Abstract
OBJECTIVE Shunt obstruction by cells and/or tissue is the most common cause of shunt failure. Ventricular catheter obstruction alone accounts for more than 50% of shunt failures in pediatric patients. The authors sought to systematically collect explanted ventricular catheters from the Seattle Children's Hospital with a focus on elucidating the cellular mechanisms underlying obstruction. METHODS In the operating room, explanted hardware was placed in 4% paraformaldehyde. Weekly, samples were transferred to buffer solution and stored at 4°C. After consent was obtained for their use, catheters were labeled using cell-specific markers for astrocytes (glial fibrillary acidic protein), microglia (ionized calcium-binding adapter molecule 1), and choroid plexus (transthyretin) in conjunction with a nuclear stain (Hoechst). Catheters were mounted in custom polycarbonate imaging chambers. Three-dimensional, multispectral, spinning-disk confocal microscopy was used to image catheter cerebrospinal fluid–intake holes...
Highlights
Shunt obstruction with cells/tissue is the most common cause of shunt failure; with ventricular catheter obstruction, alone, accounting for >50% of pediatric failures
Intraoperatively confirmed ventricular catheter obstruction was the leading cause of shunt failure, noted in 53.6% of cases
Over 30 ventricular catheters have been imaged to date, resulting in the following observations: 1) Astrocytes and microglia are the dominant cell types bound directly to catheter surfaces; 2) Cellular binding to catheters is ubiquitous even if no grossly visible tissue is apparent; 3) Commercially available catheters contain rough, irregular surfaces, at CSF intake holes, and there appears to be preferential cell binding to these rough surfaces; 4) Immunohistochemistry techniques are of limited utility when a catheter has been exposed to Bugbee wire electrocautery
Summary
Shunt obstruction with cells/tissue is the most common cause of shunt failure; with ventricular catheter obstruction, alone, accounting for >50% of pediatric failures. Methods In the operating room explanted hardware was placed in 4% paraformaldehyde. Samples were transferred to buffer solution and stored at 4°C.
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