The enigma of underdrainage in shunting with hydrostatic valves and possible solutions

Sprung, Christian; Miethke, Christoph; Schlosser, Hans-Georg; Brock, M.

doi:10.1007/3-211-32318-x_47

Cited by 19 publications

(13 citation statements)

References 18 publications

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“…It is clear that with a high opening valve pressure the probability of overdrainage is minimal, but many reports have shown that, especially in patients with NPH, clinical outcome is better with lower opening pressures. 3,11,18,19,21 The addition of a hydrostatic device may enable us to reduce the incidence of overdrainage further. 10 Citing McLaurin, 13 who stated that "the history for the evolution of ventricular shunting for hydrocephalus is largely a history of efforts to prevent the complications of shunting," the list of recent publications dealing with the complication of overdrainage is long and there are numerous attempts to use different devices to reduce the incidence and avoid reoperations necessitated by overdrainage-related events.…”

Section: Discussionmentioning

confidence: 99%

“…18 We used the same criteria for overdrainage as we did in the present study. In the previous study we found an indication for setting adjustments in 65 patients (in 22 cases [15.3% of the total collective of 144 patients] for signs and symptoms of overdrainage and in 43 patients [29.9%] for underdrainage).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, in series with adjustable valves, signs and symptoms of overdrainage reversible by valve adjustments, rather than termed "complications," would be better named "overdrainage-related events" or "remediable dysfunctions." 18,19 Hydrostatic units were designed in addition to modern adjustable valves to overcome the challenge of over-drainage, and recent data in series involving gravitational valve shunts suggest a high reliability and good clinical shunt response together with low overdrainage complication rates for these devices. 11,19,20 None of the recent studies, however, placed special emphasis on the potential benefit of adjustable and gravity-assisted valves in the nonsurgical treatment of overdrainage-related adverse events.…”

mentioning

confidence: 99%

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Shunting with gravitational valves—can adjustments end the era of revisions for overdrainage-related events?

Freimann¹,

Sprung²

2012

JNS

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Shunting with gravitational valves—can adjustments end the era of revisions for overdrainage-related events?

Freimann¹,

Sprung²

2012

JNS

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“…Despite normal CSF pressures, the drainage of large amounts of CSF (50 mL as a tap test or prolonged CSF drainage via a spinal catheter) leads to a transient improvement in the clinical symptoms. However, the drainage of CSF by spinal tap or even by shunt operations, resulting in a reduction in the CSF pressure and improvement in the clinical symptoms, is not necessarily accompanied by recovery or a reduction in ventricular size (3). To date, the underlying mechanism that transmits relatively small CSF pressure peaks into a significant, irreversible ventricular enlargement remains obscure.…”

Section: Introductionmentioning

confidence: 99%

In vivo viscoelastic properties of the brain in normal pressure hydrocephalus

et al. 2010

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Nearly half a century after the first report of normal pressure hydrocephalus (NPH), the pathophysiological cause of the disease still remains unclear. Several theories about the cause and development of NPH emphasize disease-related alterations of the mechanical properties of the brain. MR elastography (MRE) uniquely allows the measurement of viscoelastic constants of the living brain without intervention. In this study, 20 patients (mean age, 69.1 years; nine men, 11 women) with idiopathic (n = 15) and secondary (n = 5) NPH were examined by cerebral multifrequency MRE and compared with 25 healthy volunteers (mean age, 62.1 years; 10 men, 15 women). Viscoelastic constants related to the stiffness (µ) and micromechanical connectivity (α) of brain tissue were derived from the dynamics of storage and loss moduli within the experimentally achieved frequency range of 25-62.5 Hz. In patients with NPH, both storage and loss moduli decreased, corresponding to a softening of brain tissue of about 20% compared with healthy volunteers (p < 0.001). This loss of rigidity was accompanied by a decreasing α parameter (9%, p < 0.001), indicating an alteration in the microstructural connectivity of brain tissue during NPH. This disease-related decrease in viscoelastic constants was even more pronounced in the periventricular region of the brain. The results demonstrate distinct tissue degradation associated with NPH. Further studies are required to investigate the source of mechanical tissue damage as a potential cause of NPH-related ventricular expansions and clinical symptoms.

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“…The most important factor is selecting the optimal valve opening pressure for the individual patient. The selection of the most suitable valve opening pressure preoperatively is very difficult and often pressure adjustments may be required postoperatively [5]. When a nonprogrammable valve is used and there is a shunt-related complication, such as a subdural fluid collection, surgery is required to alter the opening pressure.…”

Section: Introductionmentioning

confidence: 99%

The Value of Programmable Shunt Valves for the Management of Subdural Collections in Patients with Hydrocephalus

Pachatouridis

Alexiou

Mihos

et al. 2013

The Scientific World Journal

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Background. The aim of the present study was to assess the value of electromagnetic programmable shunt valves for the treatment of subdural collections. Methods. Adult patients with hydrocephalus of various causes that were treated with programmable shunt valves during the last ten years were retrospectively studied. In 127 patients, 139 electromagnetic programmable shunt valves were implanted. Results. A nontraumatic subdural fluid collection was detected in 12 patients. The treatment of these patients consisted of reprogramming of the valve's opening pressure. In 5 patients small subdural hematomas were detected; 4 of these patients were treated by raising the opening pressure alone and one patient required surgical drainage and change of the pressure setting. Traumatic chronic subdural hematomas were detected in 6 patients. These patients were treated by surgical drainage and readjustment of the valve's opening pressure. Conclusion. The ability to treat a shunt-related complication, such as a subdural fluid collection, by reprogramming the valve's opening pressure to a higher setting is an advantage over nonprogrammable valves, and it enables the opening pressure to be slowly lowered once the fluid collection is reabsorbed. Based on our results, we believe that programmable shunt valves should be preferred.

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The enigma of underdrainage in shunting with hydrostatic valves and possible solutions

Cited by 19 publications

References 18 publications

Shunting with gravitational valves—can adjustments end the era of revisions for overdrainage-related events?

Shunting with gravitational valves—can adjustments end the era of revisions for overdrainage-related events?

In vivo viscoelastic properties of the brain in normal pressure hydrocephalus

The Value of Programmable Shunt Valves for the Management of Subdural Collections in Patients with Hydrocephalus

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