What We Should Know About the Cellular and Tissue Response Causing Catheter Obstruction in the Treatment of Hydrocephalus

Abstract

The treatment of hydrocephalus by cerebrospinal fluid shunting is plagued by ventricular catheter obstruction. Shunts can become obstructed by cells originating from tissue normal to the brain or by pathological cells in the cerebrospinal fluid for a variety of reasons. In this review, the authors examine ventricular catheter obstruction and identify some of the modifications to the ventricular catheter that may alter the mechanical and chemical cues involved in obstruction, including alterations to the surgical strategy, modifications to the chemical surface of the catheter, and changes to the catheter architecture. It is likely a combination of catheter modifications that will improve the treatment of hydrocephalus by prolonging the life of ventricular catheters to improve patient outcome.

Polyimide-based magnetic microactuators for biofouling removal

“…The gold standard for treatment of hydrocephalus is the implantation of a shunt system to divert excess CSF from the brain to another part of the body [3]. However, shunt systems are notorious for their extremely high failure rate of more than 40% within 1 year and up to 85% within 10 years of implantation [4], [5]. A large portion of this high failure rate can be attributed to biofouling-related obstruction and infection [4], [6].…”

New and improved ways to treat hydrocephalus: Pursuit of a smart shunt

“…A smart shunt also offers new options to design shunts for reduced failure rates or to reduce the impact if failure does occur. Material modifications have great potential to reduce fouling and obstruction,[31] but one could envision self-cleaning smart shunts or early warning systems that detect impending shunt failure to mitigate risks of unpredictable failure.…”

“…[30] A few new catheter designs are being discussed in the literature and one new catheter has made it to the market, but there is no data to support improved function. [31] A variety of valves are on the market, largely from four manufacturers who dominate the space, namely Medtronic, Codman, Aesculap, and Integra LifeSciences. These valves come configured as differential pressure valves, siphon-resistant valves, flow-regulating valves, and externally adjustable valves.…”

“…A great deal of work has focused on material modifications, especially of the proximal catheter, to reduce obstruction by cells or tissue; these methods have high value and have been reviewed recently by Harris et al . [31] Smart shunts could provide methods to complement material-based approaches. The use of sensors and active control mechanisms provides an opportunity for designing valves that are inherently less prone to obstruction or provide active methods to fight obstruction.…”

Neuroendoscopic Assessment of Choroid Plexus Coagulation to Release Ventricular Catheter: Note on the Seldinger Technique

“…Approximately 50% of shunts implanted for treatment of hydrocephalus fail throughout life and up to 30% fail within the first year [1,2]. A blockage of the shunt due to growth of the choroid plexus and ependymal tissue around the holes in the ventricular catheter is the major cause [3]. …”