title: Initial experience with silver-impregnated polyurethane ventricular catheter for shunting of cerebrospinal fluid in patients with infected hydrocephalus.
abstract: OBJECTIVE
  Infection is a major complication and risk factor of cerebrospinal fluid (CSF) shunting procedures. Recently, antibiotic-impregnated shunt systems have been developed in an attempt to prevent or reduce the CSF infection. The aim of this study was to determine the efficacy of silver-impregnated polyurethane ventricular catheter for shunting of CSF in patients with infected hydrocephalus.
  
  
  METHODS
  Seven patients who had hydrocephalus with high protein level and positive CSF culture underwent implantation of ventriculoperitoneal shunt with silver-impregnated polyurethane ventricular catheter. All of them experienced shunt failure previously due to infection. The Silverline ventricular catheter, which was connected to the Miethke gravity-assisted valve system and peritoneal catheter, was used in all patients. The mean follow-up period after operation was 14 months. Cerebrospinal fluid samples from the reservoir of the shunts were obtained at the end of the third month after operation in all patients.
  
  
  RESULTS
  The CSF protein level of the patients was reduced significantly, and the CSF culture became negative after shunt placement with silver-impregnated polyurethane ventricular catheters. The mean CSF silver (Ag) level was 0.51 ng/ml [parts per billion (ppb)], and blood Ag level was 3.65 ng/ml (ppb) at the first month after operation. No shunt obstruction or infection was observed in the follow-up period.
  
  
  CONCLUSIONS
  Silver-impregnated polyurethane ventricular catheters appear to be safe and well tolerated in patients who sustained infected hydrocephalus. Preliminary results suggest a complete improvement of infection. Longer follow-up and large number of patients are needed to more accurately assess the efficacy of these catheters.
authors.affiliation: Department of Neurosurgery, Gulhane Military Medical Academy, Ankara, Turkey. yusufizci@yahoo.com
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Izci
authors.forename: Halilibrahim
authors.initials: H
authors.lastname: Secer
authors.forename: Cemal
authors.initials: C
authors.lastname: Akay
authors.forename: Engin
authors.initials: E
authors.lastname: Gonul
mesh_terms: D000293:Adolescent; D000328:Adult; D055499:Catheter-Related Infections / Q000150:complications* / Q000517:prevention & control*; D002408:Catheters, Indwelling; D002556:Cerebrospinal Fluid Proteins / Q000134:cerebrospinal fluid; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005947:Glucose / Q000134:cerebrospinal fluid; D006801:Humans; D006849:Hydrocephalus / Q000134:cerebrospinal fluid / Q000150:complications* / Q000601:surgery*; D007223:Infant; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012834:Silver / Q000008:administration & dosage* / Q000097:blood / Q000134:cerebrospinal fluid / Q000652:urine; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects* / Q000379:methods*
chemical_list: D002556:Cerebrospinal Fluid Proteins; D012834:Silver; D005947:Glucose