Top

Published in:

01-07-2021 | Hydrocephalus | Original Article - CSF Circulation

CSF shunt valve occlusion—does CSF protein and cell count matter?

Published in: Acta Neurochirurgica | Issue 7/2021

Abstract

Background

Shunt obstruction is a common cause of shunt failure in the treatment of hydrocephalus. Valve occlusion is traditionally believed to originate from elevated CSF protein or cellular components, although detailed evidence is scarce and contradictory. Therefore, this study aimed to examine CSF protein and cell count as risk factors for valve obstruction.

Methods

We retrospectively examined 274 patients who underwent shunt placement for hydrocephalus between 2009 and 2018 and had at least 1 year follow-up. Age, aetiology of hydrocephalus, valve type, occurrence of revision, reason for revision and CSF protein and cell count at the time of shunt insertion and revision surgery were analysed.

Results

Thirty-two of 274 patients (11.7%) required revision surgery due to valve occlusion. Mean time to revision was 143 days. CSF white blood cell (WBC) count but not protein was associated with valve occlusion overall. Of all obstructed valve patients, 25% showed CSF protein level within the normal range, whereas 13.6% of the patients overall showed greatly elevated CSF protein level without evidence of valve obstruction. Persistently elevated CSF protein level at the time of shunt revision was significantly associated with valve obstruction within 90 days of initial insertion (early occlusion). Children with congenital malformations and post-haemorrhagic patients were significantly overrepresented in the occlusion group, particularly in the early occlusion group.

Conclusion

Pathological CSF values such as WBC count and persistently elevated protein level serves as a risk factor for early valve obstruction. Late obstruction occurs independent of normal CSF values. Infants are particularly prone to early and late valve obstructions. CSF protein level at shunt insertion is not predictive of valve occlusion.

Anderson JM, Rodriguez A, Chang DT (2008) Foreign body reaction to biomaterials. Semin Immunol 20(2):86–100CrossRef

Brydon HL, Hayward R, Harkness W, Bayston R (1995) Physical properties of cerebrospinal fluid of relevance to shunt function 1: the effect of protein upon CSF viscosity. Br J Neurosurg 9(5):639–644CrossRef

Brydon HL, Hayward R, Harkness W, Bayston R (1995) Physical properties of cerebrospinal fluid of relevance to shunt function 2: the effect of protein upon CSF surface tension and contact angle. Br J Neurosurg 9(5):645–651CrossRef

Brydon HL, Hayward R, Harkness W, Bayston R (1996) Does the cerebrospinal fluid protein concentration increase the risk of shunt complications? Br J Neurosurg 10(3):267–273CrossRef

Cheatle JT, Bowder AN, Tefft JL, Agrawal SK, Hellbusch LC (2015) Effect of protein concentration on the flow of cerebrospinal fluid through shunt tubing. Neurosurgery 77(6):972–978CrossRef

Fehrenbach MK, Bernhard M, Siekmeyer M, Lippmann N, Kiess W, Nestler U, Meixensberger J, Preuss M (2016) VP-shunt dysfunction caused by malaria CNS infection. Childs NervSyst 32(4):759–760CrossRef

Fulkerson DH, Vachhrajani S, Bohnstedt BN, Patel NB, Patel AJ, Fox BD, Jea A, Boaz JC (2011) Analysis of the risk of shunt failure or infection related to cerebrospinal fluid cell count, protein level, and glucose levels in low-birth-weight premature infants with posthemorrhagic hydrocephalus. J Neurosurg Pediatr 7(2):147–151CrossRef

Harris CA, Resau JH, Hudson EA, West RA, Moon C, Black AD, McAllister JP (2011) Effects of surface wettability, flow, and protein concentration on macrophage and astrocyte adhesion in an in vitro model of central nervous system catheter obstruction. J Biomed Mater Res A 97(4):433–440CrossRef

Kamat AS, Gretschel A, Vlok AJ, Solomons R (2018) CSF protein concentration associated with ventriculoperitoneal shunt obstruction in tuberculous meningitis. Int J Tuberc Lung Dis 22(7):788–792CrossRef

10.

Kestle J, Drake J, Milner R et al (2000) Long-term follow-up data from the shunt design trial. Pediatr Neurosurg 33(5):230–236CrossRef

11.

Laviv Y, Kasper BS, Kasper EM (2018) Vascular hyperpermeability as a hallmark of phacomatoses: is the etiology angiogenesis comparable with mechanisms seen in inflammatory pathways? Part I: historical observations and clinical perspectives on the etiology of increased CSF protein levels, CSF clotting, and communicating hydrocephalus: a comprehensive review. Neurosurg Rev 41(4):957–968CrossRef

12.

LeHanka A, Piatt J (2020) Readmission and reoperation for hydrocephalus: a population-based analysis across the spectrum of age. J Neurosurg 1–8

13.

Lenfestey RW, Smith PB, Moody MA, Clark RH, Cotten CM, Seed PC, Benjamin DK (2007) Predictive value of cerebrospinal fluid parameters in neonates with intraventricular drainage devices. J Neurosurg 107(3 Suppl):209–212PubMed

14.

