A multicenter retrospective study of heterogeneous tissue aggregates obstructing ventricular catheters explanted from patients with hydrocephalus
Abstract Background Implantation of ventricular catheters (VCs) to drain cerebrospinal fluid (CSF) is a standard approach to treat hydrocephalus. VCs fail frequently due to tissue obstructing the lumen via the drainage holes. Mechanisms driving obstruction are poorly understood. This study aimed to...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-07-01
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| Series: | Fluids and Barriers of the CNS |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12987-021-00262-3 |
| _version_ | 1818453831276560384 |
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| author | Prashant Hariharan Jeffrey Sondheimer Alexandra Petroj Jacob Gluski Andrew Jea William E. Whitehead Sandeep Sood Steven D. Ham Brandon G. Rocque Neena I. Marupudi James P. McAllister David Limbrick Marc R. Del Bigio Carolyn A. Harris |
| author_facet | Prashant Hariharan Jeffrey Sondheimer Alexandra Petroj Jacob Gluski Andrew Jea William E. Whitehead Sandeep Sood Steven D. Ham Brandon G. Rocque Neena I. Marupudi James P. McAllister David Limbrick Marc R. Del Bigio Carolyn A. Harris |
| author_sort | Prashant Hariharan |
| collection | DOAJ |
| description | Abstract Background Implantation of ventricular catheters (VCs) to drain cerebrospinal fluid (CSF) is a standard approach to treat hydrocephalus. VCs fail frequently due to tissue obstructing the lumen via the drainage holes. Mechanisms driving obstruction are poorly understood. This study aimed to characterize the histological features of VC obstructions and identify links to clinical factors. Methods 343 VCs with relevant clinical data were collected from five centers. Each hole on the VCs was classified by degree of tissue obstruction after macroscopic analysis. A subgroup of 54 samples was analyzed using immunofluorescent labelling, histology and immunohistochemistry. Results 61.5% of the 343 VCs analyzed had tissue aggregates occluding at least one hole (n = 211) however the vast majority of the holes (70%) showed no tissue aggregates. Mean age at which patients with occluded VCs had their first surgeries (3.25 yrs) was lower than in patients with non-occluded VCs (5.29 yrs, p < 0.02). Mean length of time of implantation of occluded VCs, 33.22 months was greater than for non-occluded VCs, 23.8 months (p = 0.02). Patients with myelomeningocele had a greater probability of having an occluded VC (p = 0.0426). VCs with occlusions had greater numbers of macrophages and astrocytes in comparison to non-occluded VCs (p < 0.01). Microglia comprised only 2–6% of the VC-obstructing tissue aggregates. Histologic analysis showed choroid plexus occlusion in 24%, vascularized glial tissue occlusion in 24%, prevalent lymphocytic inflammation in 29%, and foreign body giant cell reactions in 5% and no ependyma. Conclusion Our data show that age of the first surgery and length of time a VC is implanted are factors that influence the degree of VC obstruction. The tissue aggregates obstructing VCs are composed predominantly of astrocytes and macrophages; microglia have a relatively small presence. |
| first_indexed | 2024-12-14T21:45:14Z |
| format | Article |
| id | doaj.art-38e2917193ac4764999c8175445c5ce2 |
| institution | Directory Open Access Journal |
| issn | 2045-8118 |
| language | English |
| last_indexed | 2024-12-14T21:45:14Z |
| publishDate | 2021-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Fluids and Barriers of the CNS |
| spelling | doaj.art-38e2917193ac4764999c8175445c5ce22022-12-21T22:46:22ZengBMCFluids and Barriers of the CNS2045-81182021-07-0118111210.1186/s12987-021-00262-3A multicenter retrospective study of heterogeneous tissue aggregates obstructing ventricular catheters explanted from patients with hydrocephalusPrashant Hariharan0Jeffrey Sondheimer1Alexandra Petroj2Jacob Gluski3Andrew Jea4William E. Whitehead5Sandeep Sood6Steven D. Ham7Brandon G. Rocque8Neena I. Marupudi9James P. McAllister10David Limbrick11Marc R. Del Bigio12Carolyn A. Harris13Wayne State University Dept. of Biomedical EngineeringWayne State University Dept. of Chemical Engineering and Materials ScienceWayne State University Dept. of Chemical Engineering and Materials ScienceDept. of Neurosurgery, Wayne State University School of MedicineRiley Hospital for Children at IU HealthTexas Children’sDepartments