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SmartShunt - The Hydrocephalus Project

English title SmartShunt - The Hydrocephalus Project
Applicant Kurtcuoglu Vartan
Number 120531
Funding scheme Interdisciplinary projects
Research institution Institut für Energietechnik ETH Zürich
Institution of higher education ETH Zurich - ETHZ
Main discipline Clinical Pathophysiology
Start/End 01.09.2008 - 31.08.2012
Approved amount 866'375.00
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All Disciplines (12)

Discipline
Clinical Pathophysiology
Fluid Dynamics
Experimental Microbiology
Organic Chemistry
Mechanical Engineering
Clinical Immunology and Immunopathology
Surgery
Technical Physics
Other disciplines of Engineering Sciences
Neurophysiology and Brain Research
Biomedical Engineering
Material Sciences

Keywords (17)

Normal Pressure Hydrocephalus; Magnetic Resonance Imaging; Cerebrospinal Fluid; CSF Shunt; Shunt Infection; Computational Fluid Dynamics; Brain Mechanics; Control System; Biofilm; Bacterial Adhesion; Infection Prevention; Hydrogel; Surface Coating; Finite Element Method; Fluid-Structure Interaction; Porous Media; Intracranial Dynamics

Lay Summary (English)

Lead
Lay summary
This project aims at conducting the basic research necessary for the subsequent development of a smart cerebrospinal fluid drainage system for normal pressure hydrocephalus that addresses the key shortcomings of current drainage technology: infections, poor cerebrospinal fluid flow control and mechanical failure.

The term “normal pressure hydrocephalus” (NPH) describes a clinical entity consisting of the triad of walking disturbance, memory loss and urine incontinence, coupled with the findings of normal cerebrospinal fluid (CSF) pressure and enlarged brain ventricles. The preferred treatment for NPH is the continuous drainage of CSF from the brain ventricular space to the patient’s peritoneal space through an assembly of implanted catheters and a one-way differential pressure valve against overdrainage and CSF reflux. This assembly is referred to as “CSF shunt”. The mechanical failure rate of these CSF shunts is up to 40% within the first year of implantation and 4 to 5% in the subsequent years. The shunt infection rate is about 5%. As a consequence, roughly half of the treated patients require follow-up surgery within the first two years. Current shunts rely on differential-pressure valves to control CSF drainage. In most of them, the opening pressure cannot be changed after implantation. Patients with this standard type of valve often suffer from the symptoms of CSF over- or underdrainage.

We have developed a novel shunt concept that addresses all of the above problems. The envisioned shunt regulates CSF drainage using a smart control system, which analyzes the patient’s intracranial dynamics to determine the required outflow rate. Exposure of the cerebrospinal fluid to the surfaces of the shunt is minimized through an innovative design, thereby minimizing the adhesion area for pathogens and reducing the potential for infections. This design also reduces the number of moving parts that are in contact with the CSF, thus limiting the risk of mechanical failure.

Within this project, we will develop a computational model of the CSF spaces based on magnetic resonance imaging (MRI) data. This model will allow us to investigate the optimal control algorithm for the envisioned shunt. We will clinically investigate the shunt infection and surgical implantation process in order to optimize our innovative shunt design with respect to infections and mechanical failure. We will, finally, build a demonstrator and testing system, from which the envisioned shunt can be developed.
Direct link to Lay Summary Last update: 21.02.2013

