Treatment of hydrocephalus in adults by placement of an open ventricular shunt

Sotelo, Julio; Izurieta, Mario; Arriada, Nicasio

doi:10.3171/jns.2001.94.6.0873

Cited by 23 publications

(30 citation statements)

References 54 publications

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“…The hydrostatic pressure gradient of the catheter is not dependent on its length, but rather on the vertical distance between the inlet and the outlet. The gravity force is so important that the so-called “siphon” effect, described in countless reports,[3840424956] corresponds, by far, to the most intense hydrokinetic force acting upon the velocity of flow, and therefore upon the amount of fluid drained. In the laboratory, under experimental conditions, when a container (simulating the ventricles) is connected to a recipient (simulating the peritoneum) by a catheter 1 m long and of 1 mm internal diameter (ID), the following changes occur; if the container and the recipient are located at the same level and the connecting catheter lies horizontal, there is absence of flow from one to the other; in contrast, if the container is elevated 55 cm between the tips of the catheter in a vertical position, there is a flow of 80 ml/min to the recipient (115 l/day).…”

Section: Hydrokinetic Characteristics Of Ventriculoperitoneal Shuntingmentioning

confidence: 99%

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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Section: Hydrokinetic Characteristics Of Ventriculoperitoneal Shuntingmentioning

confidence: 99%

The hydrokinetic parameters of shunts for hydrocephalus might be inadequate

Sotelo

2012

Surg Neurol Int

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“…[3] A recent study by Soleto et al . [4] reported satisfactory results with the use of an open ventricular shunt, in adults. This was an open catheter whose distal end had an internal diameter of 0.51mm.…”

Section: Discussionmentioning

confidence: 99%

“…[3] Soleto et al . [4] have reported satisfactory results with the use of an open ventricular shunt, which is an open distal part catheter with 0.51 mm internal diameter. The ‘catheter à fentes’ operates as an open ventricular shunt, similar to differential pressure valves.…”

Section: Introductionmentioning

confidence: 99%

Using ′Catheter ΰ fentes′ for management of childhood hydrocephalus: A prospective study of ninety-six cases

Sanoussi

Bawa

Kelani

et al. 2010

J Surg Tech Case Report

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Objective:To evaluate the management of childhood hydrocephalus using the ‘catheter à fentes’ as a ventriculoperitoneal shunt.Materials and Methods:A prospective study from January 2003 to January 2004 was carried out in the Neurosurgery Department of the National Hospital Niamey (Niger-Republic). Ninety-six infants with hydrocephalus, between the ages of 1 to 22 months were treated with ‘catheter à fentes’ as a ventriculoperitoneal shunt.Results:Ninety-six infants with hydrocephalus, between the ages of 1 and 22 months were included in this study, over a period of 31 months; 53% of the infants were females. The symptoms evolved over three months in 89.55% of the cases (n = 85). Hydrocephalus was post-infective in 51% of the cases, associated with spina bifida in 32% of the cases, neonatal bleeding in 7.2% of the cases; brain abnormalities were found in 6.2%, and tumor in 3.1% of the cases. The head circumference was greater than 2SD in all cases; 87.53% of the infants had psychomotor retardation (less than 80 QD according to the Lezine score). Ventricular dilation was triventricular in 17.70% and tetra ventricular in 82.29% of the cases. ‘Catheter à fentes’ models of high pressure, medium pressure, and low pressure were used. Hydrodynamic complications (hyperdrainage, obstruction, underdrainage) occurred in 7.9% of the cases, and these were handled with simple observation in follow-up clinics. The average regression of head circumference three months postoperatively, for all the three models of ‘catheter à fentes,’ was 3.73 cm.Conclusion:This study shows that the usage of ‘catheter à fentes’ for treatment of childhood hydrocephalus gives satisfactory results.

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“…It is important to recognise that CSF physiology in the erect position differs from that in the supine position because CSF is mainly drained in the erect position by a siphon effect, not ICP [17,20]. Mechanisms to prevent overdrainage are classified in five categories as follows: [15] Programmable pressure valves There have been many reports that emphasise the efficacy of the programmable pressure valve at controlling overdrainage [8,11,13,22,24]. The fact that many neurosurgeons determine the CP of the CH valve according to the ICP obtained from the spinal or ventricular tap in the supine position is insignificant.…”

Section: Discussionmentioning

confidence: 99%