Development of an In Vitro Hemorrhagic Hydrocephalus Model for Functional Evaluation of Magnetic Microactuators Against Shunt Obstructions
Development of an In Vitro Hemorrhagic Hydrocephalus Model for Functional Evaluation of Magnetic Microactuators Against Shunt Obstructions
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DOI：
10.1016/j.wneu.2021.08.048
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发表时间：
2021-10-27
影响因子：
2
通讯作者：
Lee, Hyowon
中科院分区：
文献类型：
--
作者：
Devathasan, Dillon;Bentley, R. Timothy;Lee, Hyowon
目的：脑室出血后放置的脑室-腹膜分流管闭塞是常见的并发症。本研究的目的是建立一种出血性脑积水模型，以评估脑室导管(VC)内振荡微执行器预防分流梗阻的能力。方法：建立高风险分流梗阻的体外脑积水模型。磷酸盐缓冲液、血液和凝血酶通过脑室-腹膜分流管驱动8小时。5个VC安装了微执行器，并与5个对照VC进行了比较。该微执行器在外加磁场的作用下持续30分钟。测量模拟侧脑室内的压力。结果：在5个对照分流中，发生6个阻塞(3个VC，3个瓣膜-远端导管)，而在5个微执行器分流中发生1个阻塞(VC)。在对照组和微执行器组，8小时内离开分流管的中位数分别为30毫升和256毫升。微执行器组达到40毫米汞柱脑室内压力的中位时间(13.8分钟比8小时)、中位总时间40毫米汞(6.2小时比0.0小时)和中位最大压力(192毫米汞比36毫米汞)显著改善(P<；0.01)。结论：除了保护腔静脉外，微执行器似乎还能防止血肿阻塞瓣膜或远端导管，导致低脑室压持续时间更长。通过将患者的头部置于外部磁场中而激活的微执行器可以减少出血性脑积水的分流障碍。
OBJECTIVE: Occlusion of ventriculoperitoneal shunts placed after intraventricular hemorrhage occurs frequently. The objective of this study was to develop a hemorrhagic hydrocephalus model to assess the ability of an oscillating microactuator within the ventricular catheter (VC) to prevent shunt obstruction. METHODS: An in vitro hydrocephalus model with extreme risk of shunt obstruction was created. Phosphate-buffered saline, blood, and thrombin were driven through ventriculoperitoneal shunts for 8 hours. Five VCs were fitted with a microactuator and compared with 5 control VCs. The microactuator was actuated by an external magnetic field for 30 minutes. Pressure within the imitation lateral ventricle was measured. RESULTS: In the 5 control shunts, 6 obstructions devel-oped (3 VC, 3 valve-distal catheter) compared with 1 obstruction (VC) in the 5 microactuator shunts. In the control and microactuator groups, the median volume exiting the shunts in 8 hours was 30 mL versus 256 mL. Median time to reach an intraventricular pressure of 40 mm Hg (13.8 minutes vs. >8 hours), median total time >40 mm Hg (6.2 hours vs. 0.0 hours), and median maximum pressure (192 mm Hg vs. 36 mm Hg) were significantly improved in the microactuator group (P < 0.01). CONCLUSIONS: In addition to protecting the VC, the microactuator appeared to prevent hematoma obstructing the valve or distal catheter, resulting in a much longer duration of low intraventricular pressures. A microactuator activated by placing the patient's head in an external mag-netic field could reduce shunt obstructions in hemorrhagic hydrocephalus.