First-in-Human Experience With Integration of a Hydrocephalus Shunt Device Within a Customized Cranial Implant

Chad R. Gordon, Amir Wolff, Gabriel F. Santiago, Kenneth Liebman, Erol Veznedaroglu, Frank D. Vrionis, Judy Huang, Henry Brem, Mark Luciano

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Implantable shunt devices are critical and life saving for hydrocephalus patients. However, these devices are fraught with high complication rates including scalp dehiscence, exposure, and extrusion. In fact, high shunt valve profiles are correlated with increased complications compared to those with lower profiles. As such, we sought a new method for integrating shunt valves for those challenging patients presenting with scalp-related complications. OBJECTIVE: To safely implant and integrate a hydrocephalus shunt valve device within a customized cranial implant, in an effort to limit its high-profile nature as a main contributor to shunt failure and scalp breakdown, and at the same time, improve patient satisfaction by preventing contour deformity. METHODS: A 64-yr-old male presented with an extruding hydrocephalus shunt valve and chronic, open scalp wound. The shunt valve was removed and temporary shunt externalization was performed. He received 2 wk of culture-directed antibiotics. Next, a contralateral craniectomy was performed allowing a new shunt valve system to be implanted within a low-profile, customized cranial implant. All efforts were made, at the patient's request, to decrease the high-profile nature of the shunt valve contributing to his most recent complication. RESULTS: First-in-human implantation was performed without complication. Postoperative shunt identification and programming was uncomplicated. The high-profile nature of the shunt valve was decreased by 87%. At 10 mo, the patient has experienced no complications and is extremely satisfied with his appearance. CONCLUSION: This first-in-human experience suggests that a high-profile hydrocephalus shunt device may be safely integrated within a customized cranial implant.

Original languageEnglish (US)
Pages (from-to)608-615
Number of pages8
JournalOperative neurosurgery (Hagerstown, Md.)
Volume17
Issue number6
DOIs
StatePublished - Dec 1 2019

Fingerprint

Hydrocephalus
Scalp
Equipment and Supplies
Patient Satisfaction
Anti-Bacterial Agents
Wounds and Injuries

Keywords

  • Cranial implant
  • Cranioplasty
  • Hydrocephalus shunt
  • Implant extrusion
  • Scalp wound
  • Shunt complication
  • Ventriculoperitoneal shunt

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

First-in-Human Experience With Integration of a Hydrocephalus Shunt Device Within a Customized Cranial Implant. / Gordon, Chad R.; Wolff, Amir; Santiago, Gabriel F.; Liebman, Kenneth; Veznedaroglu, Erol; Vrionis, Frank D.; Huang, Judy; Brem, Henry; Luciano, Mark.

In: Operative neurosurgery (Hagerstown, Md.), Vol. 17, No. 6, 01.12.2019, p. 608-615.

Research output: Contribution to journalArticle

Gordon, Chad R. ; Wolff, Amir ; Santiago, Gabriel F. ; Liebman, Kenneth ; Veznedaroglu, Erol ; Vrionis, Frank D. ; Huang, Judy ; Brem, Henry ; Luciano, Mark. / First-in-Human Experience With Integration of a Hydrocephalus Shunt Device Within a Customized Cranial Implant. In: Operative neurosurgery (Hagerstown, Md.). 2019 ; Vol. 17, No. 6. pp. 608-615.
@article{33494fc10a9d48c181ddcafed0abdab7,
title = "First-in-Human Experience With Integration of a Hydrocephalus Shunt Device Within a Customized Cranial Implant",
abstract = "BACKGROUND: Implantable shunt devices are critical and life saving for hydrocephalus patients. However, these devices are fraught with high complication rates including scalp dehiscence, exposure, and extrusion. In fact, high shunt valve profiles are correlated with increased complications compared to those with lower profiles. As such, we sought a new method for integrating shunt valves for those challenging patients presenting with scalp-related complications. OBJECTIVE: To safely implant and integrate a hydrocephalus shunt valve device within a customized cranial implant, in an effort to limit its high-profile nature as a main contributor to shunt failure and scalp breakdown, and at the same time, improve patient satisfaction by preventing contour deformity. METHODS: A 64-yr-old male presented with an extruding hydrocephalus shunt valve and chronic, open scalp wound. The shunt valve was removed and temporary shunt externalization was performed. He received 2 wk of culture-directed antibiotics. Next, a contralateral craniectomy was performed allowing a new shunt valve system to be implanted within a low-profile, customized cranial implant. All efforts were made, at the patient's request, to decrease the high-profile nature of the shunt valve contributing to his most recent complication. RESULTS: First-in-human implantation was performed without complication. Postoperative shunt identification and programming was uncomplicated. The high-profile nature of the shunt valve was decreased by 87{\%}. At 10 mo, the patient has experienced no complications and is extremely satisfied with his appearance. CONCLUSION: This first-in-human experience suggests that a high-profile hydrocephalus shunt device may be safely integrated within a customized cranial implant.",
keywords = "Cranial implant, Cranioplasty, Hydrocephalus shunt, Implant extrusion, Scalp wound, Shunt complication, Ventriculoperitoneal shunt",
author = "Gordon, {Chad R.} and Amir Wolff and Santiago, {Gabriel F.} and Kenneth Liebman and Erol Veznedaroglu and Vrionis, {Frank D.} and Judy Huang and Henry Brem and Mark Luciano",
year = "2019",
month = "12",
day = "1",
doi = "10.1093/ons/opz003",
language = "English (US)",
volume = "17",
pages = "608--615",
journal = "Operative Neurosurgery",
issn = "2332-4252",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - First-in-Human Experience With Integration of a Hydrocephalus Shunt Device Within a Customized Cranial Implant

