While CSF diversion is highly effective at treating hydrocephalus, shunting is unfortunately associated with a very high revision rate. Studies have demonstrated that proximal catheter obstruction is a major cause of failure. A novel proximal access device was developed, and pilot testing was performed in a sheep model of hydrocephalus.
开云体育世界杯赔率
Hydrocephalus was induced in 8 sheep using a cisternal injection of 4 ml of 25% kaolin, and the sheep were randomized to either a standard ventricular catheter or a novel intraparenchymal stent (IPS). Both groups received identical valves and distal catheters. The novel device included a 3D-printed stainless steel port and a 6 × 40–mm covered peripheral vascular stent. Animals were euthanized for signs of hydrocephalus or at a time point of 2 months. MRI was performed to determine ventricular size. Time to failure and Evans indices were compared using the Wilcoxon rank-sum test.
RESULTS
All 4 experimental devices were placed without difficulty into the right lateral ventricle. There was a trend toward longer survival in the experimental group (40 vs 26 days, p = 0.24). Within the IPS group, 3 of the 4 sheep did not experience clinical symptoms of shunt failure and had an average of 37% decrease in Evans index. While 3 of 4 traditional proximal catheters demonstrated debris within the inlet holes, there was no obstructive material found in the IPSs.
CONCLUSIONS
An IPS was successfully used to treat hydrocephalus in a sheep model. While statistical significance was not achieved, there were clear benefits to using a stent, including a decreased clog rate and the ability to perform a percutaneous revision. Further testing is needed to ensure efficacy and safety prior to human application.
ABBREVIATIONS
ETV = endoscopic third ventriculostomy;IPS = intraparenchymal stent;VPS = ventriculoperitoneal shunt.
INCLUDE WHEN CITINGPublished online June 30, 2023; DOI: 10.3171/2023.5.PEDS22545.
DisclosuresThis study used a patented technology that was filed by the University of Rochester. Dr. Stone is an inventor listed on the patent. While there is no direct financial compensation for this work, the University of Rochester and Dr. Stone may financially benefit from this research. Dr. Santangelo has no financial relationship to the patent or licensing company.
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