• Maria Garcia-Bonilla, Carolyn A Harris, Saibal Bandyopadhyay, Jason Moore, Jeff Horbatiuk, David D Limbrick, Rajiv Swarup, Jayne Crouthamel, Andrew Jones, Ahmad Khasawneh, Alexandra Petroj, Simran Hehar, Mariana Sierra, Jennifer Anderson, Ryann Murray, Michael R Talcott, and James P McAllister.
• 1Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
• J. Neurosurg. 2024 Mar 1; 140 (3): 627638627-638.

ObjectiveVentriculoperitoneal shunting, the most common treatment for the neurological disorder hydrocephalus, has a failure rate of up to 98% within 10 years of placement, mainly because of proximal obstruction of the ventricular catheter (VC). The authors developed a new VC design modified with tethered liquid perfluorocarbon (TLP) and tested it in a porcine model of hydrocephalus. In this study, they aimed to determine if their TLP VC design reduced cell surface attachment and consequent shunt obstruction in the pig model.MethodsTLP VCs were designed to reduce drainage hole obstruction using modified TLP and slightly enlarged draining holes, but their number and placement remained very similar to standard VCs. First, the authors tested the device in nonhydrocephalic rats to assess biocompatibility. After confirming safety, they implanted the VCs in hydrocephalic pigs. Hydrocephalus was induced by intracisternal kaolin injections in 30-day-old domestic juvenile pigs. Surgical implantation of the ventriculoperitoneal shunt (clinical control or TLP) was performed 10-14 days postinduction and maintained up to 30 days posttreatment. MRI was performed to measure ventricular volume before treatment and 10 and 30 days after treatment. Histological and immunohistochemical analyses of brain tissue and explanted VCs, intracranial pressure measurement, and clinical scoring were performed when the animals were euthanized.ResultsTLP VCs showed a similar surgical feel, kink resistance, and stiffness to control VCs. In rats (biocompatibility assessment), TLP VCs did not show brain inflammatory reactions after 30 or 60 days of implantation. In pigs, TLP VCs demonstrated increased survival time, improved clinical outcome scores, and significantly reduced total attached cells on the VCs compared with standard clinical control VCs. TLP VCs exhibited similar, but not worse, results related to ventriculomegaly, intracranial pressure, and the local tissue response around the cortical shunt track in pigs.ConclusionsTLP VCs may be a strong candidate to reduce proximal VC obstruction and improve hydrocephalus treatment.

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