Implantable Systems for Continuous Liquorpheresis and CSF Replacement.

Manuel Menéndez González

doi:10.7759/cureus.1022

Abstract

Liquorpheresis (cerebrospinal fluid filtration) comprises a therapeutical approach that has been proposed to treat several neurological conditions where antibodies, inflammatory mediators, or abnormal peptides are the cause or play an important role in the pathogenesis of the disease. Continuous or intermittent cerebrospinal fluid (CSF) replacement may be an alternative approach not explored thus far.Here, we review previous experiences in the use of liquorpheresis in autoimmune and degenerative neurological diseases. Then we describe previous technical reports and provide some new innovations in order to design bidirectional CSF shunting systems that can be complemented either with a deposit of artificial CSF or with a filter of CSF, allowing CSF replacement or liquorpheresis respectively. Both options would lead to mechanical dilution of the patient’s CSF.

Highlights

Liquorpheresis (CSF filtration) comprises a new therapeutical approach that has been proposed to treat several neurological conditions where soluble proteins or peptides within the nervous system play an important role in the physiopathology of the disease
Patent US20090131850A1, entitled “Method and apparatus for removing harmful proteins from a mammalian's ventricular cerebrospinal fluid” devices bidirectional ventricular-peritoneal derivations complemented with a pump and a filter allowing the removal of proteins from CSF [7]
With the availability of artificial cerebrospinal fluid (aCSF), CSF replacement seems a feasible intervention from a technical point of view

Summary

Introduction

Liquorpheresis (CSF filtration) comprises a new therapeutical approach that has been proposed to treat several neurological conditions where soluble proteins or peptides within the nervous system play an important role in the physiopathology of the disease. Patent US20090131850A1, entitled “Method and apparatus for removing harmful proteins from a mammalian's ventricular cerebrospinal fluid” devices bidirectional ventricular-peritoneal derivations complemented with a pump and a filter allowing the removal of proteins from CSF [7] It can be considered the first claimed patent claim of an implantable system for continuous liquorpheresis. Using current technology as starting point, we envision new developments to construct implantable systems aimed at infusing either aCSF (CSF replacement) or the own patient’s CSF after filtration (liquorpheresis) This model comprises a series of interconnected elements, reservoirs, and access ports, allowing both to drain CSF to the outside (to an external collector) or to the peritoneum and to infuse CSF into the ventricular system (ventriculo-peritoneal) or the spinal subarachnoid space (lumbo-peritoneal derivation). The concentration of target molecules is much lower in the outflow fluid than in the inflow fluid

Discussion

Conclusions

Disclosures