1 / 9

Research Update

Research Update. Sukhi Basati Director: Andreas Linninger LPPD Lab Meeting 10/2010. Historical Research in HC. Leonardo DaVinci accurately drew the ventricular system in 1510. Key and Retzius used India Ink for anatomy examinations in 1875.

abner
Télécharger la présentation

Research Update

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Research Update Sukhi Basati Director: Andreas Linninger LPPD Lab Meeting 10/2010 LPPD

  2. Historical Research in HC Leonardo DaVinci accurately drew the ventricular system in 1510. Key and Retzius used India Ink for anatomy examinations in 1875. Kellie-Monro Doctrine  1783 Monro proposed that an increase in volume of blood, brain, or CSF will lead to an increase in ICP. Thus if one of these elements increases in volume, the other two must decrease. In 1824 Kellie confirmed this. Occlusion of the aqueduct via cotton swabs to produce occlusive hydrocephalus by Dandy and Blackfan in 1913. Dandy 1919 Conducted experiments on dogs and verified CSF production sites. Bering 1955 Dog experiments concluded that Choroid Plexus was central in CSF formation. By removing a choroid plexus from one lateral ventricle and creating communicating hydrocephalus he observed that ventricle dilation occurred only with the intact choroid plexus.

  3. Historical Research in HC Hakim 1976  proposed an important model of the brain as a sponge, postulating that large transmural pressure differences between the SAS and ventricles cause ventricular enlargement by squeezing water out of the brain parenchyma. Di Rocco 1978  Injected balloons into brains of lambs to obtain CSF dynamic parameters. DelBigio and Bruni 1988  observed collapse of capillaries following hydrocephalus, and found a decrease in cerebral blood flow following long term hydrocephalus. Greitz 1993  Observed timing of CSF pulse with arterial systolic pulse. Enzmann and Pelc 1993  established the temporal and quantitative relationship between blood flow and CSF flow using cine MRI. Pickard and Pena 2004  quantified decrease in cerebral blood flow via PET scans in patients with communicating hydrocephalus.

  4. Paper Review: Aging Impact on Brain Biomechanics with Applications to Hydrocephalus K.P. Wilkie, C.S. Drapaca, S. Sivaloganathan Mathematical medicine and biology Summary: The authors determine displacement of tissue using age-dependent shear complex modulus data. Methods: They input modulus data from another author into their model to calculate the steady-state elastic modulus. Model parameter values are used to numerically simulate brain with pulsatile ventricular pressure. Results: increases from infant value of 621 Pa to young adult of 955 Pa and then it decreases with age. They suggest the low steady-state elastic modulus of infant brain (and older brains) increases susceptibility to large deformations and thus ventricular expansion.

  5. Results: Maximum displacement in normal case due to pulse Infants = 3 mm Adults = 48 nm HC case:

  6. Boundary condition modification for infant case: • Infant skull povides 40 – 50% of the resistive force that the adult skull provides • modified it to 85 % later on to match experimental observations

  7. Hospital care for children with hydrocephalus in the United States: utilization, charges, comorbidies, and deaths Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus Simon et. Al 2008. J. Neurosurg Pediatrics • For each year in 1997, 2000, 2003 there were 38,000-40,000 admissions, ~400,000 hospital days, and total hospital charges of $1.4 – 2.0 billion • accounts for 3.1% of all pediatric hospital charges J. M. Drake et. Al. Neurosurgery, 1998. • Patients received one of 3 valves: • Standard differential pressure valve • Delta valve (Medtronic) includes siphon-control • Orbis-Sigma valve (Cordis) with a variable resistance component One hundred-fifty patients reached an endpoint; shunt obstruction occurred in 108 (31.4%), overdrainage in 12 (3.5%), loculated ventricles in 2(0.6%), and infection in 28 (8.1%). Sixty-one percent were shunt failure-free at 1 year and 47% at 2 years, with a median shunt failure-free duration of 656 days. Results: Treatment

  8. Coagulation? Perforation holes in ventricular catheters – is less more? U. Thomale et. Al 2010. Childs Nerv Syst. Occlusion is almost guaranteed in patients with slit ventricles

  9. Goals for next few weeks: Proposal! Fix Literature Database Set up anesthesia on west side Induce HC at UIC LPPD 10/2010

More Related