Flow-regulated versus differential pressure-regulated shunt valves for adult patients with normal pressure hydrocephalus

Ziebell, Morten; Wetterslev, Jørn; Tisell, Magnus; Gluud, Christian; Juhler, Marianne

doi:10.1002/14651858.cd009706.pub2

Cited by 23 publications

(11 citation statements)

References 39 publications

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“…Furthermore, the presence of a high quantity of CSF in the hydranencephaly predisposes them to this complication. There is no evidence from randomized clinical trials indicating flow-regulated and differential pressure regulated shunt valves difference with regard to clinical outcome, shunt failure, or intervention risks [37]. Thus, it can be concluded that the combination of the two systems through our technique reduces the risk of overdrainage.…”

Section: Discussionmentioning

confidence: 87%

A Technique for Treatment of Overdrainage in Ventriculoperitoneal Shunt

Kpelao

Békéti

Moumouni

et al. 2017

IrJNS

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Background and Importance:Overdrainage is a complication of ventriculoperitoneal shunt but adjustable valves and anti-siphon devices can prevent it. These very expensive valves are most often inaccessible, so that the majority of the valves available in Togo are fixed differential pressure valves. Although overdrainage is a widely-known issue, we aimed to introduce a new risk factor and the way we manage this complication.Case Presentation: This case series study included all patients who had overdrainage or a high potential risk of overdrainage (hydranencephaly). Our technique consisted of partial ligation of the peritoneal catheter at the level of the thorax by non-resorbable wire while controlling the drainage rate at the slots. The goal was to transform this fixed differential pressure valve into a pressure-controlled and flow-regulated one. Patients were followed for 1, 3 and 6 months, postoperatively. Conclusion:Hydranencephaly predisposes patients to overdrainage. The partial ligature of the catheter is an effective technique for treating or preventing overdrainage.

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Section: Discussionmentioning

confidence: 87%

A Technique for Treatment of Overdrainage in Ventriculoperitoneal Shunt

Kpelao

Békéti

Moumouni

et al. 2017

IrJNS

View full text Add to dashboard Cite

show abstract

“…[32][33][34][35][36][37][38] This disparity occurs due to the variation in the selection of patients in different studies and the absence of a single, universally accepted scale for analysis of improvement in the patient. The rate of major complications (severe intraoperative hemorrhage, subdural hematoma, neurologic deficits, epilepsy, cardiac arrhythmias, hypothalamic dysfunction, cerebrospinal fluid leakage, infection) occurs in about 6% of patients after surgery.…”

Section: Surgery Rehabilitation or Conservative Treatmentmentioning

confidence: 99%

“…These valves may differ in price, given that programmable valves and flow-regulated valves involve more advanced technology and are more expensive. [32][33][34][35][36][37][38] Although the concept of normal pressure suggests that the CSF pressure is normal, there is in fact an intermittent variation in CSF pressure with a normal average. Qualitative evaluation through epidural monitoring reveals Lundberg B waves with spikes of up to 50 mmHg, occurring mainly at night.…”

Section: Surgery Rehabilitation or Conservative Treatmentmentioning

confidence: 99%

Evidences in the treatment of idiopathic normal pressure hydrocephalus

Oliveira

Reis

Trindade

et al. 2015

Rev. Assoc. Med. Bras.

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“…However, the Codman-Hakim Programmable Valve (CHPV) was developed in collaboration with Dr. Salomón Hakim, a Colombian neurosurgeon known to have named iNPH in the 1980s (3), and has been in use since 1992. Developments in shunt valve systems with programming pressure have dramatically reduced the problems of CSF over-and under-drainage and increased shunt effectiveness in elderly patients with iNPH (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Nowadays, numerous patients with iNPH are treated with shunt surgery, according to the Japanese and international guidelines for the management of iNPH (16)(17)(18)(19)(20)(21).…”

Section: Introductionmentioning

confidence: 99%

Reconsidering Ventriculoperitoneal Shunt Surgery and Postoperative Shunt Valve Pressure Adjustment: Our Approaches Learned From Past Challenges and Failures

et al. 2022

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Treatment for idiopathic normal pressure hydrocephalus (iNPH) continues to develop. Although ventriculoperitoneal shunt surgery has a long history and is one of the most established neurosurgeries, in the 1970s, the improvement rate of iNPH triad symptoms was poor and the risks related to shunt implantation were high. This led experts to question the surgical indication for iNPH and, over the next 20 years, cerebrospinal fluid (CSF) shunt surgery for iNPH fell out of favor and was rarely performed. However, the development of programmable-pressure shunt valve devices has reduced the major complications associated with the CSF drainage volume and appears to have increased shunt effectiveness. In addition, the development of support devices for the placement of ventricular catheters including preoperative virtual simulation and navigation systems has increased the certainty of ventriculoperitoneal shunt surgery. Secure shunt implantation is the most important prognostic indicator, but ensuring optimal initial valve pressure is also important. Since over-drainage is most likely to occur in the month after shunting, it is generally believed that a high initial setting of shunt valve pressure is the safest option. However, this does not always result in sufficient improvement of the symptoms in the early period after shunting. In fact, evidence suggests that setting the optimal valve pressure early after shunting may cause symptoms to improve earlier. This leads to improved quality of life and better long-term independent living expectations. However, in iNPH patients, the remaining symptoms may worsen again after several years, even when there is initial improvement due to setting the optimal valve pressure early after shunting. Because of the possibility of insufficient CSF drainage, the valve pressure should be reduced by one step (2–4 cmH2O) after 6 months to a year after shunting to maximize symptom improvement. After the valve pressure is reduced, a head CT scan is advised a month later.

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Flow-regulated versus differential pressure-regulated shunt valves for adult patients with normal pressure hydrocephalus

Cited by 23 publications

References 39 publications

A Technique for Treatment of Overdrainage in Ventriculoperitoneal Shunt

A Technique for Treatment of Overdrainage in Ventriculoperitoneal Shunt

Evidences in the treatment of idiopathic normal pressure hydrocephalus

Reconsidering Ventriculoperitoneal Shunt Surgery and Postoperative Shunt Valve Pressure Adjustment: Our Approaches Learned From Past Challenges and Failures

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