First experiences with an adjustable gravitational valve in childhood hydrocephalus

Rohde, Veit; Haberl, Ernst-Johannes; Ludwig, Hans; Thomale, Ulrich-Wilhelm

doi:10.3171/2008.11.peds08154

Cited by 47 publications

(19 citation statements)

References 17 publications

(17 reference statements)

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“…The 1-year survival rate was 81%, and the overall shunt failure was 16.2%; these findings are in agreement with other recent reports 12,13,23,24) . Seven patients who demonstrated overdrainage had cranial defects when shunt surgery was performed (41%, p = 0.629).…”

Section: Shunt Failures and Complicationssupporting

confidence: 82%

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A Comparative Result of Ventriculoperitoneal Shunt, Focusing Mainly on Gravity-Assisted Valve and Programmable Valve

Lee

Seo

Choe

et al. 2010

J Korean Neurosurg Soc

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Objective : Despite rapid evolution of shunt devices, the complication rates remain high. The most common causes are turning from obstruction, infection, and overdrainage into mainly underdrainage. We investigated the incidence of complications in a consecutive series of hydrocephalic patients. Methods : From January 2002 to December 2009, 111 patients underwent ventriculoperitoneal (VP) shunting at our hospital. We documented shunt failures and complications according to valve type, primary disease, and number of revisions. Results : Overall shunt survival time was 268 weeks. Mean survival time of gravity-assisted valve (GAV) was 222 weeks versus 286 weeks for other shunts. Survival time of programmable valves (264 weeks) was longer than that of pressure-controlled valves (186 weeks). The most common cause for shunt revision was underdrainage (13 valves). The revision rate due to underdrainage in patients with GAV (7 of 10 patients) was higher than that for other valve types. Of 7 patients requiring revision for GAV underdrainage, 6 patients were bedridden. The overall infection rate was 3.6%, which was lower than reported series. Seven patients demonstrating overdrainage had cranial defects when operations were performed (41%), and overdrainage was improved in 5 patients after cranioplasty. Conclusion : Although none of the differences was statistically significant, some of the observations were especially notable. If a candidate for VP shunting is bedridden, GAV may not be indicated because it could lead to underdrainage. Careful procedure and perioperative management can reduce infection rate. Cranioplasty performed prior to VP shunting may be beneficial.

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Section: Shunt Failures and Complicationssupporting

confidence: 82%

“…Although much pro- 3,7,8) , but 20% seems to be the rate cited most often 5,27) . Recently, new shunt technologies have been introduced to minimize overdrainage, including the GAV (the concept for which had already been introduced by Hakim in 1975), the programmable valve, and the programmable GAV 9,17,23) .…”

Section: Discussionmentioning

confidence: 99%

A Comparative Result of Ventriculoperitoneal Shunt, Focusing Mainly on Gravity-Assisted Valve and Programmable Valve

Lee

Seo

Choe

et al. 2010

J Korean Neurosurg Soc

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“…Nevertheless, the feasibility of using this shunt system in an infant population is demonstrated, which has similarly been shown for a general pediatric population. 20,43,48 The use of the gravitational unit of the system to try to counteract severe overdrainage is also well tolerated by infants. Clinical observation has shown that during long-term follow-up, signs and symptoms of overdrainage (e.g., decreased ventricular size on imaging, diminished development of head circumference, and headaches) may develop with the advancing growth and activity of the child.…”

Section: Discussionmentioning

confidence: 99%

“…The ventricular catheter was placed in a frontal precoronal position in all patients to allow the valve to be placed in a strictly vertical position subcutaneously behind the ear. 43 The ventricular catheter was connected to a bur hole reservoir. Antibiotic-impregnated silicon tubes (Bactiseal; Johnson & Johnson) were used for all cases from 2009 on, and the tubes were fixated with nonresorbable ligatures.…”

Section: Progav Systemmentioning

confidence: 99%

Long-term survival rates of gravity-assisted, adjustable differential pressure valves in infants with hydrocephalus

