Hydrodynamics of the Certas™ programmable valve for the treatment of hydrocephalus

Eklund, Anders; Koskinen, Lars-Owe D.; Williams, Michael A.; Luciano, Mark; Dombrowski, Stephen; Malm, Jan

doi:10.1186/2045-8118-9-12

Cited by 13 publications

(10 citation statements)

References 23 publications

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“…Another hypothesis is that CSF dynamics may require longer times (> 24 h) to adapt to a new valve setting. The hydrodynamics of valve setting adjustments have been investigated in several in vitro studies [1,6,8,10]. Information on the effect of valve setting adjustments on ICP in vivo is scarce.…”

Section: Discussionmentioning

confidence: 99%

“…The hydrodynamics of valve setting adjustments have been investigated in several in vitro studies [ 1 , 6 , 8 , 10 ]. Information on the effect of valve setting adjustments on ICP in vivo is scarce.…”

Section: Discussionmentioning

confidence: 99%

“…Another important obstacle for the creation of "smart' shunts is that information on the effect of valve adjustments on ICP in vivo is limited. Benchmark laboratory tests are routinely performed to assess shunt systems functionality and they help predict the effect that valve settings adjustments will have on CSF flow and consequently on ICP [1,6,8,10]. However, due to the complexity of the CSF dynamics, these predictions can fail in vivo.…”

Section: Introductionmentioning

confidence: 99%

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Paradoxical response of intracranial pressure to shunt valve setting adjustments

et al. 2020

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Background The hydrodynamics of cerebrospinal fluid shunts have been described in vitro; however, knowledge on the response of intracranial pressure (ICP) to valve settings adjustments in vivo is limited. This study describes the effect of adjusting the shunt valve setting on ICP in a cohort of patients with complex symptom management. Method Single-centre retrospective observational study. Patients who underwent ICP-guided valve setting adjustments during 24-h continuous ICP monitoring, between 2014 and 2019, were included. Patients with suspected shunt malfunction were excluded. Median night ICP before and after the valve adjustments were compared (Δ night ICP). The responses of ICP to valve adjustment were divided into 3 different groups as follows: expected, paradoxical and no response. The frequency of the paradoxical response and its potential predicting factors were investigated. Results Fifty-one patients (37 females, 14 males, mean age 38 years) receiving 94 valve setting adjustments met the study inclusion criteria. Patients’ underlying conditions were most commonly hydrocephalus (47%) or idiopathic intracranial hypertension (43%). The response of ICP to valve setting adjustments was classified as ‘expected’ in 54 cases (57%), ‘paradoxical’ in 17 cases (18%) and ‘no effect’ (Δ night ICP < 1 mmHg) in 23 cases (24%). There was a significant correlation between the Δ night ICP and the magnitude of valve setting change in both the investigated valves (Miethke ProGAV, p = 0.01 and Medtronic Strata, p = 0.02). Conclusions Paradoxical ICP changes can occur after shunt valve setting adjustments. This observation should be taken into account when performing ICP-guided valve adjustments and is highly relevant for the future development of “smart” shunt systems.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Paradoxical response of intracranial pressure to shunt valve setting adjustments

et al. 2020

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“…Opening pressures for different shunt models were transformed to mm H 2 O for conformity. 3,9 At one of the centers, a retrospective post hoc analysis on all patients undergoing surgical treatment for their SDH was performed by a senior consultant scrutinizing the patient files and CT/MR images of the brain. The combined information from these files and investigations was evaluated for symptoms and signs and classified as surgery needed or not needed.…”

Section: Registry Data and Validationmentioning

confidence: 99%

Subdural hematomas in 1846 patients with shunted idiopathic normal pressure hydrocephalus: treatment and long-term survival

