Mechanical dysfunction of ventriculoperitoneal shunts caused by calcification of the silicone rubber catheter

Anne-Laure BochService de Neurochirurgie, Hôpital Necker—Enfants Malades, Paris, France; and École de Physique et de Chimie Industrielles de Paris, Paris, France

Search for other papers by Anne-Laure Boch in
Current site
Google Scholar
PubMed
Close
 M.D.
,
Éric HermelinService de Neurochirurgie, Hôpital Necker—Enfants Malades, Paris, France; and École de Physique et de Chimie Industrielles de Paris, Paris, France

Search for other papers by Éric Hermelin in
Current site
Google Scholar
PubMed
Close
 M.Sc.
,
Christian Sainte-RoseService de Neurochirurgie, Hôpital Necker—Enfants Malades, Paris, France; and École de Physique et de Chimie Industrielles de Paris, Paris, France

Search for other papers by Christian Sainte-Rose in
Current site
Google Scholar
PubMed
Close
 M.D.
, and
Spiros SgourosService de Neurochirurgie, Hôpital Necker—Enfants Malades, Paris, France; and École de Physique et de Chimie Industrielles de Paris, Paris, France

Search for other papers by Spiros Sgouros in
Current site
Google Scholar
PubMed
Close
 M.D.
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $525.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $624.00
USD  $45.00
USD  $525.00
USD  $624.00
Print or Print + Online Sign in

Object. The authors studied new and calcified shunt catheters to identify the prevalence of failures caused by aging materials in the shunt. Complications associated with these devices have various origins. Among late complications, fracture or migration of the system is related to the subcutaneous adhesion of the distal tubing in a growing child. A review of a cohort of 64 children who underwent shunt placement in 1980 with barium-impregnated distal catheters showed that 10 of these patients underwent reoperation for complications related to aging of the shunt material. This group represents 15% of the whole series and 30% of those children who were followed for more than 3 years. The true impact of aging of materials on shunt function is probably underestimated.

Methods. The authors performed physical, chemical, and mechanical analyses of the retrieved aged catheters and also of new catheters, resulting in the following findings: 1) calcifications were observed only on the external surface of the catheter, predominantly in its subcutaneous segment at the level of the neck and anterior chest wall; 2) calcifications contained particles of free silicon and barium sulfate, signifying fragmentation of the polymer; 3) the microstructure of the silicone polymer was modified: microfractures and alteration of the polymeric network were observed; 4) silanol groups were observed on the external surface of the catheter; and 5) the mechanical properties of the silicone rubber were degraded, and the aged catheters were more brittle than the new ones, with ruptures at elongations and fracture energy much lower than that seen in new catheters.

Furthermore, in vitro testing with a metastable solution of simulated body fluid demonstrated the critical impact of pH variations in liquid media and surface degradation of the catheters on the precipitation of hydroxylapatite crystals.

Conclusions. Although most shunt complications can be addressed by better patient management and surgical technique, late complications appear to be partly related to aging of the material. Distal tubing calcifications have been observed in barium-impregnated catheters. The industry recently responded to these observations by introducing plain silicone-coated shunt tubing; further evaluation will show what improvement can be expected.

  • Collapse
  • Expand
  • 1.

    Anderson HC: Normal and abnormal mineralization in mammals. Trans Am Soc Artif Intern Org 27:702708, 1981 Anderson HC: Normal and abnormal mineralization in mammals. Trans Am Soc Artif Intern Org 27:702–708, 1981

    • Search Google Scholar
    • Export Citation
  • 2.

    Bierbrauer KS, , Storrs BB, & McLone DG, et al: A prospective, randomized study of shunt function and infections as a function of shunt placement. Pediatr Neurosurg 16:287291, 1990/91 Bierbrauer KS, Storrs BB, McLone DG, et al: A prospective, randomized study of shunt function and infections as a function of shunt placement. Pediatr Neurosurg 16:287–291, 1990/91

    • Search Google Scholar
    • Export Citation
  • 3.

    Brydon HL, , Bayston R, & Hayward RD, et al: Explanted shunt valves: factors contributing to their failure. Eur J Pediatr Surg 4 (Suppl 1):3738, 1994 Brydon HL, Bayston R, Hayward RD, et al: Explanted shunt valves: factors contributing to their failure. Eur J Pediatr Surg 4 (Suppl 1):37–38, 1994

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Clyde BL, & Albright AL: Evidence for a patent fibrous tract in fractured, outgrown, or disconnected ventriculoperitoneal shunts. Pediatr Neurosurg 23:2025, 1995 Clyde BL, Albright AL: Evidence for a patent fibrous tract in fractured, outgrown, or disconnected ventriculoperitoneal shunts. Pediatr Neurosurg 23:20–25, 1995

    • Search Google Scholar
    • Export Citation
  • 5.