Responsible applicant and co-applicants

Employees

Publications

Publication
Age-specific characteristics and coupling of cerebral arterial inflow and cerebrospinal fluid dynamics.
Schmid Daners Marianne, Knobloch Verena, Soellinger Michaela, Boesiger Peter, Seifert Burkhardt, Guzzella Lino, Kurtcuoglu Vartan (2012), Age-specific characteristics and coupling of cerebral arterial inflow and cerebrospinal fluid dynamics., in PloS one, 7(5), 37502-37502.
Craniospinal Pressure-Volume Dynamics in Phantom Models
Bottan Simone, Schmid Daners Marianne, Guzzella Lino, Poulikakos Dimos, Kurtcuoglu Vartan (2012), Craniospinal Pressure-Volume Dynamics in Phantom Models, in IEEE Transactions on Biomedical Engineering, 1-1.
Sparsity transform k-t principal component analysis for accelerating cine three-dimensional flow measurements
Knobloch Verena, Boesiger Peter, Kozerke Sebastian (2012), Sparsity transform k-t principal component analysis for accelerating cine three-dimensional flow measurements, in Magnetic Resonance in Medicine, 1-1.
Phantom model of physiologic intracranial pressure and cerebrospinal fluid dynamics.
Bottan Simone, Poulikakos Dimos, Kurtcuoglu Vartan (2012), Phantom model of physiologic intracranial pressure and cerebrospinal fluid dynamics., in IEEE Transactions on Biomedical Engineering, 59(6), 1532-8.
Bayesian multipoint velocity encoding for concurrent flow and turbulence mapping
Binter C, Knobloch V, Manka R, Sigfridsson A, Kozerke S (2012), Bayesian multipoint velocity encoding for concurrent flow and turbulence mapping, in Magnetic Resonance in Medicine, 1-1.
Comparison of Velocity Vector Fields and Turbulent Kinetic Energy Measured by MRI and Particle Tracking Velocimetry in a Realistic Aortic Phantom
Knobloch V, Binter C, Gulan U, Lüthi B, Boesiger P, Kozerke S (2012), Comparison of Velocity Vector Fields and Turbulent Kinetic Energy Measured by MRI and Particle Tracking Velocimetry in a Realistic Aortic Phantom, in Proceedings of the Annual Meeting of the International Society of Magnetic Resonance in Medicine, Melbourne, Australia.
Multi-Point Velocity Encoding for Simultaneous Assessment of Arterial, Venous and Cerebrospinal Flow
Knobloch V, Binter C, Boesiger P, Kozerke S (2012), Multi-Point Velocity Encoding for Simultaneous Assessment of Arterial, Venous and Cerebrospinal Flow, in Proceedings of the Annual Meeting of the International Society of Magnetic Resonance in Medicine, Melbourne, Australia.
Role of rifampin against propionibacterium acnes biofilm in vitro and in an experimental foreign-body infection model
Tafin UF, Corvec S, Betrisey B, Zimmerli W, Trampuz A (2012), Role of rifampin against propionibacterium acnes biofilm in vitro and in an experimental foreign-body infection model, in Antimicrobial Agents and Chemotherapy, 1-1.
Computational fluid dynamics for the assessment of cerebrospinal fluid flow and its coupling with cerebral blood flow
Kurtcuoglu V (2011), Computational fluid dynamics for the assessment of cerebrospinal fluid flow and its coupling with cerebral blood flow, in Miller K (ed.), Springer, New York, 169-187.
Gentamicin improves the activities of daptomycin and vancomycin against Enterococcus faecalis in vitro and in an experimental foreign-body infection model
