<i>In vivo</i>assessment of hydrocephalus shunt

Petrella, Gianpaolo; Czosnyka, Marek; Smielewski, Peter; Allin, David; Guazzo, E.; Pickard, John D.; Czosnyka, Zofia

doi:10.1111/j.1600-0404.2009.01176.x

Cited by 32 publications

(23 citation statements)

References 16 publications

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“…As a result, measurement of CSF outflow resistance can be used to determine if a shunt is functioning or obstructed. The R out of a patient with an obstructed shunt is high, and usually similar to the patient’s pre-shunt R out [10,11]. In Europe, when patients are evaluated for suspected hydrocephalus, infusion testing is often used to characterize the CSF dynamic system to determine whether R out is abnormal [12] and shunt malfunction is present [10,13].…”

Section: Discussionmentioning

confidence: 99%

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

Eklund

Koskinen

Williams

et al. 2012

Fluids Barriers CNS

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BackgroundThe new Certas™ shunt for the treatment of hydrocephalus has seven standard pressure settings that according to the manufacturer range from 36 to 238 mmH2O, and an additional “Virtual Off” setting with an opening pressure >400 mmH2O. Information on actual pressure response and reliability of shunt performance is important in clinical application, especially the “Virtual Off” setting as a non-surgical replacement for shunt ligation. The objective of this study was to evaluate the in-vitro hydrodynamic performance of the Certas™ shunt.MethodsSix new Certas™ shunts with proximal and distal catheters were tested with an automated, computerized test system that raised the pressure from zero to a maximum pressure and back to zero at each valve setting. Opening pressure and flow resistance were determined.ResultsFor settings 1–7 the measured opening pressure range was 26 to 247 mmH2O, and the mean change in opening pressure for a one-step adjustment was between 33 and 38 mmH2O. For setting 8 (“Virtual Off”) the measured mean opening pressure was 494 ± 34 mmH2O (range 451 to 556 mmH2O). The mean outflow resistance was 7.0 mmHg/ml/min (outflow conductance 17.9 μl/s/kPa).ConclusionsThe six shunts had similar characteristics and closely matched the manufacturer’s specifications for opening pressure at settings 1–7. The opening pressure for the “Virtual Off” setting was nearly 500 mmH2O, which is 100 mmH2O higher than the manufacturer’s specification of “>400” and should be functionally off for most patients with communicating hydrocephalus. Clinical studies are needed to evaluate if the CSF dynamic profile persists after implantation in patients.

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Section: Discussionmentioning

confidence: 99%

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

Eklund

Koskinen

Williams

et al. 2012

Fluids Barriers CNS

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“…Por tanto, el dictamen de disfunción valvular suele requerir la utilización de otros recursos diagnósticos, especialmente en los casos de disfunción crónica (los agudos suelen tener una clínica y una radiología altamente sugestiva). En la literatura se han descrito algunos méto-dos relacionados con ellos, como la realización de test de infusión 19 , con resultados positivos. Sin embargo, estos test precisan de la manipulación del reservorio, con los riesgos de deterioro del mismo que ello conlleva y evalúan el funcionamiento del shunt sin informar acerca de la situación y la dinámica de la PIC en el paciente.…”

Section: Discussionunclassified

Utilidad de la monitorización de la PIC en pacientes con sospecha de disfunción valvular

et al. 2011

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“…It is not unusual for patients with VP shunt malfunction to lack radiographic evidence of ventricular dilatation on imaging 7. An infusion study performed revealed that the baseline pressure was low and non-pulsatile (figure 2B).…”

Section: Investigationsmentioning

confidence: 99%

Use of CSF infusion studies to unblock occluded hydrocephalus ventricular shunt catheters: a preliminary report of two patients

Nabbanja

Pickard

Lalou³

et al. 2018

BMJ Case Reports

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Two patients with ventriculoperitoneal shunts presented with symptoms of raised intracranial pressure indicative of possible shunt malfunction. During investigation, to eliminate this possibility, cerebral spinal fluid infusion studies were performed, which indicated proximal occlusion of the shunts in both cases. Retrograde flush of the ventricular catheter was performed during temporary compression of the siphon-control device, a manoeuvre which blocks distal flow. After the use of this technique, both patients' symptoms improved and they have remained symptom-free for over 2 years. This case report validates the role that infusion studies can play in clearing a blocked ventricular catheter shunt.

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In vivoassessment of hydrocephalus shunt

Abstract: In vivo shunt testing is easy, safe and clinically useful, aiding decision in difficult clinical situations, where shunt malfunction is suspected but not certain. It also has satisfactory positive predictive power.

Cited by 32 publications

References 16 publications

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

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

Utilidad de la monitorización de la PIC en pacientes con sospecha de disfunción valvular

Use of CSF infusion studies to unblock occluded hydrocephalus ventricular shunt catheters: a preliminary report of two patients

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