Distal slit valve and clinically relevant CSF overdrainage in children with hydrocephalus

Virella, Anthony A.; Galarza, Marcelo; Masterman‐Smith, Michael; Lemus, Rafael; Lazareff, Jorge A.

doi:10.1007/s00381-001-0544-1

Cited by 10 publications

(3 citation statements)

References 23 publications

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“…Virella et al examined DSV shunts in 2002, and although the primary objective of their study was to evaluate the incidence of overdrainage, they also compared the failure rates and patterns of 101 patients with DVS shunts to those of 40 patients with Delta valves, finding no difference in overall failure between the groups. 8 First-time failure rates were 31% for the DSV group and 30% for the Delta valve group, which was consistent with our findings of no overall difference in failure rate. In the DSV group, 61% of first-time failures were proximal and 26% were distal.…”

Section: Summary Of Past Studiessupporting

confidence: 91%

“…It has been speculated in numerous papers that proximity to the choroid plexus and higher CSF protein levels contribute to proximal catheter occlusion. 8 It is not surprising that the DSV shunts would have more distal malfunctions, but we would expect the proximal catheters to become occluded at an equal rate in both groups, leading to a higher overall failure rate in the DSV group, but this was not the case. The reason for this is unknown.…”

Section: Discussion and Review Of The Literaturementioning

confidence: 89%

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Survival and failure trends of cerebrospinal fluid shunts with distal slit valves: comparative study and literature review

Wetzel

Waldman

Texakalidis

et al. 2020

Journal of Neurosurgery: Pediatrics

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OBJECTIVEThe malfunction rates of and trends in various cerebrospinal fluid (CSF) shunt designs have been widely studied, but one area that has received little attention is the comparison of the peritoneal distal slit valve (DSV) shunt to other conventional valve (CV) type shunts. The literature that does exist comes from older case series that provide only indirect comparisons, and the conclusions are mixed. Here, the authors provide a direct comparison of the overall survival and failure trends of DSV shunts to those of other valve type shunts.METHODSThree hundred seventy-two new CSF shunts were placed in pediatric patients at the authors’ institution between January 2011 and December 2015. Only ventriculoperitoneal (VP) shunts were eligible for study inclusion. Ventriculoatrial, lumboperitoneal, cystoperitoneal, subdural-peritoneal, and spinal shunts were all excluded. Rates and patterns of shunt malfunction were compared, and survival curves were generated. Patterns of failure were categorized as proximal failure, distal failure, simultaneous proximal and distal (proximal+distal) failure, removal for infection, externalization for abdominal pseudocyst, and addition of a ventricular catheter for loculated hydrocephalus.RESULTSA total of 232 VP shunts were included in the final analysis, 115 DSV shunts and 117 CV shunts. There was no difference in the overall failure rate or time to failure between the two groups, and the follow-up period was statistically similar between the groups. The DSV group had a failure rate of 54% and a mean time to failure of 17.8 months. The CV group had a failure rate of 50% (p = 0.50) and a mean time to failure of 18.5 months (p = 0.56). The overall shunt survival curves for these two groups were similar; however, the location of failure was significantly different between the two groups. Shunts with DSVs had proportionately more distal failures than the CV group (34% vs 14%, respectively, p = 0.009). DSV shunts were also found to have proximal+distal catheter occlusions more frequently than CV shunts (23% vs 5%, respectively, p = 0.005). CV shunts were found to have significantly more proximal failures than the DSV shunts (53% vs 27%, p = 0.028). However, the only failure type that carried a statistically significant adjusted hazard ratio in a multivariate analysis was proximal+distal catheter obstruction (CV vs DSV shunt: HR 0.21, 95% CI 0.05–0.81).CONCLUSIONSThere appears to be a difference in the location of catheter obstruction leading to the malfunction of shunts with DSVs compared to shunts with CVs; however, overall shunt survival is similar between the two. These failure types are also affected by other factors such etiology of hydrocephalus and endoscope use. The implications of these findings are unclear, and this topic warrants further investigation.

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Section: Summary Of Past Studiessupporting

confidence: 91%

Section: Discussion and Review Of The Literaturementioning

confidence: 89%

Survival and failure trends of cerebrospinal fluid shunts with distal slit valves: comparative study and literature review

Wetzel

Waldman

Texakalidis

et al. 2020

Journal of Neurosurgery: Pediatrics

View full text Add to dashboard Cite

show abstract

“…Reinprecht et al [30] fanden bei 8 von 78 Kindern (10,25 %) Überdrainagekomplikationen nach der Implantation eines programmierbaren Hakim Ventils. In einer weiteren Studie von Virella et al werden bei der Verwendung des DS-Ventils (distal slit valve) in 47,5 % Schlitzventrikel beschrieben, allerdings zumeist ohne klinisch relevante Symptomatik [34]. In dieser Studie konnten trotz Implantation von einer eher sehr niedrigen Druckstufe von 4/19 cm H 2 O keine bildmorphologischen Zeichen einer Überdrainage festgestellt werden.…”

Section: Original Articleunclassified

Die Behandlung des kindlichen Hydrocephalus mit hydrostatischen Ventilen

Cedzich

Wießner²

2003

Zentralbl Neurochir

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Complications of CSF-shunt systems may not only prolong hospitalization, but also influence dramatically the neurological and mental outcome of patients, especially of premature newborns. Shunt complications may be caused by mechanical problems such as shunt occlusion or dysfunction of the valve itself. Another cause of shunt complications is the overdrainage and, lastly, shunt infection. The choice of the specific shunt system seems to play an important role in avoiding the above mentioned complications. In this study 32 children with hydrocephali due to different etiologies were treated with hydrostatic valves, the so called Pädi GAV (pediatric hydrostatic valve) valves developed by Miethke. In addition to mechanical occlusions and shunt infections, the overdrainage related complications, such as subdural hematomas/ fluid collections, slit ventricles and secondary craniosynostoses were taken into consideration. None of the patients showed these complications. On the contrary, postoperative MRI or the ultrasound demonstrated prominent ventricles comparing these with those of non-hydrocephalic children as measured by the Evans-Index and FOR (fronto-to-occipital ratio). Whether the overdrainage-related complications actually reduced using Pädi GAV valves will be shown by further long-term follow ups. This study aims to evaluate the initial experience with the Pädi GAV shunt system, particularly with respect to the overdrainage-related problems.

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Chiari I anatomy after ventriculoperitoneal shunting: posterior fossa volumetric evaluation with MRI

et al. 2006

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Distal slit valve and clinically relevant CSF overdrainage in children with hydrocephalus

Abstract: We did not find a direct correlation between clinically relevant CSF overdrainage and DSV.

Cited by 10 publications

References 23 publications

Survival and failure trends of cerebrospinal fluid shunts with distal slit valves: comparative study and literature review

Survival and failure trends of cerebrospinal fluid shunts with distal slit valves: comparative study and literature review

Die Behandlung des kindlichen Hydrocephalus mit hydrostatischen Ventilen

Chiari I anatomy after ventriculoperitoneal shunting: posterior fossa volumetric evaluation with MRI

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