The influence of cerebrospinal fluid on blood coagulation and the implications for ventriculovenous shunting

Vandersteene, Jelle; Baert, Edward; Planckaert, Guillaume M J; Berghe, Thomas Van Den; Roost, Dirk Van; Dewaele, Frank; Henrotte, Michaël; Somer, Filip De

doi:10.3171/2017.11.jns171510

Cited by 10 publications

(12 citation statements)

References 30 publications

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“…When CSF is infused, ACT remains stable whereas both CR and PF increase significantly more than in RL and CTRL groups. This finding confirms the coagulation enhancing effect of CSF, 23 which seems to compensate for the fibrinogen deprivation and the consumption of clotting factors due to the in vitro test.…”

Section: Discussionsupporting

confidence: 81%

“…The infusion of fluids results in hemodilution that may bias the results. The rate of 2 ml/h in combination with limited duration of 60 min for each circuit was chosen to minimize hemodilution and related blood coagulation disturbances: 23 By limiting the duration of the experiment and the infusion rate, the volume percentage of the infusion fluid was only 5.88% at the end of the experiment. This is significantly lower than 9%–11%, which is the known threshold for infusion fluids like CSF and RL to affect blood coagulation properties.…”

Section: Discussionmentioning

confidence: 99%

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A new dynamic model for in vitro evaluation of intravascular devices

et al. 2018

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Introduction: A dynamic model to evaluate thrombus formation on intravascular catheters in vitro is presented. The model enables fluid infusion, variation in the catheter orientation, and variable flow conditions. It was applied on a catheter used to shunt cerebrospinal fluid to a vein, a dural venous sinus, for the treatment of hydrocephalus. Methods: Fresh human blood-filled circuits were circulated in a non-occlusive roller pump. A catheter infused either with cerebrospinal fluid, Ringer's lactate, or no fluid (control) was inserted through each circuit's wall. Sixteen circuits (six cerebrospinal fluid, six Ringer's lactate, four control) ran for 60 min. Qualitative assessment was performed by measuring viscoelastic properties of blood at the start and end of the experiment; quantitative evaluation of clot formation by scanning electron microscope. Results: Average blood velocity was 79 mm/s, with a pressure wave between 5 and 15 mm Hg. At the experiment's end, the infused fluid represented 5.88% of the blood/infusion volume in the circuit. The control circuits showed no statistical difference between the start and end for viscoelastic testing, whereas both Ringer's lactate and cerebrospinal fluid enhanced coagulation, most pronounced for the latter. Most thrombus material was observed on catheters in the cerebrospinal fluid group. Clot formation was less pronounced on the surface of the catheter facing the blood flow. Discussion: A dynamic model for intravascular catheter testing mimics better clinical conditions when evaluating blood-material interaction. Catheter position, blood flow around the catheter, and infusion fluid all have a potential impact on the hemocompatibility of a given catheter.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

A new dynamic model for in vitro evaluation of intravascular devices

et al. 2018

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“…Since the venous pressure in the superior sagittal sinus was 5-10 cmH 2 O, and the lowest pressure in the Medtronic adjustable shunt tube was 5 cmH 2 O, the high cranial pressure hydrocephalus shunt had a better effect. It has been reported that low cranial pressure or normal pressure ventriculosinus shunt has a poor prognosis (10,11). In this group, 2 cases were cured after ventriculo-bladder shunt due to low preoperative intracranial pressure and no significant changes in postoperative symptoms and ventricular size.…”

Section: Discussionmentioning

confidence: 74%

Ventriculosinus shunt as a reliable option in the treatment of failed ventriculoperitoneal shunt: report of 19 cases and review of the literature

Zheng

2021

Ann Palliat Med

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Background: The authors of this study aim to summarize their experience with lateral ventriculosinus shunt in the treatment of hydrocephalus patients and assess its clinical value.Methods: Ventriculoperitoneal shunt was performed but failed due to obstruction and infection of the shunt. Lateral ventriculosinus shunt was inserted in 19 hydrocephalus patients by a Medtronic programmable shunt valve. All 19 patients suffered from either an obstruction or infection after ventriculoperitoneal shunting, while 11 cases had a peritoneal obstruction, 8 cases had an intracranial infection, and 1 case had an intra-abdominal infection. Among the 19 cases, there were 2 cases with obstructive hydrocephalus and 17 cases with communicating hydrocephalus.Results: All clinical symptoms of 9 patients disappeared completely, while for 8 patients, noticeable improvement was accomplished, and only 2 patients showed no improvement. All 19 cases were followed up for 6 to 60 months. During the follow-up period, in 17 patients the shunt remained effective, while 2 cases underwent removal of the shunt due to low preoperative intracranial pressure and no significant changes in postoperative symptoms and ventricular size. During follow-up there was no thrombosis in the sagittal sinus, and no infection, over drainage, intracranial hemorrhage, or subdural effusion occurred. Conclusions:We demonstrate that lateral ventriculosinus shunt is a reliable option for failed ventriculoperitoneal shunt hydrocephalus patients. Nevertheless, the effectiveness and possible complications of this method need further confirmation by observation in a study with a larger cohort.

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“…Some in vitro studies showed that adding CSF to blood makes blood hypercoagulable. They found the accelerated conversion from fibrinogen to fibrin, gradual shortening of the activated clotting time, increased the clot rate, and higher platelet activation after the addition of CSF [25,26]. Indeed, CSF contains tissue factor and coagulation proteins.…”

Section: Csfmentioning

confidence: 99%

“…Apart from these clotting factors, immunoglobulins and other immunological factors in CSF can cause neuroinflammation, leading to a procoagulant state [17]. In pathological conditions, the concentration of coagulation proteins and the imbalance between tissue factor and tissue factor pathway inhibitor even increase, resulting in a more pronounced procoagulant effect of CSF [26,27]. However, adding CSF to blood enhances coagulability requiring a starting concentration of 5-9%.…”

Section: Csfmentioning

confidence: 99%

Thrombosis associated with ventriculoatrial shunts

Guan

Xiao

et al. 2021

Neurosurg Rev

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Ventriculoatrial shunts are the most common second-line procedure for cases in which ventriculoperitoneal shunts are unsuitable. Shunting-associated thrombosis is a potentially life-threatening complication after ventriculoatrial shunt insertion. The overall prevalence of this complication is still controversial because of substantial differences in the numbers found in studies using clinical data and in those analyzing postmortem findings. The etiology of thrombosis may be multifactorial, including shunt catheter itself, contents of cerebrospinal fluid, shunt infection, and genetic disorder. The clinical presentation can vary widely, ranging from asymptomatic to a life-threatening condition. Timely recognition of thromboembolic lesions is critical for treatment. However, early diagnosis and management is still challenging because of a relatively long asymptomatic latency and lack of clear guideline recommendations. The purpose of this review is to provide an overview of ventriculoatrial shunt thrombosis, especially to focus on its etiopathogenesis, diagnosis, treatment, and prevention.

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The influence of cerebrospinal fluid on blood coagulation and the implications for ventriculovenous shunting

Cited by 10 publications

References 30 publications

A new dynamic model for in vitro evaluation of intravascular devices

A new dynamic model for in vitro evaluation of intravascular devices

Ventriculosinus shunt as a reliable option in the treatment of failed ventriculoperitoneal shunt: report of 19 cases and review of the literature

Thrombosis associated with ventriculoatrial shunts

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