Addressing the siphoning effect in new shunt designs by decoupling the activation pressure and the pressure gradient across the valve

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Although several improvements have been observed in the past few years in shunt technology, currently available systems still present several associated problems. Among these, overdrainage along with its complications remains one of the great challenges for new shunt designs. To address the so-called siphoning effect, the authors provide a practical example of how it is possible to decouple the activation pressure and the pressure gradient across the valve through a 3–key component system. In this new shunt design, the flow is expected to depend only on the intracranial pressure and not on the pressure gradient across the valve, thus avoiding the so-called siphoning effect.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors used computer models to theoretically evaluate the mechanical variables involved in the operation of the newly designed valve, such as the fluid's Reynolds number, proximal pressure, distal pressure, pressure gradient, actual flow rate, and expected flow rate. After fabrication of the first superscaled model, the authors performed benchmark tests to analyze the performance of the new shunt prototype, and the obtained data were compared with the results predicted by the previous mathematical models.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The final design of the new paddle wheel valve with the 3–key component antisiphoning system was tested in the hydrodynamics laboratory to prove that the siphoning effect did not occur. According to the calculations obtained using the LabVIEW program during the experiments, each time the distal pressure decreased without an increase in the proximal pressure (despite the range of the pressure gradient), the pin blocked the spinning of the paddle wheels, and the calculated fluid velocity through the system tended to zero. Such a situation was significantly different from the expected flow rate for such a pressure gradient in a siphoning situation without the new antisiphon system.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The design of this new prototype with a 3–key component antisiphoning system demonstrated that it is possible to decouple the activation pressure and the pressure gradient across the valve, avoiding the siphoning effect. Although further developments are necessary to provide a model compatible to clinical use, the authors believe that this new prototype illustrates the possibility of successfully addressing the siphoning effect by using a simple 3–key component system that is able to decouple the activation pressure and the pressure gradient across the valve by using a separate pressure chamber. It is expected that such proof of concept may significantly contribute to future shunt designs attempting to address the problem of overdrainage due to the siphoning effect.</jats:p></jats:sec>

Updating technology of shunt valves

“…A different approach to the problem of the siphoning effect is seen in the Orbis Sigma valve (Cordis Corporation). In contrast to pressure regulating valves, this valve is designed to be a flow regulating device allowing a fairly constant flow rate over a wide range of differential pressures [30][31][32][33][34] .…”

“…Several level I studies have demonstrated a significant improvement in over-drainage complications with antisiphon devices or the application of programmable valves or flow-regulated valves [30][31][32][33][34] .…”