A 12-year single-center retrospective analysis of antisiphon devices to prevent proximal ventricular shunt obstruction for hydrocephalus

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OBJECTIVE

Recent evidence points to gravity-dependent chronic shunt overdrainage as a significant, if not leading, cause of proximal shunt failure. Yet, shunt overdrainage or siphoning persists despite innovations in valve technology. The authors examined the effectiveness of adding resistance to flow in shunt systems via antisiphon devices (ASDs) in preventing proximal shunt obstruction.

METHODS

A retrospective observational cohort study was completed on patients who had an ASD (or additional valve) added to their shunt system between 2004 and 2016. Detailed clinical, radiographic, and surgical findings were examined. Shunt failure rates were compared before and after ASD addition.

RESULTS

Seventy-eight patients with shunted hydrocephalus were treated with placement of an ASD several centimeters distal to the primary valve. The records of 12 of these patients were analyzed separately due to a complex shunt revision history (i.e., > 10 lifetime shunt revisions). The authors found that adding an ASD decreased the 1-year ventricular catheter obstruction rates in the “simple” and “complex” groups by 67.3% and 75.8%, respectively, and the 5-year rates by 43.3% and 65.6%, respectively. The main long-term ASD complication was ASD removal for presumed valve pressure intolerance in 5 patients.

CONCLUSIONS

Using an ASD may result in significant reductions in ventricular catheter shunt obstruction rates. If confirmed with prospective studies, this observation would lend further evidence that chronic shunt overdrainage is a central cause of shunt malfunction, and provide pilot data to establish clinical and laboratory studies that assess optimal ASD type, number, and position, and eventually develop shunt valve systems that are altogether resistant to siphoning.

ABBREVIATIONS ASD = antisiphon device; ICP = intracranial pressure.

Article Information

Correspondence Bermans J. Iskandar: University of Wisconsin Hospitals and Clinics, Madison, WI. iskandar@neurosurgery.wisc.edu.

INCLUDE WHEN CITING Published online September 6, 2019; DOI: 10.3171/2019.6.PEDS1951.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Proximal shunt revision rates after ASD placement in “simple” patients. A: The 1-year number of proximal shunt revisions after ASD implantation in “simple” shunt patients dropped by 67.3% (n = 66 patients; Poisson regression, p < 0.0001). B: The number of patients with no proximal shunt obstruction during the study period almost doubled (mixed-effects logistic regression; p = 0.0008). C: The 5-year number of proximal shunt revisions after ASD implantation in “simple” shunt patients dropped by 43.3% (n = 30 patients; Poisson regression, p = 0.0411). D: The number of patients with no proximal shunt obstruction during the study period doubled (mixed-effects logistic regression; p = 0.0433).

  • View in gallery

    Proximal shunt revision rates after ASD placement in “complex” patients. A: The 1-year number of proximal shunt revisions after ASD implantation in “complex” shunt patients dropped by 75.8% (n = 12 patients; Poisson regression, p = 0.0103). B: The number of patients with no proximal shunt obstruction during the study period doubled (mixed-effects logistic regression, p = 0.0581). C: The 5-year number of proximal shunt revisions after ASD implantation in “complex” shunt patients dropped by 65.6% (n = 10 patients; Poisson regression, p = 0.0354). D: The number of patients with no proximal shunt obstruction during the study period tripled (mixed-effects logistic regression, p = 0.0234).

  • View in gallery

    ICP in response to ASD placement. Median ICP after ASD addition increased significantly in the upright position (upper; n = 10, Wilcoxon matched-pairs test, p = 0. 002), and minimally, if at all, in the supine position (lower; n = 10, Wilcoxon matched-pairs test, p = 0.625), indicating that the ASD functions predominantly as an antigravitational device.

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