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anti-siphon_device

Anti-siphon device

Most available cerebrospinal fluid diversion systems utilize differential pressure valves that often allow overshunting, resulting in complications due to the siphoning of fluid from the ventricular system. 1).

Indications

Slit ventricle treatment:

Antisiphon devices (ASDs) of various working principles were developed to overcome overdrainage-related complications associated with ventriculoperitoneal shunting.

Though rare, complication associated with overdrainage is certainly a problem in children.

Patients who received shunts with antisiphon device do not show any overdrainage 2).

Devices

Integra antisiphon device

Siphonguard

Both CSF shunts work properly, but at the lowest setting the opening pressure of the Strata NSC was near 0 and in the Codman Hakim it was twice the manufacturer's specifications. The resistance in the Strata NSC was below the normal physiological range, and in the Codman Hakim device it was in the lower range of normal. The ASD did not change the shunt characteristics in the lying position and therefore might not do so in children. If this is the case, then a shunt system with an integrated ASD could be implanted at the first shunt insertion, thus avoiding a second operation and the possibility of infection 3).

see SiphonX


Freimann et al. analyzed three gravity-dependent ASDs (ShuntAssistant [SA], Miethke; Gravity Compensating Accessory [GCA], Integra; SiphonX [SX], Sophysa), two membrane-controlled ASDs (Anti-Siphon Device [IASD], Integra; Delta Chamber [DC], Medtronic), and one flow-regulated ASD (SiphonGuard [SG], Codman). Defined pressure conditions within a simulated shunt system were generated (differential pressure 10-80 cmH2O), and the specific flow and pressure characteristics were measured. In addition, the gravity-dependent ASDs were measured in defined spatial positions (0-90°).

The flow characteristics of the three gravity-assisted ASDs were largely dependent upon differential pressure and on their spatial position. All three devices were able to reduce the siphoning effect, but each to a different extent (flow at inflow pressure: 10 cmH2O, siphoning -20 cmH2O at 0°/90°: SA, 7.1 ± 1.2*/2.3 ±  0.5* ml/min; GCA, 10.5 ± 0.8/3.4 ± 0.4* ml/min; SX, 9.5 ± 1.2*/4.7 ± 1.9* ml/min, compared to control, 11.1 ± 0.4 ml/min [*p < 0.05]). The flow characteristics of the remaining ASDs were primarily dependent upon the inflow pressure effect (flow at 10 cmH2O, siphoning 0 cmH2O/ siphoning -20cmH2O: DC, 2.6 ± 0.1/ 4 ± 0.3* ml/min; IASD, 2.5 ± 0.2/ 0.8 ± 0.4* ml/min; SG, 0.8 ± 0.2*/ 0.2 ± 0.1* ml/min [*p < 0.05 vs. control, respectively]).

The tested ASDs were able to control the siphoning effect within a simulated shunt system to differing degrees. Future comparative trials are needed to determine the type of device that is superior for clinical application 4).


Case series

The effects of an anti-siphon device (ASD) on shunt flow and intracranial pressure (ICP) in 16 children with hypertensive hydrocephalus were examined using quantitative radionuclide shuntography (99mTc) with the children in supine and sitting positions. The average age of these patients was 9.5 years. Results were compared with those recorded in 36 patients with adult normal-pressure hydrocephalus (NPH). The closing pressure levels of shunt valve used were low in 8 cases, medium in 7 and high in 1. Half the children (8) had shunt systems with, and the other 8 without, ASD. In the children who had the shunt system without ASD, sitting shunt flow was significantly greater than supine shunt flow, which indicated overdrainage. Conversely, in children who had the shunt system with ASD, supine shunt flow was greater than sitting shunt flow. Because ASD prevented overdrainage, ICP was higher with the shunt system with ASD than with the shunt system without ASD. Without ASD, sitting shunt flow of children was lower than that of adult patients with NPH because of the lower hydrostatic pressure, which correlated with their height. Conversely, in the presence of a shunt system with ASD, sitting shunt flow of children was greater than that of adults, because of the higher ICP and lower hydrostatic pressure. The effect of ASD was smaller in children than in adults, because positive pressure over the ASD was greater (hypertension vs normal pressure) and negative pressure under the ASD was less (short vs tall) in children than in adults. Thus, in children the ASD was effective in preventing overdrainage 5).

1)
Horton D.D., Williams G., Pollay M. (1991) The Effectiveness of a Siphon Control Device in Preventing the Complications of Overshunting. In: Matsumoto S., Tamaki N. (eds) Hydrocephalus. Springer, Tokyo
2)
Khan RA, Narasimhan KL, Tewari MK, Saxena AK. Role of shunts with antisiphon device in treatment of pediatric hydrocephalus. Clin Neurol Neurosurg. 2010 Oct;112(8):687-90. doi: 10.1016/j.clineuro.2010.05.008. Epub 2010 Jun 19. PubMed PMID: 20646829.
3)
Arnell K, Koskinen LO, Malm J, Eklund A. Evaluation of Strata NSC and Codman Hakim adjustable cerebrospinal fluid shunts and their corresponding antisiphon devices. J Neurosurg Pediatr. 2009 Mar;3(3):166-72. doi: 10.3171/2008.10.PEDS08118. PubMed PMID: 19338461.
4)
Freimann FB, Kimura T, Stockhammer F, Schulz M, Rohde V, Thomale UW. In vitro performance and principles of anti-siphoning devices. Acta Neurochir (Wien). 2014 Nov;156(11):2191-9. doi: 10.1007/s00701-014-2201-y. Epub 2014 Aug 16. PubMed PMID: 25123252.
5)
Tokoro K, Chiba Y, Abe H, Tanaka N, Yamataki A, Kanno H. Importance of anti-siphon devices in the treatment of pediatric hydrocephalus. Childs Nerv Syst. 1994 May;10(4):236-8. PubMed PMID: 7923233.
anti-siphon_device.txt · Last modified: 2019/04/18 12:08 by administrador