    Coleman DL: Mineralization of blood pump bladders. Trans Am Soc Artif Intern Organs 27:708713, 1981 Coleman DL: Mineralization of blood pump bladders. Trans Am Soc Artif Intern Organs 27:708–713, 1981

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Cuka GM, & Hellbusch LC: Fractures of the peritoneal catheter of cerebrospinal fluid shunts. Pediatr Neurosurg 22:101103, 1995 Cuka GM, Hellbusch LC: Fractures of the peritoneal catheter of cerebrospinal fluid shunts. Pediatr Neurosurg 22:101–103, 1995

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Decq P, , Barat JL, & Duplessis E, et al: Shunt failure in adult hydrocephalus: flow-controlled shunt versus differential pressure shunts—a cooperative study in 289 patients. Surg Neurol 43:333339, 1995 Decq P, Barat JL, Duplessis E, et al: Shunt failure in adult hydrocephalus: flow-controlled shunt versus differential pressure shunts—a cooperative study in 289 patients. Surg Neurol 43:333–339, 1995

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Del Bigio MR, & Fedoroff S: Short-term response of brain tissue to cerebrospinal fluid shunts in vivo and in vitro. J Biomed Mat Res 26:979987, 1992 Del Bigio MR, Fedoroff S: Short-term response of brain tissue to cerebrospinal fluid shunts in vivo and in vitro. J Biomed Mat Res 26:979–987, 1992

    • Search Google Scholar
    • Export Citation
  • 9.

    Drake JM, & Sainte-Rose C: The Shunt Book. Cambridge, MA: Blackwell, 1995 Drake JM, Sainte-Rose C: The Shunt Book. Cambridge, MA: Blackwell, 1995

    • Search Google Scholar
    • Export Citation
  • 10.

    Echizenya K, , Satoh M, & Murai H, et al: Mineralization and biodegradation of CSF shunting systems. J Neurosurg 67:584591, 1987 Echizenya K, Satoh M, Murai H, et al: Mineralization and biodegradation of CSF shunting systems. J Neurosurg 67:584–591, 1987

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Elisevitch K, , Mattar AG, & Cheeseman F: Biodegradation of distal shunt catheters. Pediatr Neurosurg 21:7176, 1994 Elisevitch K, Mattar AG, Cheeseman F: Biodegradation of distal shunt catheters. Pediatr Neurosurg 21:71–76, 1994

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Epstein F: How to keep shunts functioning, or “the impossible dream.” Clin Neurosurg 32:608631, 1985 Epstein F: How to keep shunts functioning, or “the impossible dream.” Clin Neurosurg 32:608–631, 1985

    • Search Google Scholar
    • Export Citation
  • 13.

    Goldblum RM, , Pelley RP, & O'Donell AA, et al: Antibodies to silicone elastomers and reactions to ventriculoperitoneal shunts. Lancet 340:510513, 1992 Goldblum RM, Pelley RP, O'Donell AA, et al: Antibodies to silicone elastomers and reactions to ventriculoperitoneal shunts. Lancet 340:510–513, 1992

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Gower DJ, , Lewis JC, & Kelly DL Jr: Sterile shunt malfunction. A scanning electron microscopic perspective. J Neurosurg 61:10791084, 1984 Gower DJ, Lewis JC, Kelly DL Jr: Sterile shunt malfunction. A scanning electron microscopic perspective. J Neurosurg 61:1079–1084, 1984

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Griebel R, , Khan M, & Tan L: CSF shunt complications: an analysis of contributory factors. Childs Nerv Syst 1:7780, 1985 Griebel R, Khan M, Tan L: CSF shunt complications: an analysis of contributory factors. Childs Nerv Syst 1:77–80, 1985

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Griebel RW, , Hoffman HJ, & Becker L: Calcium deposits on CSF shunts. Clinical observations and ultrastructural analysis. Childs Nerv Syst 3:180182, 1987 Griebel RW, Hoffman HJ, Becker L: Calcium deposits on CSF shunts. Clinical observations and ultrastructural analysis. Childs Nerv Syst 3:180–182, 1987

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Harasaki H, , McMahon J, & Richards T, et al: Calcification in cardiovascular implants: degraded cell related phenomena. Trans Am Soc Artif Intern Org 31:489494, 1985 Harasaki H, McMahon J, Richards T, et al: Calcification in cardiovascular implants: degraded cell related phenomena. Trans Am Soc Artif Intern Org 31:489–494, 1985

    • Search Google Scholar
    • Export Citation
  • 18.

