Fluids and Barriers of the CNS | |
Hydrodynamics of the Certas™ programmable valve for the treatment of hydrocephalus | |
Jan Malm4  Stephen M Dombrowski2  Mark G Luciano2  Michael A Williams3  Lars-Owe D Koskinen4  Anders Eklund1  | |
[1] Department of Radiation Sciences, Umeå University, Umeå, S-901 85, Sweden;Department of Neurosurgery, Cleveland Clinic, Cleveland, US;Department of Neurology, The Sandra and Malcolm Berman Brain & Spine Institute, Sinai Hospital, Baltimore, US;Department of Clinical Neuroscience, Umeå University, Umeå, Sweden | |
关键词: Conductance; Outflow resistance; Intracranial pressure; Shunt; Cerebrospinal fluid; CSF; Normal pressure hydrocephalus; Hydrocephalus; | |
Others : 807232 DOI : 10.1186/2045-8118-9-12 |
|
received in 2012-03-23, accepted in 2012-05-29, 发布年份 2012 | |
【 摘 要 】
Background
The 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.
Methods
Six 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.
Results
For 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).
Conclusions
The 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.
【 授权许可】
2012 Eklund et al.; licensee BioMed Central Ltd.
【 预 览 】
Files | Size | Format | View |
---|---|---|---|
20140708104540706.pdf | 623KB | download | |
Figure 4. | 18KB | Image | download |
Figure 3. | 20KB | Image | download |
Figure 2. | 52KB | Image | download |
Figure 1. | 36KB | Image | download |
【 图 表 】
Figure 1.
Figure 2.
Figure 3.
Figure 4.
【 参考文献 】
- [1]Hoya K, Tanaka Y, Uchida T, Takano I, Nagaishi M, Kowata K, Hyodo A: Treatment of traumatic acute subdural hematoma in adult hydrocephalus patients with cerebrospinal fluid shunt. Clin Neurol Neurosurg 2012, 114:211-216.
- [2]Lundkvist B, Eklund A, Koskinen LO, Malm J: An adjustable CSF shunt: advices for clinical use. Acta Neurol Scand 2003, 108:38-42.
- [3]Malm J, Lundkvist B, Eklund A, Koskinen LO, Kristensen B: CSF outflow resistance as predictor of shunt function. A long-term study. Acta Neurol Scand 2004, 110:154-160.
- [4]Arnell K, Koskinen LO, Malm J, Eklund A: Evaluation of Strata NSC and Codman Hakim adjustable cerebrospinal fluid shunts and their corresponding antisiphon devices. J Neurosurg Pediatr 2009, 3:166-172.
- [5]Hassan M, Higashi S, Yamashita J: Risks in using siphon-reducing devices in adult patients with normal-pressure hydrocephalus: bench test investigations with Delta valves. J Neurosurg 1996, 84:634-641.
- [6]Malm J, Jacobsson J, Birgander R, Eklund A: Reference values for CSF outflow resistance and intracranial pressure in healthy elderly. Neurology 2011, 76:903-909.
- [7]Lundkvist B, Koskinen LO, Birgander R, Eklund A, Malm J: Cerebrospinal fluid dynamics and long-term survival of the Strata valve in idiopathic normal pressure hydrocephalus. Acta Neurol Scand 2011, 124:115-121.
- [8]Boon AJ, Tans JT, Delwel EJ, Egeler_Peerdeman SM, Hanlo PW, Wurzer HA, Avezaat CJ, de_Jong DA, Gooskens RH, Hermans J: Dutch normal-pressure hydrocephalus study: prediction of outcome after shunting by resistance to outflow of cerebrospinal fluid. J Neurosurg 1997, 87:687-693.
- [9]Boon AJ, Tans JT, Delwel EJ, Egeler_Peerdeman SM, Hanlo PW, Wurzer HA, Avezaat CJ, de_Jong DA, Gooskens RH, Hermans J: Dutch Normal-Pressure Hydrocephalus Study: randomized comparison of low- and medium-pressure shunts. J Neurosurg 1998, 88:490-495.
- [10]Eklund A, Lundkvist B, Koskinen LO, Malm J: Infusion technique can be used to distinguish between dysfunction of a hydrocephalus shunt system and a progressive dementia. Med Biol Eng Comput 2004, 42:644-649.
- [11]Petrella G, Czosnyka M, Smielewski P, Allin D, Guazzo EP, Pickard JD, Czosnyka ZH: In vivo assessment of hydrocephalus shunt. Acta Neurol Scand 2009, 120:317-323.
- [12]Malm J, Sundstrom N, Cesarini KG, Edsbagge M, Kristensen B, Leijon G, Eklund A: Implementation of a new CSF dynamic device: a multicenter feasibility study in 562 patients. Acta Neurol Scand 2012, 125:199-205.
- [13]Czosnyka ZH, Czosnyka M, Pickard JD: Shunt testing in-vivo: a method based on the data from the UK shunt evaluation laboratory. Acta Neurochir Suppl 2002, 81:27-30.
- [14]Zemack G, Romner B: Adjustable valves in normal-pressure hydrocephalus: a retrospective study of 218 patients. Neurosurgery 2002, 51:1392-1400.
- [15]Portnoy HD, Schulte RR, Fox JL, Croissant PD, Tripp L: Anti-siphon and reversible occlusion valves for shunting in hydrocephalus and preventing post-shunt subdural hematomas. J Neurosurg 1973, 38:729-738.
- [16]De Keulenaer BL, De Waele JJ, Powell B, Malbrain ML: What is normal intra-abdominal pressure and how is it affected by positioning, body mass and positive end-expiratory pressure? Intensive Care Med 2009, 35:969-976.
- [17]Relkin N, Marmarou A, Klinge P, Bergsneider M, Black PM: Diagnosing Idiopathic Normal-pressure Hydrocephalus. Neurosurgery 2005, 57:4-16.
- [18]Stephensen H, Tisell M, Wikkelso C: Intracranial pressure during wakefulness and sleep in 55 adult patients with chronic hydrocephalus. Neurosurgery 2006, 59:326-332.
- [19]Miyake H, Ohta T, Kajimoto Y, Nagao K: New concept for the pressure setting of a programmable pressure valve and measurement of in vivo shunt flow performed using a microflowmeter. Technical note. J Neurosurg 2000, 92:181-187.
- [20]Bergsneider M, Yang I, Hu X, McArthur DL, Cook SW, Boscardin WJ: Relationship between Valve Opening Pressure, Body Position, and Intracranial Pressure in Normal Pressure Hydrocephalus: Paradigm for Selection of Programmable Valve Pressure Setting. Neurosurgery 2004, 55:851-859.
- [21]Tisell M, Tullberg M, Hellstrom P, Edsbagge M, Hogfeldt M, Wikkelso C: Shunt surgery in patients with hydrocephalus and white matter changes. J Neurosurg , 114:1432-1438.
- [22]Silverberg GD, Mayo M, Saul T, Fellmann J, Carvalho J, McGuire D: Continuous CSF drainage in AD: results of a double-blind, randomized, placebo-controlled study. Neurology 2008, 71:202-209.
- [23]Shellock FG, Bedwinek A, Oliver-Allen M, Wilson SF: Assessment of MRI issues for a 3-T “immune” programmable CSF shunt valve. AJR Am J Roentgenol 2012, 197:202-207.