title: A model of in-vivo hydrocephalus shunt dynamics for blockage and performance diagnostics.
abstract: The accumulation of excess cerebrospinal fluid in the ventricles of the brain results in hydrocephalus, a condition that is fatal if left untreated. The usual remedy is to insert a shunt into the ventricles of the brain, which drains excess fluid away, moderated by a pressure dependent valve. It is important that the system functions properly so that a reasonable intracranial pressure is maintained. Unfortunately, pressure measurements in the ventricles are highly invasive, while pressure measurements in the shunt outside the skull may not detect any blockage in the catheter inside. Here we develop a model primarily aimed at detecting in vivo a blockage and other shunt malfunction using non-invasive measurements, so that shunt valves can be adjusted accordingly. The system offers a clear insight into how currently available clinical measurements may be utilized. We then extend this to investigate the phenomenon of 'chatter' (rapid opening and closing) and other mechanisms including intracranial pressure pulsatility. Although simple, the model offers a clear indication of what is required for successful regulation of both intracranial pressure and shunt flow.
authors.affiliation: Department of Medical Physics and Bioengineering, Southampton General Hospital, Southampton, Hampshire. SO16 6YD, UK.
authors.forename: D
authors.initials: D
authors.lastname: Schley
authors.forename: J
authors.initials: J
authors.lastname: Billingham
authors.forename: R J
authors.initials: RJ
authors.lastname: Marchbanks
mesh_terms: D002552:Cerebral Ventricles / Q000502:physiology; D015170:Cerebrospinal Fluid Pressure; D002557:Cerebrospinal Fluid Shunts / Q000592:standards*; D004868:Equipment Failure; D006801:Humans; D006849:Hydrocephalus / Q000134:cerebrospinal fluid / Q000601:surgery*; D008954:Models, Biological