Sundström¹,

Lagebrant

Eklund³

et al. 2018

Journal of Neurosurgery

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OBJECTIVE Subdural hematoma (SDH) is the most common serious adverse event in patients with shunts. Adjustable shunts are used with increasing frequency and make it possible to noninvasively treat postoperative SDH. The objective of this study was to describe the prevalence and treatment preferences of SDHs, based on fixed or adjustable shunt valves, in a national cohort of patients with shunted idiopathic normal pressure hydrocephalus (iNPH), as well as to evaluate the effect of SDH and treatment on long-term survival. METHODS Patients with iNPH who received a CSF shunt in Sweden from 2004 to 2015 were included in a prospective quality registry (n = 1846) and followed regarding SDH, its treatment, and mortality. The treatment of SDH was categorized into surgery, opening pressure adjustments, or no treatment. RESULTS During the study period, the proportion of adjustable shunts increased from 75% to 95%. Ten percent (n = 184) of the patients developed an SDH. In 103 patients, treatment was solely opening pressure adjustment. Surgical treatment was used in 66 cases (36%), and 15 (8%) received no treatment. In patients with fixed shunt valves, 90% (n = 17) of SDHs were treated surgically compared with 30% (n = 49) in patients with adjustable shunts (p < 0.001). There was no difference in long-term patient survival between the SDH and non-SDH groups or between different treatments. CONCLUSIONS SDH remains a common complication after shunt surgery, but adjustable shunts reduced the need for surgical interventions. SDH and treatment did not significantly affect survival in this patient group, thus the noninvasive treatment offered by adjustable shunts considerably reduces the level of severity for this common adverse event.

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“…This was connected to a pediatric Codman Certas valve (DePuy Codman, Raynham, MA), which was set to 3 (approximately 8 mmHg). [ 5 ] The distal catheter was placed in the peritoneal cavity. A contralateral Ommaya reservoir was then placed into the frontal horn of the left lateral ventricle.…”

Section: Case Reportmentioning

confidence: 99%

Use of a stop-flow programmable shunt valve to maximize CNS chemotherapy delivery in a pediatric patient with acute lymphoblastic leukemia

et al. 2014

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Background:The requirement for frequent intraventricular drug delivery in the setting of shunt dependence is particularly challenging in the treatment of central nervous system infection, neoplastic disease, and hemorrhage. This is especially relevant in the pediatric population where both hematogenous malignancy requiring intrathecal drug delivery and shunt-dependent hydrocephalus are more prevalent. Intrathecal and intraventricular chemotherapy agents can be prematurely diverted in these shunt-dependent patients.Case Description:We report the use of a stop-flow programmable shunt valve to maximize delivery of intraventricular chemotherapy in a child with acute lymphoblastic leukemia and disseminated intravascular coagulation who presented with spontaneous intracerebral and intraventricular hemorrhages. The patient then developed posthemorrhagic hydrocephalus and eventually progressed to shunt dependence but still required frequent intraventricular chemotherapy administration. A ventriculoperitoneal shunt, equipped with a valve that allows for near cessation of cerebrospinal fluid flow (Certas®, Codman, Raynham, MA), and a contralateral Ommaya reservoir were inserted to maximize intraventricular dissemination of chemotherapy.Conclusions:To the best of our knowledge, this is the first reported case of the use of a high-resistance programmable valve being used to virtually cease cerebrospinal fluid flow through the distal catheter temporarily in order to maximize intraventricular drug dissemination in a pediatric patient with acute lymphoblastic leukemia.

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Hydrodynamics of the Certas™ programmable valve for the treatment of hydrocephalus

Cited by 13 publications

References 23 publications

Paradoxical response of intracranial pressure to shunt valve setting adjustments

Paradoxical response of intracranial pressure to shunt valve setting adjustments

Subdural hematomas in 1846 patients with shunted idiopathic normal pressure hydrocephalus: treatment and long-term survival

Use of a stop-flow programmable shunt valve to maximize CNS chemotherapy delivery in a pediatric patient with acute lymphoblastic leukemia

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