Review: treatment of hydrocephalus in adults

Arriada, Nicasio; Sotelo, Julio

doi:10.1016/s0090-3019(02)00894-7

Cited by 19 publications

(22 citation statements)

References 108 publications

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“…[294658] To prevent this unavoidable effect, countless anti-siphon devices or gravity-controlled valves have been designed. [241920] Their function is the interruption of CSF flow when the hydrostatic suction exceeds the minimal intracranial pressure. Thus, these devices are directed to stop the transit of CSF when intraventricular pressure lowers below the setting value of the valve (100 mm H 2 O).…”

Section: Dysfunctions Of Ventriculoperitoneal Shuntsmentioning

confidence: 99%

“…However, even in this case, hydrocephalus is rarely induced due to the very large capacity for CSF absorption common to all individuals. [2] Thus, it seems reasonable that if the only steady parameter in the rather complex physiology and dynamics of CSF is its production, at a constant rate of 0.35 ml/min, for an approximate amount of 500 ml/day, this singular value should be considered for the design of a device that intends to prevent its intracranial accumulation. This principle would apply for all pathologies that induce hydrocephalus.…”

Section: Csf Production: a Singular Parametermentioning

confidence: 99%

“…This “shunt” (which actually is a medical catheter) was developed initially for hydrocephalus secondary to cysticercosis; however, after the initial results, it was tested in a comprehensive variety of hydrocephalus in adults and proved to be very effective. [235253545657] The pathophysiology of hydrocephalus due to cysticercosis is very severe (mean survival after diagnosis 1.8 years) and the CSF shows indeed a high content of cells and proteins. That is why all common shunts are obstructed soon after surgery.…”

Section: Ventriculoperitoneal Shunt Devoid Of Valvular Mechanismsmentioning

confidence: 99%

“…Considering that all shunting devices whose functioning is based on a valve that responds to internal hydrostatic pressure have failed after six decades of countless designs and that in the opinion of most experts, we are still far from achieving an ideal shunt,[26162325324251596062] it might be time to reconsider the fundamental principles upon which all technological research for shunts has been grounded and adopt a novel stratagem. An innovative model could be based on CSF production,[1047] rather than on hydrostatic pressure.…”

Section: A Proposal For the Development Of A Novel Shunt For Hydrocepmentioning

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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