Implantation of ventricular catheters (VCs) to drain cerebrospinal fluid (CSF) is a standard approach to treat hydrocephalus. VCs fail frequently due to tissue obstructing the lumen via the drainage holes. Mechanisms driving obstruction are poorly understood. This study aimed to characterize the histological features of VC obstructions and identify links to clinical factors. 343 VCs with relevant clinical data were collected from five centers. Each hole on the VCs was classified by degree of tissue obstruction after macroscopic analysis. A subgroup of 54 samples was analyzed using immunofluorescent labelling, histology and immunohistochemistry. 61.5% of the 343 VCs analyzed had tissue aggregates occluding at least one hole (n = 211) however the vast majority of the holes (70%) showed no tissue aggregates. Mean age at which patients with occluded VCs had their first surgeries (3.25 yrs) was lower than in patients with non-occluded VCs (5.29 yrs, p < 0.02). Mean length of time of implantation of occluded VCs, 33.22 months was greater than for non-occluded VCs, 23.8 months (p = 0.02). Patients with myelomeningocele had a greater probability of having an occluded VC (p = 0.0426). VCs with occlusions had greater numbers of macrophages and astrocytes in comparison to non-occluded VCs (p < 0.01). Microglia comprised only 2–6% of the VC-obstructing tissue aggregates. Histologic analysis showed choroid plexus occlusion in 24%, vascularized glial tissue occlusion in 24%, prevalent lymphocytic inflammation in 29%, and foreign body giant cell reactions in 5% and no ependyma. Our data show that age of the first surgery and length of time a VC is implanted are factors that influence the degree of VC obstruction. The tissue aggregates obstructing VCs are composed predominantly of astrocytes and macrophages; microglia have a relatively small presence.

中文翻译：

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脑积水患者异质组织聚集物阻塞脑室导管的多中心回顾性研究

植入脑室导管 (VC) 以引流脑脊液 (CSF) 是治疗脑积水的标准方法。由于组织通过引流孔阻塞管腔，VC 经常失败。导致阻塞的机制知之甚少。本研究旨在描述 VC 阻塞的组织学特征并确定与临床因素的联系。从五个中心收集了 343 个具有相关临床数据的 VC。在宏观分析后，VC 上的每个孔按组织阻塞程度进行分类。使用免疫荧光标记、组织学和免疫组织化学分析了 54 个样本的亚组。在分析的 343 个 VC 中，61.5% 的组织聚集体至少堵塞了一个孔（n = 211），但绝大多数孔（70%）没有显示组织聚集体。闭塞 VC 患者首次手术的平均年龄（3.25 岁）低于非闭塞 VC 患者（5.29 岁，p < 0.02）。闭塞 VC 的平均植入时间为 33.22 个月，大于未闭塞 VC 的 23.8 个月（p = 0.02）。脊髓脊膜膨出患者发生闭塞 VC 的可能性更大（p = 0.0426）。与非闭塞 VC 相比，闭塞 VC 的巨噬细胞和星形胶质细胞数量更多（p < 0.01）。小胶质细胞仅占 VC 阻塞组织聚集体的 2-6%。组织学分析显示 24% 的脉络丛闭塞，24% 的血管化神经胶质组织闭塞，29% 的普遍淋巴细胞炎症，5% 的异物巨细胞反应，无室管膜。我们的数据显示，第一次手术的年龄和植入 VC 的时间长度是影响 VC 阻塞程度的因素。阻碍 VC 的组织聚集体主要由星形胶质细胞和巨噬细胞组成；小胶质细胞的存在相对较小。