Early Shunting Using the Parallel Shunt System in Hemorrhagic Hydrocephalus: In Vitro Testing of Handling, Technical Com
In order to minimize the duration of external cerebrospinal fluid (CSF) drainage after hemorrhagic hydrocephalus we are testing a parallel shunt system that can be implanted very early after bleeding. It should be able to tolerate a high load of protein a
- PDF / 580,437 Bytes
- 3 Pages / 595.276 x 790.866 pts Page_size
- 68 Downloads / 158 Views
Abstract In order to minimize the duration of external cerebrospinal fluid (CSF) drainage after hemorrhagic hydrocephalus we are testing a parallel shunt system that can be implanted very early after bleeding. It should be able to tolerate a high load of protein and blood in the CSF. After clearance of the CSF, the valveless arm of the shunt is closed by a percutaneous manipulation and the valve-arm is opened. Keywords Hemorrhagic hydrocephalus • parallel shunt system • infection rate
Introduction The current standard of care in intraventricular haemorrhage (IVH) in adults is an external ventricular drainage (EVD) system to monitor the intracranial pressure and treat hydrocephalus and to drain the bloody cerebrospinal fluid. After IVH, erythrocytes and high protein concentrations are sustained in the CSF for a long time. This requires a long-standing external CSF drainage before shunting. The reported infection risk of this two-step procedure ranges up to 50%. The purpose of this study is to significantly decrease the rate of ventriculitis by early shunting using a parallel dual shunt after a maximum of 5 days of EVD.
group will undergo early shunting on days 3–5 after EVD according to the CSF properties and radio-morphological findings (Fig. 1, Table 1), and early shunting is carried out with the parallel dual shunt system (modified by Pizzi) (Fig. 2). The other sample group will undergo late shunting after normalization of the CSF-properties. The optimal time for closing the valveless arm depends on radiological criteria. For conformation, puncture of the burr-hole reservoir for analysing the CSF properties is optional. The patients will be followed up by the Glasgow Outcome Scale. Blood infection parameter and serial cranial CT will be carried out in the follow-up during the in-hospital period, after 4 weeks and after 3 months (Table 2). Two parallel shunt systems are implanted, sharing one burr-hole and ventricular catheter with a larger diameter (1.5 mm), coupled by a Y-connector and one peritoneal catheter. One end of this arrangement carries an Integra Hakim valve system (Integra Neuroscience, Germany). To prevent blood from passing through the valve arm, an up-stream on–off switch has been introduced. The other end is a valveless shunt with low filtration properties and an upstream on–off switch. The position of the upper part of the body and head will regulate the CSF flow rate in the valveless arm. The optimal time of closing this arm has been previously mentioned. We are about to develop a diverting unit to replace the first Y-connector and the two upstream on–off switches that can be adjusted on either one of the arrangement’s arms by an external magnetic device. In vitrotesting was done in our hospital with bloody CSF-like artificial solution in numerous valve systems.
Materials and Methods After insertion of an EVD system into all patients, a further procedure is carried out in a randomized exploratory phaseII study with 15 patients in each patient group. One patient
U. Meier (), F. Al-Zain, an
Data Loading...
