Shunt survival rates by using the adjustable differential pressure valve combined with a gravitational unit (proGAV) in pediatric neurosurgery

Abstract

In a concept of avoiding chronic overdrainage by using the proGAV in hydrocephalic children, we observed a good rate of valve and shunt survival. Compared to previous reported series, we experienced the proGAV as a reliable tool for the treatment of pediatric hydrocephalus.

In vitro performance and principles of anti-siphoning devices

“…Complications such as orthostatic headaches or subdural effusions can arise as acute sequelae under these conditions, and require revision or adjustment of the shunt [4,20]. Slit-like ventricles with possible obstruction of the ventricular catheter, microcephaly, calvarial hyperostosis, or shunt-induced Chiari malformations are also possible complications following chronic CSF overdrainage, especially in pediatric hydrocephalus patients [27].…”

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

“…After promising early results, the standard regimen was changed to include infant patients. 18,48 In the present study, we report the shunt and valve survival rates and the reasons for valve exchanges exclusively for the infant cohort. The retrospective investigation of revisions and complication rates in this young patient cohort shows limited shunt and valve survival rates.…”

“…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.…”

“…Perhaps the most relevant data from the study include the survival rate of primary implants in infants without any previous interventions (n = 79), which was 85% at 12 months and 59% at 85 months for the valve and 78% at 12 months and 39% at 85 months for the shunt; these data may have the strongest value for comparison with data from the literature. In our previous report, 48 which examined 237 children with hydrocephalus who had a proGAV implant, 62 infants with a mean follow-up of 21 months (6-38 months) were included. The Kaplan-Meier valve survival rate after 12 months for all children in this study was similar to the present data (valve, 81% and shunt, 72%).…”

“…13,19,21,46 We previously reported on the use of an adjustable DP valve with gravitational assistance, the proGAV (MIETHKE, B. Braun, Aesculap), and were able to show the feasibility of this device for the treatment of childhood hydrocephalus, as well as its acceptance by patients and caretakers. 18,48 The treatment of hydrocephalus in infants is especially challenging due to their less developed immune status, delicate skin condition, rapidly changing cerebral dimensions, closure of the fontanelle and cranial sutures, and the wide range of intracranial and intraabdominal pressure conditions being influenced (e.g., by crying and abdominal pressure). Only a few studies have addressed treatment for hydrocephalus exclusively in an infant population.…”