Mineralization and biodegradation of CSF shunting systems

Abstract

The mineralization and biodegradation of cerebrospinal fluid shunting systems were studied using material from 25 shunts that had been implanted for between 6 days and 10 years. New unused materials were also examined for comparison. Surface changes in six systems could be observed under an operating microscope. Substantial quantities of a white deposit had adhered to the tubing in four of the shunts. These changes were most advanced in the galeal penetrative portion of the shunts and are believed to have been caused by mechanical stress. Scanning electron microscopic analysis revealed surface wrinkles, microscopic holes, and tiny particles, suggesting deterioration of the material itself. An energy-dispersive analysis using x-rays demonstrated that the surface deposits were due to mineralization of calcium phosphate and that the tiny particle growth was aluminum. These changes may be a consequence of the degradation of silicone rubber. A discriminant analysis of the mineralization was carried out; thus, the age of the host and the duration of system implantation could be correlated with the incidence of mineralization (p less than 0.1). A measurement of the physical properties showed progressive change with a remarkable deterioration in systems implanted for more than 5 years.

Complete intraventricular migration of the ventriculoperitoneal shunt

“…Any fixation point can cause interruption by causing tension of the shunt. In addition, immune reaction can cause calcification and dissolution of the shunt material [9,10]. During surgical procedure, a loose binding or use of absorbable suture material on connection part can lead to detachment in the shunt system by causing tension.…”

Calcification on the Ventricle Wall Associated With a Shunt Tube-Case Report-

“…4,6,8) However, scanning electron microscope analyses of shunts in place for long periods have disclosed irregular tube surfaces due to degradation, calcium deposits in dented portions of the tube, and fibrosis with calcification extending to the surrounding tissues. 1,3) Degradation of the tube surface will expose the impregnated barium, which induces chemical reactions and results in calcification and fibrosis. 3) Mechanical stress on the shunt tube is greatest in the neck, and tube calcification is most commonly found in that area.…”

“…1,3) Degradation of the tube surface will expose the impregnated barium, which induces chemical reactions and results in calcification and fibrosis. 3) Mechanical stress on the shunt tube is greatest in the neck, and tube calcification is most commonly found in that area. 3,7) Our patient also had calcification in the neck portion of the shunt tube.…”

“…3) Mechanical stress on the shunt tube is greatest in the neck, and tube calcification is most commonly found in that area. 3,7) Our patient also had calcification in the neck portion of the shunt tube. However, calcification on the ventricle wall associated with a shunt tube is extremely rare, perhaps because tubes in the brain have fewer mechanical stresses.…”

Late pediatric ventriculoperitoneal shunt failures: a Singapore tertiary institution's experience

“…This corroborates the literature that, first of all, reports that the majority of VPS catheter degradations have been found to occur after 5 years from the time of surgery. 17,19 Second, early complications related to operative technique and initial patient management would be resolved after such a long time interval. Our study cohort demonstrates that the majority of patients have a VPS fracture with or without in vivo catheter disconnection, followed by VPS blockage, as the main clinical presentations for late VPS complications.…”