Gebert

Schulz

Schwarz

et al. 2016

PED

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OBJECTIVE The use of adjustable differential pressure valves with gravity-assisted units in shunt therapy of children with hydrocephalus was reported to be feasible and promising as a way to avoid chronic overdrainage. In this single-center study, the authors' experiences in infants, who have higher rates of shunt complications, are presented. METHODS All data were collected from a cohort of infants (93 patients [37 girls and 56 boys], less than 1 year of age [mean age 4.1 ± 3.1 months]) who received their first adjustable pressure hydrocephalus shunt as either a primary or secondary implant between May 2007 and April 2012. Rates of valve and shunt failure were recorded for a total of 85 months until the end of the observation period in May 2014. RESULTS During a follow-up of 54.2 ± 15.9 months (range 26–85 months), the Kaplan-Meier rate of shunt survival was 69.2% at 1 year and 34.1% at 85 months; the Kaplan-Meier rate of valve survival was 77.8% at 1 year and 56% at 85 months. Survival rates of the shunt were significantly inferior if the patients had previous shunt surgery. During follow-up, 44 valves were exchanged in cases of infection (n = 19), occlusion (n = 14), dysfunction of the adjustment unit (n = 10), or to change the gravitational unit (n = 1). CONCLUSIONS Although a higher shunt complication rate is observed in infant populations compared with older children, reasonable survival rates demonstrate the feasibility of using this sophisticated valve technology. The gravitational unit of this valve is well tolerated and its adjustability offers the flexible application of opening pressure in an unpredictable cohort of patients. This may adequately address overdrainage-related complications from early in treatment.

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“…The chosen resistance of the gravitational unit (vertical position) of the proGAV valve was 20 cm H 2 O. 27 In all patients peritoneal diversion of the CSF was used. In cases in which 2 ventricular catheters were placed the catheters were connected via a Yshaped connector proximal to the single implanted valve.…”

Section: Surgerymentioning

confidence: 99%

Navigated endoscopic surgery for multiloculated hydrocephalus in children

Schulz¹,

Böhner

Knaus³

et al. 2010

PED

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Object Multiloculated hydrocephalus remains a challenging condition to treat in the pediatric hydrocephalic population. In a retrospective study, the authors reviewed their experience with navigated endoscopy to treat multiloculated hydrocephalus in children. Methods Between April 2004 and September 2008, navigated endoscopic procedures were performed in 16 children with multiloculated hydrocephalus (median age 8 months, mean age 16.1 ± 23.3 months). In all patients preoperative MR imaging was used for planning entry sites and trajectories of the endoscopic approach for cyst perforation and catheter positioning. Intraoperatively, a rigid endoscope was tracked by the navigation system. For all children the total number of operative procedures, navigated endoscopic procedures, implanted ventricular catheters, and drained compartments were recorded. In addition, postoperative complications and radiological follow-up data were analyzed. Results In 16 children, a total of 91 procedures were performed to treat multiloculated hydrocephalus, including 29 navigated endoscopic surgeries. Finally, 21 navigated procedures involved 1 ventricular catheter and 8 involved 2 catheters for CSF diversion via the shunt. The average number of drained compartments in a shunt was 3.6 ± 1.7 (range 2–9 compartments). In 9 patients (56%) a navigated endoscopic procedure constituted the last procedure within the follow-up period. One additional surgery was necessary in 3 patients (19%) after navigated endoscopy, and in 4 patients (25%) 2 further procedures were necessary after navigated endoscopy. Serial follow-up MR imaging demonstrated evidence of sufficient CSF diversion in all patients. Conclusions Navigated endoscopic surgery is a safe and effective treatment option for multiloculated hydrocephalus. The combination of the endoscopic approach and neuronavigation further refines preoperative planning and intraoperative orientation. The aim of treatment is to drain as many compartments as possible and as soon as possible, thereby establishing sufficient CSF drainage with few ventricular catheters in single shunt systems. Close clinical and radiological follow-up is mandatory because multiple revisions are likely.

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First experiences with an adjustable gravitational valve in childhood hydrocephalus

Cited by 47 publications

References 17 publications

A Comparative Result of Ventriculoperitoneal Shunt, Focusing Mainly on Gravity-Assisted Valve and Programmable Valve

A Comparative Result of Ventriculoperitoneal Shunt, Focusing Mainly on Gravity-Assisted Valve and Programmable Valve

Long-term survival rates of gravity-assisted, adjustable differential pressure valves in infants with hydrocephalus

Navigated endoscopic surgery for multiloculated hydrocephalus in children

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