How to Choose a Shunt for Patients with Normal Pressure Hydrocephalus : A Short Guide to Selecting the Best Shunt Assembly
Sahuquillo Barris, Juan (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Rosas, Katiuska (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Calvo, Helena (Hospital Universitari Vall d'Hebron)
Alcina, Aloma (Hospital Universitari Vall d'Hebron)
Gándara, Dario F. (Hospital Universitari Vall d'Hebron. Institut de Recerca)
López-Bermeo, Diego (Hospital Universitari Vall d'Hebron)
Poca Pastor, María Antonia (Universitat Autònoma de Barcelona. Departament de Cirurgia)

Data:	2021
Resum:	Most patients with hydrocephalus are still managed with the implantation of a cerebrospinal fluid (CSF) shunt in which the CSF flow is regulated by a differential-pressure valve (DPV). Our aim in this review is to discuss some basic concepts in fluid mechanics that are frequently ignored but that should be understood by neurosurgeons to enable them to choose the most adequate shunt for each patient. We will present data, some of which is not provided by manufacturers, which may help neurosurgeons in selecting the most appropriate shunt. To do so, we focused on the management of patients with idiopathic "normal-pressure hydrocephalus" (iNPH), as one of the most challenging scenarios, in which the combination of optimal technology, patient characteristics, and knowledge of fluid mechanics can significantly modify the surgical results. For a better understanding of the available hardware and its evolution over time, we will have a second look at the design of the first DPV and the reasons why additional devices were incorporated to control for shunt overdrainage and its related complications. We try to persuade the reader that a clear understanding of the physical concepts of the CSF and shunt dynamics is key to understand the pathophysiology of iNPH and to improve its treatment.
Ajuts:	European Commission. Horizon 2020 75332 Instituto de Salud Carlos III PI18/00468 Ministerio de Economía y Competitividad DTS16/00087 Ministerio de Economía y Competitividad PI2015-64358-C2-1-R
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Differential-pressure valves ; Hydrocephalus ; Normal-pressure hydrocephalus ; Fluid mechanics ; Shunt overdrainage ; Antisiphon device
Publicat a:	Journal of clinical medicine, Vol. 10 (march 2021) , ISSN 2077-0383

DOI: 10.3390/jcm10061210
PMID: 33803977

18 p, 3.4 MB

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