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Comparison of anti-siphon devices: how do they affect CSF dynamics in supine and upright posture?
Umeå University, Faculty of Medicine, Department of Radiation Sciences.
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2017 (English)In: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 159, no 8, 1389-1397 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Three different types of anti-siphon devices (ASDs) have been developed to counteract siphoning-induced overdrainage in upright posture. However, it is not known how the different ASDs affect CSF dynamics under the complex pressure environment seen in clinic due to postural changes. We investigated which ASDs can avoid overdrainage in upright posture best without leading to CSF accumulation.

METHODS: Three shunts each of the types Codman Hakim with SiphonGuard (flow-regulated), Miethke miniNAV with proSA (gravitational), and Medtronic Delta (membrane controlled) were tested. The shunts were compared on a novel in vitro setup that actively emulates the physiology of a shunted patient. This testing method allows determining the CSF drainage rates, resulting CSF volume, and intracranial pressure in the supine, sitting, and standing posture.

RESULTS: The flow-regulated ASDs avoided increased drainage by closing their primary flow path when drainage exceeded 1.39 ± 0.42 mL/min. However, with intraperitoneal pressure increased in standing posture, we observed reopening of the ASD in 3 out of 18 experiment repetitions. The adjustable gravitational ASDs allow independent opening pressures in horizontal and vertical orientation, but they did not provide constant drainage in upright posture (0.37 ± 0.03 mL/min and 0.26 ± 0.03 mL/min in sitting and standing posture, respectively). Consequently, adaptation to the individual patient is critical. The membrane-controlled ASDs stopped drainage in upright posture. This eliminates the risk of overdrainage, but leads to CSF accumulation up to the volume observed without shunting when the patient is upright.

CONCLUSIONS: While all tested ASDs reduced overdrainage, their actual performance will depend on a patient's specific needs because of the large variation in the way the ASDs influence CSF dynamics: while the flow-regulated shunts provide continuous drainage in upright posture, the gravitational ASDs allow and require additional adaptation, and the membrane-controlled ASDs show robust siphon prevention by a total stop of drainage.

Place, publisher, year, edition, pages
2017. Vol. 159, no 8, 1389-1397 p.
Keyword [en]
Animal testing alternatives, Anti-siphon device, Cerebrospinal fluid shunt, In vitro, Overdrainage, Posture
National Category
Natural Sciences
Research subject
Neurology
Identifiers
URN: urn:nbn:se:umu:diva-137838DOI: 10.1007/s00701-017-3249-2ISI: 000405530900004PubMedID: 28660395OAI: oai:DiVA.org:umu-137838DiVA: diva2:1128361
Available from: 2017-07-25 Created: 2017-07-25 Last updated: 2017-08-21Bibliographically approved

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Eklund, Anders
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