Experiences with a gravity-assisted valve in hydrocephalic children

Clinical article

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Object

Over the past decade, a gravity-assisted valve (GAV) has become a standard device in many European pediatric hydrocephalus centers. Because past comparative clinical outcome studies on valve design have not included any GAV, the authors in this trial evaluated the early results of GAV applications in a pediatric population.

Methods

For a minimum of 2 years the authors monitored 169 of 182 hydrocephalic children who received a pediatric GAV at their first CSF shunt insertion (61.5%) or as a substitute for any differential pressure valve (38.5%) at 1 of 7 European pediatric hydrocephalus centers. Outcomes were categorized as valve survival (primary outcome) or shunt survival (secondary outcome). The end point was defined as valve explantation.

Results

Within a follow-up period of 2 years, the valve remained functional in 130 (76.9%) of 169 patients. One hundred eight of these patients (63.9%) had an uncomplicated clinical course without any subsequent surgery, and 22 (13%) were submitted to a valve-preserving catheter revision without any further complications during the follow-up period. Thirty-nine patients (23.1%) reached an end point of valve explantation: 13 valve failures from infection (7.7%), 8 (4.7%) from overdrainage, and 18 (10.6%) from underdrainage.

Conclusions

Compared with nongravitational shunt designs, a GAV does not substantially affect the early complication rate. Valve-preserving shunt revisions do not increase the risk of subsequent valve failure and therefore should not be defined as an end point in studies on valve design. A significant impact of any well-established valve design on the early complication rate in shunt surgery is not supported by any current data; therefore, this correlation should be dismissed. As overdrainage-related complications have been shown to occur late, the presumed advantages of a pediatric GAV remain to be shown in a long-term study.

Abbreviation used in this paper: GAV = gravity-assisted valve.
Article Information

Contributor Notes

Address correspondence to: Ernst Johannes Haberl, Priv.Doz. Dr. med., Selbständiger Arbeitsbereích Pädiatrische Neurochirurgie der Charité, Charité Campus Virchow, D-13344 Berlin, Germany. email: hannes.haberl@charite.de.
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References
  • 1

    Allin DMCzosnyka ZHCzosnyka MRichards HKPickard JD: In vitro hydrodynamic properties of the Miethke ProGAV hydrocephalus shunt. Cerebrospinal Fluid Res 3:92006

    • Search Google Scholar
    • Export Citation
  • 2

    Aschoff AKremer PBenesch CFruh KKlank AKunze S: Overdrainage and shunt technology. A critical comparison of programmable, hydrostatic and variable-resistance valves and flow-reducing devices. Childs Nerv Syst 11:1932021995

    • Search Google Scholar
    • Export Citation
  • 3

    Cedzich CWießner A: Die Behandlung des kindlichen Hydrocephalus mit hydrostatischen Ventilen. Zentralbl Neurochir 64:51572003

  • 4

    Choksey MSMalik IA: Zero tolerance to shunt infections: can it be achieved?. J Neurol Neurosurg Psychiatry 75:87 912004

  • 5

    Choux MGenitori LLang DLena G: Shunt implantation: reducing the incidence of shunt infection. J Neurosurg 77:875 8801992

  • 6

    Czosnyka ZCzosnyka MRichards HPickard J: Posture-related overdrainage: comparison of the performance of 10 hydrocephalus shunts in vitro. Neurosurgery 42:3273331998

    • Search Google Scholar
    • Export Citation
  • 7

    Di Rocco C: Is the slit ventricle syndrome always a slit ventricle syndrome?. Childs Nerv Syst 10:49581994

  • 8

    Drake JMKestle JRMilner RCinalli GBoop FPiatt J Jr: Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery 43:2943051998

    • Search Google Scholar
    • Export Citation
  • 9

    Eymann RKiefer MSteudel W: Pediatric gravitational shunts: initial results from a prospective study. J Neurosurg 106:1791842007

    • Search Google Scholar
    • Export Citation
  • 10

    Eymann RSteudel WIKiefer M: Pediatric gravitational shunts: initial results from a prospective study. J Neurosurg 106:3 Suppl1791842007

    • Search Google Scholar
    • Export Citation
  • 11

    Hanlo PWCinalli GVandertop WPFaber JOJBogeskov LBorgesen SE: Treatment of hydrocephalus determined by the European Orbis Sigma valve II survey: a multicenter prospective 5-year shunt survival study in children and adults in whom a flow-regulating shunt was used. J Neurosurg 99:52572003

    • Search Google Scholar
    • Export Citation
  • 12

    Jain HSgouros SWalsh AHockley A: The treatment of infantile hydrocephalus: “differential-pressure” or “flow-control” valves. Childs Nerv Syst 16:2422462000

    • Search Google Scholar
    • Export Citation
  • 13

    Kulkarni AVRabin DDrake JM: An instrument to measure the health status in children with hydrocephalus: the Hydrocephalus Outcome Questionnaire. J Neurosurg 101:2 Suppl1341402004

    • Search Google Scholar
    • Export Citation
  • 14

    Meling TREgge ADue-Tønnessen B: The gravity-assisted Paedi-Gav valve in the treatment of pediatric hydrocephalus. Pediatr Neurosurg 41:8142005

    • Search Google Scholar
    • Export Citation
  • 15

    Oikonomou JAschoff AHashemi BKunze S: New valves— new dangers? 22 valves (38 probes) designed in the ‘nineties in ultralong-term tests (365 days).’. Eur J Pediatr Surg 9:Suppl 123261999

    • Search Google Scholar
    • Export Citation
  • 16

    Park JKim GJHwang SK: Valve inclination influences the performance of gravity-assisted valve. Surg Neurol 68:14182007

  • 17

    Rekate HL: Classification of slit-ventricle syndromes using intracranial pressure monitoring. Pediatr Neurosurg 19:15201993

  • 18

    Serlo WHeikkinen ESaukkonen ALvon Wendt L: Classification and management of the slit ventricle syndrome. Childs Nerv Syst 1:1941991985

    • Search Google Scholar
    • Export Citation
  • 19

    Sood SBarrett RJPowell THam SD: The role of lumbar shunts in the management of slit ventricles: does the slit-ventricle syndrome exist?. J Neurosurg 103:2 Suppl1191232005

    • Search Google Scholar
    • Export Citation
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