AU - Gordon, Chad R.

AU - Wolff, Amir

AU - Santiago, Gabriel F.

AU - Liebman, Kenneth

AU - Veznedaroglu, Erol

AU - Vrionis, Frank D.

AU - Huang, Judy

AU - Brem, Henry

AU - Luciano, Mark

PY - 2019/12/1

Y1 - 2019/12/1

N2 - BACKGROUND: Implantable shunt devices are critical and life saving for hydrocephalus patients. However, these devices are fraught with high complication rates including scalp dehiscence, exposure, and extrusion. In fact, high shunt valve profiles are correlated with increased complications compared to those with lower profiles. As such, we sought a new method for integrating shunt valves for those challenging patients presenting with scalp-related complications. OBJECTIVE: To safely implant and integrate a hydrocephalus shunt valve device within a customized cranial implant, in an effort to limit its high-profile nature as a main contributor to shunt failure and scalp breakdown, and at the same time, improve patient satisfaction by preventing contour deformity. METHODS: A 64-yr-old male presented with an extruding hydrocephalus shunt valve and chronic, open scalp wound. The shunt valve was removed and temporary shunt externalization was performed. He received 2 wk of culture-directed antibiotics. Next, a contralateral craniectomy was performed allowing a new shunt valve system to be implanted within a low-profile, customized cranial implant. All efforts were made, at the patient's request, to decrease the high-profile nature of the shunt valve contributing to his most recent complication. RESULTS: First-in-human implantation was performed without complication. Postoperative shunt identification and programming was uncomplicated. The high-profile nature of the shunt valve was decreased by 87%. At 10 mo, the patient has experienced no complications and is extremely satisfied with his appearance. CONCLUSION: This first-in-human experience suggests that a high-profile hydrocephalus shunt device may be safely integrated within a customized cranial implant.

AB - BACKGROUND: Implantable shunt devices are critical and life saving for hydrocephalus patients. However, these devices are fraught with high complication rates including scalp dehiscence, exposure, and extrusion. In fact, high shunt valve profiles are correlated with increased complications compared to those with lower profiles. As such, we sought a new method for integrating shunt valves for those challenging patients presenting with scalp-related complications. OBJECTIVE: To safely implant and integrate a hydrocephalus shunt valve device within a customized cranial implant, in an effort to limit its high-profile nature as a main contributor to shunt failure and scalp breakdown, and at the same time, improve patient satisfaction by preventing contour deformity. METHODS: A 64-yr-old male presented with an extruding hydrocephalus shunt valve and chronic, open scalp wound. The shunt valve was removed and temporary shunt externalization was performed. He received 2 wk of culture-directed antibiotics. Next, a contralateral craniectomy was performed allowing a new shunt valve system to be implanted within a low-profile, customized cranial implant. All efforts were made, at the patient's request, to decrease the high-profile nature of the shunt valve contributing to his most recent complication. RESULTS: First-in-human implantation was performed without complication. Postoperative shunt identification and programming was uncomplicated. The high-profile nature of the shunt valve was decreased by 87%. At 10 mo, the patient has experienced no complications and is extremely satisfied with his appearance. CONCLUSION: This first-in-human experience suggests that a high-profile hydrocephalus shunt device may be safely integrated within a customized cranial implant.

KW - Cranial implant

KW - Cranioplasty

KW - Hydrocephalus shunt

KW - Implant extrusion

KW - Scalp wound

KW - Shunt complication

KW - Ventriculoperitoneal shunt

UR - http://www.scopus.com/inward/record.url?scp=85075044872&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85075044872&partnerID=8YFLogxK

U2 - 10.1093/ons/opz003

DO - 10.1093/ons/opz003

M3 - Article

C2 - 30753624

AN - SCOPUS:85075044872

VL - 17

SP - 608

EP - 615

JO - Operative Neurosurgery

JF - Operative Neurosurgery

SN - 2332-4252

IS - 6

ER -