Lorber J, Bhat US (1974) Posthaemorrhagic hydrocephalus: diagnosis, differential diagnosis, treatment, and long-term results. Arch Dis Child 49(10):751–762CrossRef

15.

Ludwig H, Reitemeyer M, Bock H, Sigler M (2019) Hydrocephalus shunt therapy: current titanium shunt valve implants obstructed by internal tissue proliferations identified as extracellular matrix membranes. Childs Nerv Syst. https://doi.org/10.1007/s00381-019-04467-8CrossRefPubMed

16.

Mallucci CL, Jenkinson MD, Conroy EJ et al (2019) Antibiotic or silver versus standard ventriculoperitoneal shunts (BASICS): a multicentre, single-blinded, randomised trial and economic evaluation. The Lancet 394(10208):1530–1539CrossRef

17.

McGirt MJ, Leveque J-C, Wellons JC III, Villavicencio AT, Hopkins JS, Fuchs HE, George TM (2002) Cerebrospinal fluid shunt survival and etiology of failures: a seven-year institutional experience. Pediatr Neurosurg 36(5):248–255CrossRef

18.

Mohanty A, Vasudev MK, Sampath S, Radhesh S, Sastry Kolluri VR (2002) Failed endoscopic third ventriculostomy in children: management options. Pediatr Neurosurg 37(6):304–309CrossRef

19.

Notarianni C, Vannemreddy P, Caldito G, Bollam P, Wylen E, Willis B, Nanda A (2009) Congenital hydrocephalus and ventriculoperitoneal shunts: influence of etiology and programmable shunts on revisions: clinical article. PED 4(6):547–552CrossRef

20.

Paff M, Alexandru-Abrams D, Muhonen M, Loudon W (2018) Ventriculoperitoneal shunt complications: a review. Interdisciplinary Neurosurgery 13:66–70CrossRef

21.

Preuss M, Kutscher A, Wachowiak R, Merkenschlager A, Bernhard MK, Reiss-Zimmermann M, Meixensberger J, Nestler U (2015) Adult long-term outcome of patients after congenital hydrocephalus shunt therapy. Childs NervSyst 31(1):49–56CrossRef

22.

Rammos S, Klopfenstein J, Augspurger L, Augsburger L, Wang H, Wagenbach A, Poston J, Lanzino G (2008) Conversion of external ventricular drains to ventriculoperitoneal shunts after aneurysmal subarachnoid hemorrhage: effects of site and protein/red blood cell counts on shunt infection and malfunction. J Neurosurg 109(6):1001–1004CrossRef

23.

Reddy GK, Bollam P, Caldito G (2014) Long-term outcomes of ventriculoperitoneal shunt surgery in patients with hydrocephalus. World Neurosurg 81(2):404–410CrossRef

24.

Riva-Cambrin J, Kestle JRW, Holubkov R et al (2016) Risk factors for shunt malfunction in pediatric hydrocephalus: a multicenter prospective cohort study. PED 17(4):382–390CrossRef

25.

Sgouros S, Dipple SJ (2004) An investigation of structural degradation of cerebrospinal fluid shunt valves performed using scanning electron microscopy and energy-dispersive x-ray microanalysis. J Neurosurg 100(3):534–540CrossRef

26.

Stone JJ, Walker CT, Jacobson M, Phillips V, Silberstein HJ (2013) Revision rate of pediatric ventriculoperitoneal shunts after 15 years. J Neurosurg Pediatr 11(1):15–19CrossRef

27.

Tervonen J, Leinonen V, Jääskeläinen JE, Koponen S, Huttunen TJ (2017) Rate and risk factors for shunt revision in pediatric patients with hydrocephalus—a population-based study. World Neurosurg 101:615–622CrossRef

28.

Wagner W, Koch D (2005) Mechanisms of failure after endoscopic third ventriculostomy in young infants. J Neurosurg Pediatr 103(1):43–49CrossRef

29.

Whitelaw A, Evans D, Carter M et al (2007) Randomized clinical trial of prevention of hydrocephalus after intraventricular hemorrhage in preterm infants: brain-washing versus tapping fluid. Pediatrics 119(5):e1071–e1078CrossRef

Title: CSF shunt valve occlusion—does CSF protein and cell count matter?
Publication date: 01-07-2021
Keywords: Hydrocephalus
Hydrocephalus
Hydrocephalus
CSF Drainage
Published in: Acta Neurochirurgica / Issue 7/2021
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-021-04864-6

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

CSF shunt valve occlusion—does CSF protein and cell count matter?

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 7/2021

Infiltrative gliomas of the thalamus in children: the role of surgery in the era of H3 K27M mutant midline gliomas

Assessment of variability in motor grading and patient-reported outcome reporting: a multi-specialty, multi-national survey

Lumbar puncture position influences intracranial pressure

Compliance of the cerebrospinal space: comparison of three methods

Survival of glioblastoma in relation to tumor location: a statistical tumor atlas of a population-based cohort

Vim stereotactic radiosurgical thalamotomy for drug-resistant idiopathic Holmes tremor: a case report