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Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Pathophysiology of shunt dysfunction in shunt treated hydrocephalus
C Blegvad1, A D Skjolding, H Broholm
1University Clinic of Neurosurgery 2092, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark. christoffer.blegvad@gmail.com
Acta Neurochirurgica
|May 7, 2013
Summary
Shunt obstruction in cerebrospinal fluid shunts is caused by glial and inflammatory cells. These cells lead to tissue ingrowth in catheters and valve clogging, often due to ventricle wall contact.
Area of Science:
- Neuroscience
- Biomaterials Science
- Pathology
Background:
- Cerebrospinal fluid (CSF) shunts are vital for treating hydrocephalus.
- Shunt dysfunction, particularly obstruction, is a common complication.
- Understanding the cellular basis of shunt dysfunction is crucial for improving device longevity.
Purpose of the Study:
- To investigate the cellular responses causing ventricular catheter and shunt valve dysfunction.
- To differentiate the pathophysiological mechanisms underlying shunt obstruction in catheters versus valves.
Main Methods:
- Analysis of explanted ventricular catheters and shunt valves.
- Histopathological examination (HE staining) of intraluminal tissue.
- Cellular detachment from valves using trypsin-EDTA.
- Correlation with patient etiological and surgical data, and CT scans for catheter position.
Main Results:
- Ventricular catheters showed intraluminal glial and inflammatory tissue, correlating with adherence and ventricle wall contact.
- All examined shunt valves exhibited a consistent cellular response of glial cells, macrophages/giant cells, and lymphomonocytes.
- Obstruction in catheters was linked to intraluminal tissue, except in one case of lost ventricular contact.
Conclusions:
- Both shunt catheter and valve obstruction stem from similar cellular responses: glial and inflammatory cells.
- Two synergistic mechanisms proposed: mechanical irritation from ventricle wall contact causing ependymal exfoliation, and inflammatory reactions to shunt material.
- These combined mechanisms result in obstructive tissue ingrowth in catheters and valve clogging.
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