Low-pressure valves in hydrocephalic children: a retrospective analysis

Child's Nervous System, