{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:46:43Z","timestamp":1753890403509,"version":"3.41.2"},"reference-count":58,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Bioeng. Biotechnol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>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, <jats:italic>In Vitro<\/jats:italic> 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The shunt failure criteria were set at greater than or equal to 30 <jats:inline-formula><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><\/jats:inline-formula> such that the experiment was manually terminated if pressure surpassed 30 <jats:inline-formula><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><\/jats:inline-formula> differential pressure at any point within 24\u00a0h. 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 <jats:inline-formula><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><\/jats:inline-formula> for all samples except where the flow rate was intentionally varied. The rate of pressure increase (pressurization rate) was used in all statistical analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Over 500\u00a0h of data were gathered without leaks or ruptures. There was a statistically significant difference in the pressurization rate across blood concentration groups (<jats:italic>P = 0.005<\/jats:italic>). All the barium-impregnated and antibiotic-impregnated catheters reached 30 <jats:inline-formula><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><\/jats:inline-formula> threshold at 0.5% concentration. A statistically significant difference was observed in the pressurization rate (<jats:italic>P = 0.029<\/jats:italic>). 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 (<jats:italic>P = 0.029<\/jats:italic>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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 <jats:inline-formula><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><\/jats:inline-formula> 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 <jats:inline-formula><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><\/jats:inline-formula> had a significantly smaller pressurization rate than samples exposed to 0.5% at 0.3 <jats:inline-formula><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><\/jats:inline-formula> (<jats:italic>P = 0.029<\/jats:italic>). These findings highlight the role of clot formation in PHH shunt obstruction and suggest avenues for improved catheter design or clinical management.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fbioe.2025.1591952","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T05:28:58Z","timestamp":1751347738000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Quantitative and qualitative investigation of shunt failure in an in vitro hemorrhagic hydrocephalus model"],"prefix":"10.3389","volume":"13","author":[{"given":"Shaheer","family":"Ajaz","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmad","family":"Faryami","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayman","family":"Suhrawardy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolyn A.","family":"Harris","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"175","DOI":"10.2147\/phmt.s364447","article-title":"Congenital hydrocephalus and associated risk factors: an institution-based case\u2013control study, dessie town, north east Ethiopia","volume":"13","author":"Abebe","year":"2022","journal-title":"Pediatr. 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