    Harasaki H, , Moritz A, & Uchida N, et al: Initiation and growth of calcification in a polyurethane-coated blood pump. Trans Am Soc Artif Intern Org 33:643649, 1987 Harasaki H, Moritz A, Uchida N, et al: Initiation and growth of calcification in a polyurethane-coated blood pump. Trans Am Soc Artif Intern Org 33:643–649, 1987

    • Search Google Scholar
    • Export Citation
  • 19.

    Heggers JP, , Kossovsky N, & Parsons RW, et al: Biocompatibility of silicone implants. Ann Plast Surg 11:3845, 1983 Heggers JP, Kossovsky N, Parsons RW, et al: Biocompatibility of silicone implants. Ann Plast Surg 11:38–45, 1983

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Hermelin E: Etude de la Calcification de Cathéters en Silicone Implantables. Thesis. Paris: Université Paris VI, 1995 Hermelin E: Etude de la Calcification de Cathéters en Silicone Implantables. Thesis. Paris: Université Paris VI, 1995

    • Search Google Scholar
    • Export Citation
  • 21.

    Khan SR, & Wilkinson EJ: Scanning electron microscopy, X-ray diffraction and electron microprobe analysis of calcific deposits on intrauterine contraceptive devices. Hum Pathol 16:732738, 1985 Khan SR, Wilkinson EJ: Scanning electron microscopy, X-ray diffraction and electron microprobe analysis of calcific deposits on intrauterine contraceptive devices. Hum Pathol 16:732–738, 1985

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Koga H, , Mukawa J, & Nakata M, et al: Analysis of retained ventricular shunt catheters. Neurol Med Chir 32:824828, 1992 Koga H, Mukawa J, Nakata M, et al: Analysis of retained ventricular shunt catheters. Neurol Med Chir 32:824–828, 1992

    • Search Google Scholar
    • Export Citation
  • 23.

    Kronenthal RL: Biodegradable polymers in medicine and surgery, in Kronenthal RL, , Oser Z, & Martin E (eds): Polymers in Medicine and Surgery. New York: Plenum Press, 1975, pp 119137 Kronenthal RL: Biodegradable polymers in medicine and surgery, in Kronenthal RL, Oser Z, Martin E (eds): Polymers in Medicine and Surgery. New York: Plenum Press, 1975, pp 119–137

    • Search Google Scholar
    • Export Citation
  • 24.

    Langmoen IA, , Lundar T, & Vatne K, et al: Occurrence and management of fractured peripheral catheters in CSF shunts. Childs Nerv Syst 8:222225, 1992 Langmoen IA, Lundar T, Vatne K, et al: Occurrence and management of fractured peripheral catheters in CSF shunts. Childs Nerv Syst 8:222–225, 1992

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Li P, , Nakanishi K, & Kokubo T, et al: Induction and morphology of hydroxyapatite precipitated from metastable simulated body fluid on sol-gel prepared silica. Biomaterials 14:963968, 1994 Li P, Nakanishi K, Kokubo T, et al: Induction and morphology of hydroxyapatite precipitated from metastable simulated body fluid on sol-gel prepared silica. Biomaterials 14:963–968, 1994

    • Search Google Scholar
    • Export Citation
  • 26.

    Lian JB, , Levy RJ, & Bernhard W, et al: LVAD mineralization and γ-carboxyglutamic acid containing proteins in normal and pathologically mineralized tissues. Trans Am Soc Artif Intern Org 27:683689, 1981 Lian JB, Levy RJ, Bernhard W, et al: LVAD mineralization and γ-carboxyglutamic acid containing proteins in normal and pathologically mineralized tissues. Trans Am Soc Artif Intern Org 27:683–689, 1981

    • Search Google Scholar
    • Export Citation
  • 27.

    Nosé Y, , Harasaki H, & Murray J: Mineralization of artificial surfaces that contact blood. Trans Am Soc Artif Intern Org 27:714719, 1981 Nosé Y, Harasaki H, Murray J: Mineralization of artificial surfaces that contact blood. Trans Am Soc Artif Intern Org 27:714–719, 1981

    • Search Google Scholar
    • Export Citation
  • 28.

    Olsen L, & Frykberg T: Complications in the treatment of hydrocephalus in children. A comparison of ventriculoatrial and ventriculoperitoneal shunts in a 20-year material. Acta Paediatr Scand 72:385390, 1983 Olsen L, Frykberg T: Complications in the treatment of hydrocephalus in children. A comparison of ventriculoatrial and ventriculoperitoneal shunts in a 20-year material. Acta Paediatr Scand 72:385–390, 1983

    • Search Google Scholar
    • Export Citation
  • 29.

