Cerebrospinal fluid (CSF) is a clear, colorless body fluid found in the brain and spinal cord. CSF performs vital functions including support, shock absorber, nutrition, or immune function. Hydrocephalus is a pathological condition of abnormal accumulation of CSF caused by increased CSF production, blockage of flow or decreased absorption. The ventricles distend to accommodate elevated CSF volumes, potentially causing damage to the brain by pressing its tissue against the boney skull.
Normal pressure hydrocephalus (NPH)—an acquired condition with pathologically enlarged brain ventricles—strikes those 55 years of age and above. The Hydrocephalus Association has reported that one in 100 seniors, or 700,000 Americans, are afflicted with NPH. The classic symptom triad is difficulty walking, dementia and urinary incontinence.
There are no medicinal therapies to treat hydrocephalus. But with surgical treatment, NPH is a potentially reversible disease. Typically, these procedures entail draining excess CSF from the brain’s ventricles (cavities). A neurosurgeon begins by drilling an access point through the patient’s skull and then inserts a shunt (a silicon drainage tube) into the ventricles of the patient’s brain. These shunts (tubes) reroute continuously produced surplus CSF from the brain to the abdomen where it is dissolved.
Problems abound. Shunts (the CSF drainage tubes) in use today have one of the highest failure rates of any surgical device. Complications that arise from implanting shunts include overdrainage of CSF, underdrainage of CSF, mechanical failure, infection and obstruction. Deficiencies associated with shunts are manifest in the fact that at least 70% of the surgeries to treat hydrocephalus are repeat surgeries on existing patients.
Of course, unnecessary surgeries jeopardize the lives of patients (infections during these procedures pose a major risk) and are extremely expensive. Umea, Sweden-based Likvor has developed a suite of diagnostic tools (called CELDA) which can accurately determine whether a patient should have a shunt implanted. CELDA can also provide data on whether an existing shunt needs to be repositioned or replaced.
CELDA is a sophisticated diagnostic suite that incorporates 40 years of research. The instrument uses a high-resolution peristaltic pump to perform accurate infusion of artificial CSF or drainage of CSF, and two pressure sensors are used to measure intracranial pressure. Likvor’s CELDA Instrument also carries a built-in laser allowing the instrument to be levelled to the patient, ensuring the accuracy of recorded intracranial pressures. CELDA’s software contains ten different optional pre-programmed protocols designed to investigate CSF dynamics. Despite the complexity of CELDA, the system is operated through an easy-to-use touch screen.
One part of CELDA’s secret sauce lies in its evaluation of infusion tests. These tests are based on pressure monitoring during the infusion of a saline solution into the CSF space via a lumbar puncture. Infusion tests measure the blood’s ability to absorb additional CSF. Tests also produce the pulsation curve to better understand the patient’s possibilities to respond to a shunt operation. Patients experience less trauma with CELDA as a slower infusion rate is applied. CELDA-based infusion tests only last one hour, whereas a series of external lumbar drainage procedures can last for three days.
CELDA features a special bed that is designed with a hole in the back through which lumbar needles are inserted into patients while they are sitting up. The bed can be flattened, allowing patients to lie on their backs, which is more comfortable than lying on their sides. This bed is credited with reducing the incidence of patients’ headaches.
The CELDA method has been used to diagnose more than 12,000 patients, primarily in Scandinavia.
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