Tafin UF, Majic I, Zalila CB, Betrisey B, Corvec S, Zimmerli W, Trampuz A (2011), Gentamicin improves the activities of daptomycin and vancomycin against Enterococcus faecalis in vitro and in an experimental foreign-body infection model, in Antimicrobial Agents and Chemotherapy, 55(10), 4821-4827.
Investigating the role of choroid plexus in CSF pulsation by combining in-vivo and post-mortem MRI
Bottan S, Fritz A, Kurtcuoglu V, Schmid Daners M, Knobloch V, Langkammer C, Krebs N, Gloor M, Scheurer E, Scheffler K, Ropele S, Boesiger P, Poulikakos D, Soellinger M (2011), Investigating the role of choroid plexus in CSF pulsation by combining in-vivo and post-mortem MRI, in Proceedings of the Annual Meeting of the International Society of Magnetic Resonance in Medicine , Montreal, CanadaInternational Society for Magnetic Resonance in Medicine, Berkeley, California, U.S.A..
Probabilistic streamline estimation from accelerated Fourier velocity encoded measurements
Knobloch V, Boesiger P, Kozerke S (2011), Probabilistic streamline estimation from accelerated Fourier velocity encoded measurements, in Proceedings of the Annual Meeting of the International Society of Magnetic Resonance in Medicine , Montreal, CanadaInternational Society for Magnetic Resonance in Medicine, Berkeley, California, U.S.A..
Cerebrospinal fluid dynamics in the human cranial subarachnoid space: an overlooked mediator of cerebral disease. I. Computational model.
Gupta Sumeet, Soellinger Michaela, Grzybowski Deborah M, Boesiger Peter, Biddiscombe John, Poulikakos Dimos, Kurtcuoglu Vartan (2010), Cerebrospinal fluid dynamics in the human cranial subarachnoid space: an overlooked mediator of cerebral disease. I. Computational model., in Journal of the Royal Society, Interface / the Royal Society, 7(49), 1195-204.
Cerebrospinal fluid dynamics in the human cranial subarachnoid space: an overlooked mediator of cerebral disease. II. In vitro arachnoid outflow model.
Holman David W, Kurtcuoglu Vartan, Grzybowski Deborah M (2010), Cerebrospinal fluid dynamics in the human cranial subarachnoid space: an overlooked mediator of cerebral disease. II. In vitro arachnoid outflow model., in Journal of the Royal Society, Interface / the Royal Society, 7(49), 1205-18.
Hadamard-transform k-t PCA for cine 3D velocity vector field mapping of carotid flow
Knobloch V, Giese D, Boesiger P, Kozerke S (2010), Hadamard-transform k-t PCA for cine 3D velocity vector field mapping of carotid flow, in Proceedings of the Annual Meeting of the International Society of Magnetic Resonance in Medicine , Stokholm, SwedenInternational Society for Magnetic Resonance in Medicine, Berkeley, California, U.S.A..
Investigation of ventricular cerebrospinal fluid flow phase differences between the foramina of Monro and the aqueduct of Sylvius
Schibli M, Wyss M, Boesiger P, Guzzella L (2009), Investigation of ventricular cerebrospinal fluid flow phase differences between the foramina of Monro and the aqueduct of Sylvius, in Biomedizinische Technik, 54(4), 161-169.
In vitro emergence of rifampin resistance in Propionibacterium acnes and molecular characterization of mutations in the rpoB gene
Furustrand Tafin U, Trampuz A, Corvec S, In vitro emergence of rifampin resistance in Propionibacterium acnes and molecular characterization of mutations in the rpoB gene, in Journal of Antimicrobial Chemotherapy.

