The Sensor Reservoir—does it change management?

Bjornson, Anna; Henderson, Duncan; Lawrence, Esther; McMullan, John; Ushewokunze, Shungu

doi:10.1007/s00701-021-04729-y

Cited by 9 publications

(5 citation statements)

References 33 publications

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“…More research is needed in relation to ICP data interpretation and application to clinical decision-making. [36][37][38] As LP shunts in IIH are associated with a significantly greater revision rate, an increased hospital length of stay, and greater overall economic costs than those with VP shunts, we reserve LP shunts for those who are unable to accept the small risks associated with the cranial part of the VP shunt procedure or those who do not wish to have their driver's license restricted for 6 months as per UK national regulations on driving. 28,30,39 LP shunts with adjustable valves have also been used in IIH, and there are studies that report similar failure and complication rates between VP and LP shunts.…”

Section: Discussionmentioning

confidence: 99%

Cerebrospinal fluid shunting protocol for idiopathic intracranial hypertension for an improved revision rate

Galloway¹,

Karia²,

White³

et al. 2022

Journal of Neurosurgery

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OBJECTIVE Cerebrospinal fluid (CSF) shunting in idiopathic intracranial hypertension (IIH) is associated with high complication rates, primarily because of the technical challenges that are related to small ventricles and a large body habitus. In this study, the authors report the benefits of a standardized protocol for CSF shunting in patients with IIH as relates to shunt revisions. METHODS This was a retrospective study of consecutive patients with IIH who had undergone primary insertion of a CSF shunt between January 2014 and December 2020 at the authors’ hospital. In July 2019, they implemented a surgical protocol for shunting in IIH. This protocol recommended IIH shunt insertion by neurosurgeons with expertise in CSF disorders, a frontal ventriculoperitoneal (VP) shunt with an adjustable gravitational valve and integrated intracranial pressure monitoring device, frameless stereotactic insertion of the ventricular catheter, and laparoscopic insertion of the peritoneal catheter. Thirty-day revision rates before and after implementation of the protocol were compared in order to assess the impact of standardizing shunting for IIH on shunt complications. RESULTS The 81 patients included in the study were predominantly female (93%), with a mean age of 31 years at primary surgery and mean body mass index (BMI) of 37 kg/m2. Forty-five patients underwent primary surgery prior to implementation of the protocol and 36 patients after. Overall, 12 (15%) of 81 patients needed CSF shunt revision in the first 30 days, 10 before and 2 after introduction of the protocol. This represented a significant reduction in the early revision rate from 22% to 6% after the protocol (p = 0.036). The most common cause of shunt revision for the whole cohort was migration or misplacement of the peritoneal catheter, occurring in 6 of the 12 patients. Patients with a higher BMI were significantly more likely to have a shunt revision within 30 days (p = 0.022). CONCLUSIONS The Birmingham standardized IIH shunt protocol resulted in a significant reduction in revisions within 30 days of primary shunt surgery in patients with IIH. The authors recommend standardization for shunting in IIH as a method for improving surgical outcomes. They support the notion of subspecialization for IIH shunts, the use of a frontal VP shunt with sophisticated technology, and laparoscopic insertion of the peritoneal end.

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Section: Discussionmentioning

confidence: 99%

Cerebrospinal fluid shunting protocol for idiopathic intracranial hypertension for an improved revision rate

Galloway¹,

Karia²,

White³

et al. 2022

Journal of Neurosurgery

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“…[15][16][17] The use of telemetric sensor reservoirs in both adult and pediatric CSF disorders has been increasing over the past decade. Although many studies have reported their early experiences and feasibility [18][19][20][21] and application in clinical practice, 18,22,23 very few have performed a financial-utility analysis-namely, whether the higher base cost of a more sophisticated reservoir translates to better clinical outcomes. In a study conducted by Bjornson et al, a costeffectiveness analysis of Miethke telesensor reservoirs was performed on a cohort of 12 patients, including 3 children and 9 adults.…”

Section: Interpretation and Contextmentioning

confidence: 99%

The Impact of Intracranial Pressure Telesensors: An Observational Propensity-Matched Control Analysis of Service Demand and Costs

