@article{332ff684c810422cb15f97198fc4536d,
title = "A multicenter retrospective study of heterogeneous tissue aggregates obstructing ventricular catheters explanted from patients with hydrocephalus",
abstract = "Background: Implantation of ventricular catheters (VCs) to drain cerebrospinal fluid (CSF) is a standard approach to treat hydrocephalus. VCs fail frequently due to tissue obstructing the lumen via the drainage holes. Mechanisms driving obstruction are poorly understood. This study aimed to characterize the histological features of VC obstructions and identify links to clinical factors. Methods: 343 VCs with relevant clinical data were collected from five centers. Each hole on the VCs was classified by degree of tissue obstruction after macroscopic analysis. A subgroup of 54 samples was analyzed using immunofluorescent labelling, histology and immunohistochemistry. Results: 61.5% of the 343 VCs analyzed had tissue aggregates occluding at least one hole (n = 211) however the vast majority of the holes (70%) showed no tissue aggregates. Mean age at which patients with occluded VCs had their first surgeries (3.25 yrs) was lower than in patients with non-occluded VCs (5.29 yrs, p < 0.02). Mean length of time of implantation of occluded VCs, 33.22 months was greater than for non-occluded VCs, 23.8 months (p = 0.02). Patients with myelomeningocele had a greater probability of having an occluded VC (p = 0.0426). VCs with occlusions had greater numbers of macrophages and astrocytes in comparison to non-occluded VCs (p < 0.01). Microglia comprised only 2–6% of the VC-obstructing tissue aggregates. Histologic analysis showed choroid plexus occlusion in 24%, vascularized glial tissue occlusion in 24%, prevalent lymphocytic inflammation in 29%, and foreign body giant cell reactions in 5% and no ependyma. Conclusion: Our data show that age of the first surgery and length of time a VC is implanted are factors that influence the degree of VC obstruction. The tissue aggregates obstructing VCs are composed predominantly of astrocytes and macrophages; microglia have a relatively small presence.",
keywords = "Biobank, Hydrocephalus, Multicenter, Retrospective cohort, Shunt failure, Shunt obstruction, Surgical outcomes, Ventriculoperitoneal shunt",
author = "Prashant Hariharan and Jeffrey Sondheimer and Alexandra Petroj and Jacob Gluski and Andrew Jea and Whitehead, {William E.} and Sandeep Sood and Ham, {Steven D.} and Rocque, {Brandon G.} and Marupudi, {Neena I.} and McAllister, {James P.} and David Limbrick and {Del Bigio}, {Marc R.} and Harris, {Carolyn A.}",
note = "Funding Information: We would like to acknowledge Scott Millis of the Biostatistics and Epidemiology Research Design core for his contribution to the statistical analysis and Charles McDonnell, Kevin Zheng, Christine Dinh for their help with image collection and Mariana Sierra for helping maintain samples in the biobank. Xiaoyan Mao and Susan Janeczko helped with catheter histology and immunohistochemistry. Additionally, we would like to thank the surgeons and their teams at each institution. We appreciate the intellectual collaboration and continued IRB support from Eric Jackson (JHU). Research reported in this publication was supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under award number R01NS094570. Approximately 90% of this project was financed with federal dollars. Additional funds came from the Children's Hospital of Michigan Schotanus funds. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funding Information: We would like to acknowledge Scott Millis of the Biostatistics and Epidemiology Research Design core for his contribution to the statistical analysis and Charles McDonnell, Kevin Zheng, Christine Dinh for their help with image collection and Mariana Sierra for helping maintain samples in the biobank. Xiaoyan Mao and Susan Janeczko helped with catheter histology and immunohistochemistry. Additionally, we would like to thank the surgeons and their teams at each institution. We appreciate the intellectual collaboration and continued IRB support from Eric Jackson (JHU). Research reported in this publication was supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under award number R01NS094570. Approximately 90% of this project was financed with federal dollars. Additional funds came from the Children's Hospital of Michigan Schotanus funds. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: {\textcopyright} 2021, The Author(s).",
year = "2021",
month = dec,
doi = "10.1186/s12987-021-00262-3",
language = "English",
volume = "18",
journal = "Fluids and Barriers of the CNS",
issn = "2045-8118",
number = "1",
}