentioning

confidence: 96%

Flow-regulated external lumbar drain: applications and complications

2014

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“…Clinical and experimental results have been favorable. [3345253] In these studies, we eliminated all valvular mechanisms and the functioning of a ventriculoperitoneal bypass was dependent on the drainage capacity and fluid resistance generated solely by the peripheral catheter that goes from the skull to the peritoneum.…”

Section: Ventriculoperitoneal Shunt Devoid Of Valvular Mechanismsmentioning

confidence: 99%

“…Performance of this shunt in long-term studies in the experimental laboratory and in patients with hydrocephalus has been superior than in controls with valvular shunts. [3535457] Initial laboratory studies under hydrokinetic simulations of physiological conditions[525357] tested several variations of ID of the connecting catheter as unique mechanism for fluid resistance; the precise measure of 0.51 mm ID was shown to comply, under all physiological variations, with the desired drainage capacity. The connecting catheter of very thin ID instead of the usual catheters of wide ID showed in the laboratory to have a daily drainage capacity of approximately 500 ml under conditions that simulated common parameters of intraventricular pressure and siphon effect in humans.…”

Section: Ventriculoperitoneal Shunt Devoid Of Valvular Mechanismsmentioning

confidence: 99%

“…[52830333840] Nevertheless, even with them, the phenomenon of overdrainage is still common. [311142332354655] Results of countless studies make apparent that the classical hydrokinetic parameters that have long been taken as reference for the theoretical design of ventriculoperitoneal shunts are not reliable for a system designed to drain CSF through an artificial pathway, which runs parallel to the cerebrospinal axis.…”

Section: Introductionmentioning

confidence: 99%

“…[289182526374351] It might be assumed that if, for several years, all attempts for technical solution of hydrocephalus have proved unsatisfactory, perhaps it is time to review the framework used for technological research, rather than continue designing devices with improvements in mechanisms but identical in theoretical framework. [39142032]…”

Section: Introductionmentioning

confidence: 99%

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The hydrokinetic parameters of shunts for hydrocephalus might be inadequate

Sotelo

2012

Surg Neurol Int

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Long-term treatment of hydrocephalus continues to be dismal. Shunting is the neurosurgical procedure more frequently associated with complications, which are mostly related with dysfunctions of the shunting device, rather than to mishaps of the rather simple surgical procedure. Overdrainage and underdrainage are the most common dysfunctions; of them, overdrainage is a conspicuous companion of most devices. Even when literally hundreds of different models have been proposed, developed, and tested, overdrainage has plagued all shunts for the last 60 years. Several investigations have demonstrated that changes in the posture of the subject induce unavoidable and drastic differences of intraventricular hydrokinetic pressure and cerebrospinal fluid (CSF) drainage through the shunt. Of all the parameters that participate in the pathophysiology of hydrocephalus, the only invariable one is cerebrospinal fluid production at a constant rate of approximately 0.35 ml/min. However, this feature has not been considered in the design of currently available shunts. Our experimental and clinical studies have shown that a simple shunt, whose drainage capacity complies with this unique parameter, would prevent most complications of shunting for hydrocephalus.

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The “Valva Cerebri”: Morphometry, Topographic Anatomy and Histology of the Rhomboid Membrane at the Craniocervical Junction

et al. 2019

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The arachnoid membranes' anatomy is a controversial topic in the literature, and the rhomboid membrane at the craniovertebral junction is an element of this system that has been described poorly. Hence, the objective of our study was to examine this membrane's anatomy and histology. A total of 45 fresh formalin‐fixed human cadaveric heads were examined, and anatomic dissections and histologic examinations using standard staining methods were performed. The membrane was found to be a constant structure. It has a rhomboid shape and is located on the medulla oblongata and upper cervical spine's ventral surface within the subarachnoid space. Its average craniocaudal length is 49 mm and the short axis is 26 mm. The cranial apex is attached to the vertebral arteries' junction, and the caudal apex reaches the level of C4. The lateral apices are attached to the dura mater at the level of the denticulate ligament's second insertion. The C1 spinal nerves perforate the membrane, while the C2 roots are located dorsal to it. The membrane is attached strongly to the underlying pia mater. Histologically, it has a typical arachnoid structure, in which its adhesions to the vertebral arteries as well as to the pia mater could be verified histologically. This is the first detailed examination of the rhomboid membrane. Our results suggest that the membrane serves a valve‐like function between the spinal and cranial subarachnoid spaces. Based on our findings, further hydrodynamic studies should clarify the membrane's physiological role. Clin. Anat. 32:56–65, 2019. © 2019 Wiley Periodicals, Inc.

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Continuous-flow shunt for treatment of hydrocephalus due to lesions of the posterior fossa

Cited by 11 publications

References 31 publications

Flow-regulated external lumbar drain: applications and complications

Flow-regulated external lumbar drain: applications and complications

The hydrokinetic parameters of shunts for hydrocephalus might be inadequate

The “Valva Cerebri”: Morphometry, Topographic Anatomy and Histology of the Rhomboid Membrane at the Craniocervical Junction

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