{"doi":"10.3389/fbioe.2025.1591952","title":"Quantitative and qualitative investigation of shunt failure in an in vitro hemorrhagic hydrocephalus model","abstract":"Background Previous studies on posthemorrhagic hydrocephalus (PHH) reported notable shunt failure rates as high as 45.1% within the first six months of placement. Using the Automated, In Vitro Model for Hydrocephalus Research (AIMS), we investigated the impact of CSF-like diluted blood solution on ventricular catheters and external ventricular drains (EVD) using quantitative (flow and pressure measurements) and qualitative (real-time brightfield video capture) methods. Methods The shunt failure criteria were set at greater than or equal to 30 <mml:math xmlns:mml=\"http://www.w3.org/1998/Math/MathML\" id=\"m1\"><mml:mrow><mml:msub><mml:mrow><mml:mi>c</mml:mi><mml:mi>m</mml:mi><mml:mi>H</mml:mi></mml:mrow><mml:mn>2</mml:mn></mml:msub><mml:mi>O</mml:mi></mml:mrow></mml:math> such that the experiment was manually terminated if pressure surpassed 30 <mml:math xmlns:mml=\"http://www.w3.org/1998/Math/MathML\" id=\"m2\"><mml:mrow><mml:msub><mml:mrow><mml:mi>c</mml:mi><mml:mi>m</mml:mi><mml:mi>H</mml:mi></mml:mrow><mml:mn>2</mml:mn></mml:msub><mml:mi>O</mml:mi></mml:mrow></mml:math> differential pressure at any point within 24 h. To investigate our hypotheses, shunt failure was investigated in nine groups of catheters (n = 4 per group). Saline was utilized to dilute heparinized whole porcine blood to prepare blood-saline solutions at two concentrations of 0.05 and 0.5 volume percent (v/v%). The bulk input flow rate was set at 0.3 <mml:math xmlns:mml=\"http://www.w3.org/1998/Math/MathML\" id=\"m3\"><mml:mrow><mml:mfrac><mml:mrow><mml:mi>m</mml:mi><mml:mi>L</mml:mi></mml:mrow><mml:mi mathvariant=\"italic\">min</mml:mi></mml:mfrac></mml:mrow></mml:math> for all samples except where the flow rate was intentionally varied. The rate of pressure increase (pressurization rate) was used in all statistical analyses. Results Over 500 h of data were gathered without leaks or ruptures. There was a statistically significant difference in the pressurization rate across blood concentration groups ( P = 0.005 ). All the barium-impregnated and antibiotic-impregnated catheters reached 30 <mml:math xmlns:mml=\"http://www.w3.org/1998/Math/MathML\" id=\"m4\"><mml:mrow><mml:msub><mml:mrow><mml:mi>c</mml:mi><mml:mi>m</mml:mi><mml:mi>H</mml:mi></mml:mrow><mml:mn>2</mml:mn></mml:msub><mml:mi>O</mml:mi></mml:mrow></mml:math> threshold at 0.5% concentration. A statistically significant difference was observed in the pressurization rate ( P = 0.029 ). A more pronounced difference was observed between the antibiotic-impregnated ventricular catheters and antibiotic-impregnated EVDs. All four EVDs completed the 24-hour experiment and did not reach the pressure threshold ( P = 0.029 ). Conclusion A direct relationship was observed between blood concentration and the pressurization rate, such that shunts and EVDs that were exposed to higher concentrations of blood consistently reached 30 <mml:math xmlns:mml=\"http://www.w3.org/1998/Math/MathML\" id=\"m5\"><mml:mrow><mml:msub><mml:mrow><mml:mi>c</mml:mi><mml:mi>m</mml:mi><mml:mi>H</mml:mi></mml:mrow><mml:mn>2</mml:mn></mml:msub><mml:mi>O</mml:mi></mml:mrow></mml:math> threshold while the samples in the low-concentration groups did not. In contrast, a reverse relationship was observed between bulk flow rate and pressurization rate, such that the samples exposed to 0.5% at 0.7 <mml:math xmlns:mml=\"http://www.w3.org/1998/Math/MathML\" id=\"m6\"><mml:mrow><mml:mfrac><mml:mrow><mml:mi>m</mml:mi><mml:mi>L</mml:mi></mml:mrow><mml:mi mathvariant=\"italic\">min</mml:mi></mml:mfrac></mml:mrow></mml:math> had a significantly smaller pressurization rate than samples exposed to 0.5% at 0.3 <mml:math xmlns:mml=\"http://www.w3.org/1998/Math/MathML\" id=\"m7\"><mml:mrow><mml:mfrac><mml:mrow><mml:mi>m</mml:mi><mml:mi>L</mml:mi></mml:mrow><mml:mi mathvariant=\"italic\">min</mml:mi></mml:mfrac></mml:mrow></mml:math> ( P = 0.029 ). These findings highlight the role of clot formation in PHH shunt obstruction and suggest avenues for improved catheter design or clinical mana","journal":"Frontiers in Bioengineering and Biotechnology","year":2025,"id":569501,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9636,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":923652,"name":"Ahmad Faryami","orcid":"0000-0001-5117-6258","position":1,"is_corresponding":false},{"id":1474710,"name":"Ayman Suhrawardy","orcid":null,"position":2,"is_corresponding":false},{"id":510494,"name":"Carolyn A. Harris","orcid":"0000-0002-9700-7457","position":3,"is_corresponding":false},{"id":1270071,"name":"Shaheer Ajaz","orcid":null,"position":0,"is_corresponding":true}],"reference_count":56,"raw_metadata":null,"created_at":"2026-07-19T02:56:59.652443Z","pmid":"40666700","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}