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In vitro performance of six combinations of adjustable differential pressure valves and fixed anti-siphon devices with and without vertical motion

  • Original Article - CSF Circulation
  • Published:
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Abstract

Objective

Adjustable differential pressure (DP) valves in combination with fixed anti-siphon devices are currently a popular combination in counteracting the effects of cerebrospinal fluid overdrainage following implantation of a ventriculoperitoneal shunt system. The study examined the flow performance of three DP valves in successive combination with an anti-siphon device in an in vitro shunt laboratory with and without vertical motion.

Methods

We analyzed three DP valves (Codman Hakim Medos programmable valve [HM], Codman CertasPlus [CP], and Miethke proGAV [PG], in combination with either Codman SiphonGuard [SG] or Miethke ShuntAssistant [SA]), resulting in the evaluation of six different valve combinations. Defined DP conditions between 4 and 40 cm H2O within a simulated shunt system were generated and the specific flow characteristics were measured. In addition, combinations with SA, which is a gravity-dependent valve, were measured in defined spatial positions (90°, 60°). All device combinations were tested during vertical motion with movement frequencies of 2, 3, and 4 Hz.

Results

All valve combinations effectively counteracted the siphon effect in relation to the chosen DP. Angulation-related flow changes were similar in the three combinations of DP valve and SA in the 60° and 90° position. In CP-SA and PG-SA, repeated vertical movement at 2, 3, and 4 Hz led to significant increase in flow, whereas in HM-SA, constant increase was seen at 4 Hz only (flow change at 4Hz, DP 40 cm H2O: PG (opening pressure 4 cm H2O) 90°: 0.95 ml/min, 60°: 0.71 ml/min; HM (opening pressure 4 cm H2O) 90°: 0.66 ml/min, 60°: 0.41 ml/min; CP (PL 2) 90°: 0.94 ml/min, 60°: 0.79 ml/min; p < 0.01); however, HM-SA showed relevant motion-induced flow already at low DPs (0.85 ml/min, DP 4 cm H2O). In combinations of DP valve with SG, increase of flow was far less pronounced and even led to significant reduction of flow in certain constellations. Maximum overall flow increase was 0.46 ± 0.04 ml/min with a HM (opening pressure 12 cm H2O) at 2 Hz and a DP of 10 cm H2O, whereas maximum flow decrease was 1.12 ± 0.08 with a PG (opening pressure 4 cm H2O) at 3 Hz and a DP of 10 cmH2O.

Conclusion

In an experimental setup, all valve combinations effectively counteracted the siphon effect in the vertical position according to their added resistance. Motion-induced increased flow was consistently demonstrated in combinations of DP valve and SA. The combination of HM and SA especially showed relevant motion-induced flow already at low DPs. In combinations of DP and SG, the pattern of the motion induced flow was more inconsistent and motion even led to significant flow reduction, predominantly at DPs of 10 and 20 cmH2O.

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital Göttingen, Göttingen, Germany

    I. Fiss, P. Röhrig, C. von der Brelie, C. Bettag, F. B. Freimann & V. Rohde

  2. Department of Neurosurgery, Universitätsmedizin Göttingen, Georg-August University Göttingen, 37099, Göttingen, Germany

    I. Fiss

  3. Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany

    N. Hore & S. Brandner

  4. Department of Paediatric Neurosurgery, Charité University Hospital, Berlin, Germany

    U.-W. Thomale

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  1. I. Fiss
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  2. P. Röhrig
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  3. N. Hore
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  4. C. von der Brelie
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  5. C. Bettag
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  6. F. B. Freimann
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  7. U.-W. Thomale
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  8. V. Rohde
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  9. S. Brandner
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Correspondence to I. Fiss.

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Conflict of interest

UWT is consultant for Miethke Company and receives lecture honorarium from B. Braun-Aesculap Company. Author IF declares that he has no conflict of interest. Author PR declares that she has no conflict of interest. Author CVDB declares that he has no conflict of interest. Author CB declares that he has no conflict of interest. Author NH declares that he has no conflict of interest. Author FF declares that he has no conflict of interest. Author VR declares that he has no conflict of interest. Author SB declares that he has no conflict of interest.

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Fiss, I., Röhrig, P., Hore, N. et al. In vitro performance of six combinations of adjustable differential pressure valves and fixed anti-siphon devices with and without vertical motion. Acta Neurochir 162, 2421–2430 (2020). https://doi.org/10.1007/s00701-020-04519-y

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  • DOI: https://doi.org/10.1007/s00701-020-04519-y

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