Pandit,

Kamal,

Reischer

et al. 2024

Neurosurgery

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BACKGROUND AND OBJECTIVES: Implantable telemetric intracranial pressure (ICP) sensors (telesensors) enable routine, noninvasive ICP feedback, aiding clinical decision-making and attribution of pressure-related symptoms in patients with cerebrospinal fluid shunt systems. Here, we aim to explore the impact of these devices on service demand and costs in patients with adult hydrocephalus. METHODS: We performed an observational propensity-matched control study, comparing patients who had an MScio/Sensor Reservoir (Christoph Miethke, GmbH & Co) against those with a nontelemetric reservoir inserted between March 2016 and March 2018. Patients were matched on demographics, diagnosis, shunt-type, and revision status. Service usage was recorded with frequencies of neurosurgical admissions, outpatient clinics, scans, and further surgical procedures in the 2 years before and after shunt insertion. RESULTS: In total, 136 patients, 73 telesensors, and 63 controls were included in this study (48 matched pairs). Telesensor use led to a significant decrease in neurosurgical inpatient admissions, radiographic encounters, and procedures including ICP monitoring. After multivariate adjustment, the mean cumulative saving after 2 years was £5236 ($6338) in telesensor patients (£5498 on matched pair analysis). On break-even analysis, cost-savings were likely to be achieved within 8 months of clinical use, postimplantation. Telesensor patients also experienced a significant reduction in imaging-associated radiation (4 mSv) over 2 years. CONCLUSION: The findings of this exploratory study reveal that telesensor implantation is associated with reduced service demand and provides net financial savings from an institutional perspective. Moreover, telesensor patients required fewer appointments, invasive procedures, and had less radiation exposure, indicating an improvement in both their experience and safety.

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“…The device uses a telemetric catheter that is capable of measuring pressure (ICP), temperature (ICT), and partial pressure of oxygen (ptiO2) 57 . Another monitor is the Miethke Sensor Reservoir, which allows for noninvasive ICP measurements and subsequent CSF drainage through VPS 58 …”

Section: Technological Advancements In Wearable Devices Used To Monit...mentioning

confidence: 99%

“…57 Another monitor is the Miethke Sensor Reservoir, which allows for noninvasive ICP measurements and subsequent CSF drainage through VPS. 58 A common complication of VPS is failure. As a matter of fact, 15%−23% of shunts in adults fail within 6 months, and that rate goes up to 50% in high-risk populations.…”

Section: Patients Now Have Access To Smart Monitors Such As Raumedicmentioning

confidence: 99%

Posttraumatic hydrocephalus: Recent advances and new therapeutic strategies

Sanker,

Kundu,

El Kassem

et al. 2023

Health Science Reports

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BackgroundHydrocephalus or ventriculomegaly is a condition brought on by an overabundance of cerebrospinal fluid (CSF) in the ventricular system. The major contributor to posttraumatic hydrocephalus (PTH) is traumatic brain injuries (TBIs), especially in individuals with occupations set in industrial settings. A variety of criteria have been employed for the diagnosis of PTH, including the combination of neurological symptoms like nerve deficits and headache, as well as an initial improvement followed by a worsened relapse of altered consciousness and neurological deterioration, which is detected by computed tomography‐brain imaging that reveals gradual ventriculomegaly.AimIn this article, we discuss and summarize briefly the current understandings and advancements in the management of PTH.MethodsThe available literature for this review was searched on various bibliographic databases using an individually verified, prespecified approach. The level of evidence of the included studies was considered as per the Centre for Evidence‐Based Medicine recommendations.ResultsThe commonly practiced current treatment modality involves shunting CSF but is often associated with complications and recurrence. The lack of a definitive management strategy for PTH warrants the utilization of novel and innovative modalities such as stem cell transplantations and antioxidative stress therapies.ConclusionOne of the worst complications of a TBI is PTH, which has a high morbidity and mortality rate. Even though there hasn't been a successful method in stopping PTH from happening, hemorrhage‐derived blood, and its metabolic by‐products, like iron, hemoglobin, free radicals, thrombin, and red blood cells, may be potential targets for PTH hindrance and management. Also, using stem cell transplantations in animal models and antioxidative stress therapies in future studies can lower PTH occurrence and improve its outcome. Moreover, the integration of clinical trials and theoretical knowledge should be encouraged in future research projects to establish effective and updated management guidelines for PTH.

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The Sensor Reservoir—does it change management?

Cited by 9 publications

References 33 publications

Cerebrospinal fluid shunting protocol for idiopathic intracranial hypertension for an improved revision rate

Cerebrospinal fluid shunting protocol for idiopathic intracranial hypertension for an improved revision rate

The Impact of Intracranial Pressure Telesensors: An Observational Propensity-Matched Control Analysis of Service Demand and Costs

Posttraumatic hydrocephalus: Recent advances and new therapeutic strategies

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