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
First Cerebrospinal Fluid Hydrodynamics Symposium 08.07.2011 Zurich, Switzerland
Second European Congress on Microbial Films 06.07.2011 Copenhagen, Denmark
Second European Congress on Microbial Films 06.07.2011 Copenhagen, Denmark
6th World Congress of Biomechanics, Symposium on Cranial CSF Mechanics 01.08.2010 Singapore
The University of Western Australia, School of Mechanical and Chemical Engineering Seminar 27.07.2010 Perth, Australia
5th OpenFoam Workshop 21.06.2010 Gothenburg, Sweden


Self-organised

Title Date Place
First Cerebrospinal Fluid Hydrodynamics Symposium 08.07.2011 Zürich, Switzerland

Knowledge transfer events

Active participation

Title Type of contribution Date Place Persons involved
11th Psychoimmunology Expert Meeting 08.03.2012 Günzburg, Germany
First Meeting of the International Hydrocephalus Working Group 21.04.2011 Great Neck, New York, U.S.A.
The University of Western Australia, School of Mechanical and Chemical Engineering Seminar 27.07.2010 Perth, Australia


Awards

Title Year
Best Poster Award at the Annual Meeting of the Swiss Society for Infectious Diseases 2011

Associated projects

Number Title Start Funding scheme
100355 Beyond Vascular Anatomy: Hemodynamics in Neurovascular Imaging and Endovascular Therapy 01.10.2003 Project funding (Div. I-III)
112547 New approaches for diagnosis of implant-associated infections 01.06.2006 Project funding (Div. I-III)
116163 Multifunctional Antimicrobial Surfaces 01.04.2007 Project funding (Div. I-III)
114149 Neue antibakterielle Oberflächen auf Implantat- Materialien 01.10.2006 Project funding (Div. I-III)
112685 Role of wall stress in the pathogenesis of spontaneous dissection of the cervical carotid artery 01.02.2007 Project funding (Div. I-III)

Abstract

This multidisciplinary research project aims at conducting the basic research necessary for the subsequent development of a smart cerebrospinal fluid (CSF) shunt for normal pressure hydrocephalus (NPH) that addresses the key shortcomings of current shunt technology: infections, poor CSF flow control and mechanical failure.NPH is most commonly treated by the surgical placement of a ventriculoperitoneal shunt that drains CSF from the patient’s ventricular space to the peritoneal area. The mechanical failure rate of these shunts is up to 40% within the first year of implantation and 4 to 5% in the subsequent years. The shunt infection rate is about 5%. As a consequence, roughly half of the treated patients require follow-up surgery within the first two years.Current shunts rely on differential-pressure valves to control CSF drainage. In most of them, the opening pressure cannot be changed after implantation. Patients with this standard type of valve often suffer from the symptoms of CSF over- or underdrainage. Patients with externally adjustable valves return repeatedly to the neurosurgeon’s office for readjustment of the pressure setting, thereby considerably increasing the overall cost of the treatment.We have developed a novel shunt concept that addresses all of the above problems. The envisioned shunt regulates CSF drainage using an adaptive feedback control system that analyzes the patient’s intracranial dynamics to determine the required outflow rate, thereby addressing the experts’ call for a flow regulated rather than pressure regulated shunt. A single catheter with infection-inhibiting coating drains CSF from the ventricles to the peritoneal area. No other shunt elements are in contact with the cerebrospinal fluid, which reduces the risk of infection and mechanical failure.The funding requested in this proposal is aimed at financing the basic research that will subsequently enable the development of this smart shunt. The following tasks will be performed to this end:-Clinical multi-center study on explanted shunts to identify main infection pathways-Research and development of infection-inhibiting coating for the shunt-In-vitro and in-vivo testing of the developed coating-Research and development of MRI sequences for the non-invasive identification of NPH model parameters-Clinical external CSF drainage and MRI study on NPH patients to identify relevant NPH parameters-Research and development of analytical and computational NPH model-Research and development of feedback control algorithm for shunt valve control-Development of a functional model of the envisioned smart shunt-Development of a physical NPH phantom and test rig for testing of the smart shunt functional modelAll of the above tasks are intertwined and require the know-how of experts in their respective fields: the infection-inhibiting coating must not interfere with the sensors required for feedback control, the MRI sequence must allow for short scanning times to accommodate patients, yet must deliver accurate data for the NPH model and the clinical MRI study must provide the data necessary for the control algorithm design. This enmeshment of disciplines necessitates a multidisciplinary approach, without which the ultimate goal of providing the basis for the development of the smart shunt cannot be reached.The consortium convened for this project consists of partners from ETH Zurich with expertise in flow and mass transport in biofluids, control systems, computational modelling and surface science, the University of Zurich with expertise in MRI sequence design, the University Hospital Basel with expertise in neurosurgery, infectious diseases and neuroradiology, as well as the University of Western Australia with expertise in cerebral mechanics. Some of the project partners have successfully collaborated in the past, most recently in a related multidisciplinary project on CSF flow diagnostics and control.
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