Patients with Polycystic Kidney Disease Would Benefit from Routine Magnetic Resonance Angiographic Screening for Intracerebral Aneurysms: A Decision Analysis

Publisher Website
Google Scholar
Abstract
IT HAS LONG been assumed that a high cerebrospinal fluid protein concentration adversely affects the performance of shunts. There is little experimental evidence to support this viewpoint, however, and the few reports that have been published can be criticized for poor experimental design or presentation of results. A flow-dependent shunt perfusion model was constructed. PS Medical Flow Control valves (PS Medical Corporation, Goleta, CA) and Cordis-Hakim valves (Cordis Corporates, Miami, FL) were perfused with saline-plasma solutions in concentrations from 0 to 9 g/L of protein. Blood suspensions in dilutions from 0.25 to 1 % were also studied. The opening and dosing pressures of the valves were measured with a simple manometer, and the physical properties of the solutions were studied. The results indicated that the valves performed within the ranges specified by their manufacturers, even with markedly increased protein concentrations in the perfusate. Furthermore, the valve opening and closing pressures were lower with the protein-containing solutions than with the control solutions. Thus, the protein did not impaii shunt function and we conclude that shunts can be inserted into patients who have elevated cerebrospinal fluit protein contents. However, blood cells did adversely affect performance and, therefore, patients with hemorrhagic cerebrospinal fluid should not receive shunts.