of Neurosurgery and Pediatric Neurosurgery, Wayne State University School of Medicine and Children’s Hospital of MichiganDepartments of Neurosurgery and Pediatric Neurosurgery, Wayne State University School of Medicine and Children’s Hospital of MichiganDepartment of Neurosurgery, University of Alabama At BirminghamChildren’s Hospital of Michigan Dept. of NeurosurgerySchool of Medicine Dept. of Neurological Surgery, Washington UniversitySchool of Medicine Dept. of Neurological Surgery, Washington UniversityDepartment of Pathology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of ManitobaWayne State University Dept. of Chemical Engineering and Materials ScienceAbstract Background Implantation of ventricular catheters (VCs) to drain cerebrospinal fluid (CSF) is a standard approach to treat hydrocephalus. VCs fail frequently due to tissue obstructing the lumen via the drainage holes. Mechanisms driving obstruction are poorly understood. This study aimed to characterize the histological features of VC obstructions and identify links to clinical factors. Methods 343 VCs with relevant clinical data were collected from five centers. Each hole on the VCs was classified by degree of tissue obstruction after macroscopic analysis. A subgroup of 54 samples was analyzed using immunofluorescent labelling, histology and immunohistochemistry. Results 61.5% of the 343 VCs analyzed had tissue aggregates occluding at least one hole (n = 211) however the vast majority of the holes (70%) showed no tissue aggregates. Mean age at which patients with occluded VCs had their first surgeries (3.25 yrs) was lower than in patients with non-occluded VCs (5.29 yrs, p < 0.02). Mean length of time of implantation of occluded VCs, 33.22 months was greater than for non-occluded VCs, 23.8 months (p = 0.02). Patients with myelomeningocele had a greater probability of having an occluded VC (p = 0.0426). VCs with occlusions had greater numbers of macrophages and astrocytes in comparison to non-occluded VCs (p < 0.01). Microglia comprised only 2–6% of the VC-obstructing tissue aggregates. Histologic analysis showed choroid plexus occlusion in 24%, vascularized glial tissue occlusion in 24%, prevalent lymphocytic inflammation in 29%, and foreign body giant cell reactions in 5% and no ependyma. Conclusion Our data show that age of the first surgery and length of time a VC is implanted are factors that influence the degree of VC obstruction. The tissue aggregates obstructing VCs are composed predominantly of astrocytes and macrophages; microglia have a relatively small presence.https://doi.org/10.1186/s12987-021-00262-3HydrocephalusBiobankVentriculoperitoneal shuntShunt failureShunt obstructionRetrospective cohort |
| spellingShingle | Prashant Hariharan Jeffrey Sondheimer Alexandra Petroj Jacob Gluski Andrew Jea William E. Whitehead Sandeep Sood Steven D. Ham Brandon G. Rocque Neena I. Marupudi James P. McAllister David Limbrick Marc R. Del Bigio Carolyn A. Harris A multicenter retrospective study of heterogeneous tissue aggregates obstructing ventricular catheters explanted from patients with hydrocephalus Fluids and Barriers of the CNS Hydrocephalus Biobank Ventriculoperitoneal shunt Shunt failure Shunt obstruction Retrospective cohort |
| title | A multicenter retrospective study of heterogeneous tissue aggregates obstructing ventricular catheters explanted from patients with hydrocephalus |
| title_full | A multicenter retrospective study of heterogeneous tissue aggregates obstructing ventricular catheters explanted from patients with hydrocephalus |
| title_fullStr | A multicenter retrospective study of heterogeneous tissue aggregates obstructing ventricular catheters explanted from patients with hydrocephalus |
| title_full_unstemmed | A multicenter retrospective study of heterogeneous tissue aggregates obstructing ventricular catheters explanted from patients with hydrocephalus |
| title_short | A multicenter retrospective study of heterogeneous tissue aggregates obstructing ventricular catheters explanted from patients with hydrocephalus |
| title_sort | multicenter retrospective study of heterogeneous tissue aggregates obstructing ventricular catheters explanted from patients with hydrocephalus |
| topic | Hydrocephalus Biobank Ventriculoperitoneal shunt Shunt failure Shunt obstruction Retrospective cohort |
| url | https://doi.org/10.1186/s12987-021-00262-3 |
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