Skip to main content

Advertisement

Log in

The theoretical requirements of shunt design as determined by biomechanical testing in pediatric hydrocephalus

  • Original Papers
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

This paper reviews the mechanics of shunts currently used to treat hydrocephalus and contrasts these devices with the normal mechanism of CSF circulation. These differences are examined with reference to the biomechanical testing performed in hydrocephalus children. These studies show that in most untreated hydrocephalics, enhanced volume storage accompanies a partial absorptive defect. After treatment, volume storage changes in most children but persists in a minority. Using these tests, it is possible to describe the requirements for successful shunting of hydrocephalic children at all stages of the process. This discussion elaborates the theoretical requirements for revising current shunt design.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Cutler RWP, Page L, Galicich J, Watters GV (1968) Formation and absorption of cerebrospinal fluid in man. Brain 91:707–720

    Google Scholar 

  2. Davson H (1967) Physiology of the cerebrospinal fluid. Churchill, London

    Google Scholar 

  3. Di Chiro G (1964) Movement of the cerebrospinal fluid in human beings. Nature 204–209

  4. Di Chiro G (1964) New radiographic and isotopic procedures in neurological diagnosis. JAMA 188:524

    Google Scholar 

  5. Epstein F, Hochwald GM, Wald H, Ransohoff J (1975) Avoidance of shunt dependency. Dev Med Child Neurol 17:71–77

    Google Scholar 

  6. Fried A, Shapiro K (1986) Subtle deterioration in shunted childhood hydrocephalus: a biomechanical and clinical profile. J Neurosurg 65

  7. Lorenzo AV, Page LK, Watters GV (1970) Relationship between cerebrospinal fluid formation, absorption and pressure in human hydrocephalus. Brain 93:679–692

    Google Scholar 

  8. Marmarou A (1973) A theoretical model and experimental evaluation of the cerebrospinal fluid system. Thesis submitted to the Faculty of Drexel University, Philadelphia, Penn

  9. Marmarou A, Shulman K, LaMorgese J (1975) A compartmental analysis of compliance and outflow resistance of the CSF system. J Neurosurg 43:523–534

    Google Scholar 

  10. Marmarou A, Shulman K, Rosende RM (1978) A nonlinear analysis of the cerebrospinal fluid system and intracranial pressure dynamics. J Neurosurgery 48:332–344

    Google Scholar 

  11. Nulsen FE, Spitz EB (1952) Treatment of hydrocephalus by direct shunt from ventricles to jugular vein. Surgical Forum 2:399–403

    Google Scholar 

  12. Portnoy HD (1982) Treatment of hydrocephalus. In: Pediatric neurosurgery, surgery of the developing nervous system. Grune & Stratton, New York, pp 211–227

    Google Scholar 

  13. Portnoy HD, Shulte RR, Fox JL (1973) Antisiphon and reversible occlusion valves for shunting in hydrocephalus and preventing post-shunt subdural hematoma. J Neurosurg 38:729–738

    Google Scholar 

  14. Portnoy HD, Tripp L, Croissant PD (1976) Hydrodynamics of shunt valves. Child's Brain 2:242–256

    Google Scholar 

  15. Pudenz RH, Russell FE, Hurd AH et al. (1957) Ventriculoauriculostomy. A technique for shunting cerebrospinal fluid into the right auricle. Preliminary report. J Neurosurg 14:171–179

    Google Scholar 

  16. Rubin RC, Henderson ES, Walker MD (1966) The production of cerebrospinal fluid in man and its modification by acetazolamide. J Neurosurg 25:430–436

    Google Scholar 

  17. Salmon JH, Hajjar W, Bada HS (1977) The fontogram: a noninvasive intracranial pressure monitor. Pediatrics 60:721–725

    Google Scholar 

  18. Shapiro K, Fried A (1986) Pressure volume relationships in shunt dependent childhood hydrocephalus: the zone of pressure instability in children with acute deterioration. J Neurosurg 64:390–396

    Google Scholar 

  19. Shapiro K, Marmarou A, Shulman K (1980) Characterization of clinical CSF dynamics and neural axis compliance using the pressure-volume index. I. The normal pressure-volume index. Ann Neurol 7:508–514

    Google Scholar 

  20. Shapiro K, Marmarou A, Shulman K (1982) Abnormal brain biomechanics in the hydrocephalic child. In: Concepts in pediatric neurosurgery II, American Society for Pediatric Neurosurgery. Karger, Munich New York, pp 76–88

    Google Scholar 

  21. Shapiro K, Fried A, Marmarou A (1985) Biomechanical and hydrodynamic characterization of the hydrocephalic infant. J Neurosurg 63:69–75

    Google Scholar 

  22. Shulman K, Yarnell P, Ransohoff J (1964) Dural sinus pressure. Arch Neurol 10:575–580

    Google Scholar 

  23. Sklar FH, Beyer CW Jr, Diehl JT, Clark WK (1981) Significance of the so-called absorptive reserve in communicating hydrocephalus: a preliminary report. Neurosurgery 8:525–530

    Google Scholar 

  24. Welch K (1980) The intracranial pressure in infants. J Neurosurg 52:693–699

    Google Scholar 

  25. Welch K, Friedman V (1960) The cerebrospinal fluid values. Brain 83:454–469

    Google Scholar 

  26. Yamada H, Tajima M, Nagaya M (1975) Effect of respiratory movement on cerebrospinal fluid dynamics in hydrocephalic infant with shunts. J Neurosurg 42:194–200

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

This paper was partially supported by the National Institute of Health Teacher/Investigator Development Award NSI-EA 1K07 00769-01 NSPH

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shapiro, K., Fried, A. The theoretical requirements of shunt design as determined by biomechanical testing in pediatric hydrocephalus. Child's Nerv Syst 4, 348–353 (1988). https://doi.org/10.1007/BF00270609

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00270609

Key words

Navigation