Flow-regulated versus differential pressure valves for idiopathic normal pressure hydrocephalus: comparison of overdrainage rates and neurological outcome

Wetzel, Christian H.; Goertz, Lukas; Noé, Philipp; Spreckelsen, Niklas von; Penner, Marina; Kabbasch, Christoph; Goldbrunner, Roland; Krischek, Boris

doi:10.1007/s00701-019-04088-9

Cited by 12 publications

(11 citation statements)

References 16 publications

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“…The rate of flow of CSF past this point is dependent on the pressure gradient, and this in turn can risk over-drainage and the development of intracranial hypotension, and even subdural haematomas. Flow regulated (FR) valves were developed to counteract this siphoning phenomenon and resulting over-drainage that is particularly problematic in idiopathic normal pressure hydrocephalus (iNPH) [ 68 , 69 ]. FR valves likewise have an opening pressure threshold but will regulate the rate of flow at a constant rate (mL/h), up to a critical level, above which free drainage is permitted as a safety feature.…”

Section: Resultsmentioning

confidence: 99%

Neurosurgical CSF Diversion in Idiopathic Intracranial Hypertension: A Narrative Review

Sunderland

Jenkinson

Conroy

et al. 2021

Life

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The prevalence of idiopathic intracranial hypertension (IIH), a complex disorder, is increasing globally in association with obesity. The IIH syndrome occurs as the result of elevated intracranial pressure, which can cause permanent visual impairment and loss if not adequately managed. CSF diversion via ventriculoperitoneal and lumboperitoneal shunts is a well-established strategy to protect vision in medically refractory cases. Success of CSF diversion is compromised by high rates of complication; including over-drainage, obstruction, and infection. This review outlines currently used techniques and technologies in the management of IIH. Neurosurgical CSF diversion is a vital component of the multidisciplinary management of IIH.

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Section: Resultsmentioning

confidence: 99%

Neurosurgical CSF Diversion in Idiopathic Intracranial Hypertension: A Narrative Review

Sunderland

Jenkinson

Conroy

et al. 2021

Life

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“…21 The programmable valves and antisiphon devices can also be useful to treat these symptoms. 22,23 Chiari malformation is a rare complication reported with the shunt. The incidence was reported to high in children in upto 70% by Payner et al and Chumas et al 24,25 However, the recent series reported incidence upto 1% with usage of valve system, reducing the incidence.…”

Section: Over-drainage and Low-pressure Headachementioning

confidence: 99%

Thecoperitoneal Shunts—Our 20 Years Experience

Arumalla

Mohammed

Bhat³

et al. 2023

Indian Journal of Neurosurgery

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Introduction The thecoperitoneal shunt is a modality of cerebrospinal fluid (CSF) diversion used to treat various clinical conditions such as idiopathic intracranial hypertension (IIH), normal pressure hydrocephalus (NPH), and CSF leaks. There is a wide variability in the data regarding the utility and complications associated with it. We thus reviewed the outcomes and complications of the shunt done in our setting. Methodology The study is a retrospective review of all the thecoperitoneal shunts performed at NIMHANS (National Institute of Mental Health and Neurosciences) from January 2000 to December 2020. The demographic details, clinical profile, indications for the shunt, magnetic resonance imaging, follow-up and complications, and shunt revisions were collected and analyzed. Results Three-hundred twelve patients underwent shunt primarily at our institute. The mean follow-up of the patients was 5.2 years. The indications include pseudomeningocele in 31.4%, CSF leak from surgical site in 25.3%, IIH in 17.6%, and NPH in 7.3% patients.The shunt was more effective in pseudomeningocele in up to 95% and CSF leaks in 91% compared to 64‰ in IIH, though it is not significant (p > 0.05). The complication rate was 17% that included shunt block, wound CSF leak, infection, and subdural hygromas. The shunt malfunction was seen in 14.69% patients who underwent revision. Conclusion Thecoperitoneal shunt is a useful treatment option for various pathologies including IIH, NPH, and wound CSF leaks. They have good clinical outcomes and acceptable revision rates especially in conditions with slit ventricle. The complications such as low-pressure headache can be overcome by using adjuncts as programmable valve or antisiphon device.

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“…It is designed to improve the flow of CSF by taking advantage of the force of gravity. [25,26] Unlike traditional VP shunts, which rely on a pressure valve to regulate the flow of CSF, the gravity-assisted shunt uses a simple design that allows CSF to flow freely from the brain to the abdomen. The gravity-assisted shunt consists of two components: a long catheter that is inserted into the brain ventricles and a short catheter that is inserted into the abdominal cavity.…”

Section: Gravity-assisted Vp Shuntmentioning

confidence: 99%

“…Pressure and flow regulated valves are the two primary types of valves used in shunts, each with its advantages and limitations. [25,49,50] Pressure Regulated Valves: Pressure-regulated valves are designed to maintain a constant pressure differential between the brain and the abdomen. These valves have a spring-loaded mechanism that opens or closes depending on the pressure difference.…”

Section: Variations In Shunt Valves (Pressure Vs Flow Regulated Valves)mentioning

confidence: 99%

An overview of hydrocephalus and shunts used in the clinical management of hydrocephalus

Jakiela,

Billavara,

Kaliaperumal

et al. 2023

Preprint

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<p>As hydrocephalus is a complex neurological condition with significant clinical implications, we believe that this review article is timely to provide a comprehensive overview of shunts used in neurosurgery. This article delves into the etiology, clinical presentation, and challenges associated with hydrocephalus, while focusing primarily on the surgical placement of shunt systems as a key management strategy. We believe that this review will offer valuable insights to clinicians and researchers involved in the management of hydrocephalus. It will provide an in-depth understanding of different shunt systems, their specific characteristics, and associated advantages and limitations, thus empowering clinicians to make informed decisions tailored to individual patients.</p>

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Flow-regulated versus differential pressure valves for idiopathic normal pressure hydrocephalus: comparison of overdrainage rates and neurological outcome

Cited by 12 publications

References 16 publications

Neurosurgical CSF Diversion in Idiopathic Intracranial Hypertension: A Narrative Review

Neurosurgical CSF Diversion in Idiopathic Intracranial Hypertension: A Narrative Review

Thecoperitoneal Shunts—Our 20 Years Experience

An overview of hydrocephalus and shunts used in the clinical management of hydrocephalus

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