    Piatt JH Jr, & Carlson CV: A search for determinants of cerebrospinal fluid shunt survival: retrospective analysis of a 14-year institutional experience. Pediatr Neurosurg 19:233242, 1993 Piatt JH Jr, Carlson CV: A search for determinants of cerebrospinal fluid shunt survival: retrospective analysis of a 14-year institutional experience. Pediatr Neurosurg 19:233–242, 1993

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Ramsey DB, & Chadduck WM: Premature fractures of platinum-cured Silastic shunts. Childs Nerv Syst 8:406410, 1992 Ramsey DB, Chadduck WM: Premature fractures of platinum-cured Silastic shunts. Childs Nerv Syst 8:406–410, 1992

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Sainte-Rose C, , Hooven MD, & Hirsch JF: A new approach in the treatment of hydrocephalus. J Neurosurg 66:213226, 1987 Sainte-Rose C, Hooven MD, Hirsch JF: A new approach in the treatment of hydrocephalus. J Neurosurg 66:213–226, 1987

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Sainte-Rose C, , Piatt JH, & Renier D, et al: Mechanical complications in shunts. Pediatr Neurosurg 17:29, 1991/92 Sainte-Rose C, Piatt JH, Renier D, et al: Mechanical complications in shunts. Pediatr Neurosurg 17:2–9, 1991/92

    • Search Google Scholar
    • Export Citation
  • 33.

    Sayers MP: Shunt complications. Clin Neurosurg 23:393400, 1976 Sayers MP: Shunt complications. Clin Neurosurg 23:393–400, 1976

  • 34.

    Schoen FJ, , Harasaki H, & Kim KM, et al: Biomaterial-associated calcification: pathology, mechanisms, and strategies for prevention. J Biomed Mat Res 22 (Suppl 1):1136, 1988 Schoen FJ, Harasaki H, Kim KM, et al: Biomaterial-associated calcification: pathology, mechanisms, and strategies for prevention. J Biomed Mat Res 22 (Suppl 1):11–36, 1988

    • Search Google Scholar
    • Export Citation
  • 35.

    Sekhar LN, , Moossy J, & Guthkelch N: Malfunctioning ventriculoperitoneal shunts. Clinical and pathological features. J Neurosurg 56:411416, 1982 Sekhar LN, Moossy J, Guthkelch N: Malfunctioning ventriculoperitoneal shunts. Clinical and pathological features. J Neurosurg 56:411–416, 1982

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Shimotake K, , Kondo A, & Aoyama I, et al: Calcification of a ventriculoperitoneal shunt tube. Case report. Surg Neurol 30:156158, 1988 Shimotake K, Kondo A, Aoyama I, et al: Calcification of a ventriculoperitoneal shunt tube. Case report. Surg Neurol 30:156–158, 1988

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Sugar O, & Bailey OT: Subcutaneous reaction to silicone in ventriculoperitoneal shunts. Long-term results. J Neurosurg 41:367371, 1974 Sugar O, Bailey OT: Subcutaneous reaction to silicone in ventriculoperitoneal shunts. Long-term results. J Neurosurg 41:367–371, 1974

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Thubrikar MJ, , Deck JD, & Aouad J, et al: Role of mechanical stress in calcification of aortic bioprosthetic valves. J Thorac Cardiovasc Surg 86:115125, 1983 Thubrikar MJ, Deck JD, Aouad J, et al: Role of mechanical stress in calcification of aortic bioprosthetic valves. J Thorac Cardiovasc Surg 86:115–125, 1983

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Unuma H, , Ito K, & Ota T, et al: Precipitation of hydroxyapatite under stearic acid monolayers. J Am Ceram Soc 79:24742476, 1996 Unuma H, Ito K, Ota T, et al: Precipitation of hydroxyapatite under stearic acid monolayers. J Am Ceram Soc 79:2474–2476, 1996

    • Search Google Scholar
    • Export Citation
  • 40.

    Woodward SC: Mineralization of connective tissue surrounding implanted devices. Trans Am Soc Artif Intern Org 27:697702, 1981 Woodward SC: Mineralization of connective tissue surrounding implanted devices. Trans Am Soc Artif Intern Org 27:697–702, 1981

    • Search Google Scholar
    • Export Citation
  • 41.

    Zhao OH, , Anderson JM, & Hiltner A, et al: Theoretical analysis on cell size distribution and kinetics of foreign-body giant cell formation in vivo on polyurethane elastomers. J Biomed Mat Res 26:10191038, 1992 Zhao OH, Anderson JM, Hiltner A, et al: Theoretical analysis on cell size distribution and kinetics of foreign-body giant cell formation in vivo on polyurethane elastomers. J Biomed Mat Res 26:1019–1038, 1992

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1036 230 20
Full Text Views 210 30 0
PDF Downloads 187 39 1
EPUB Downloads 0 0 0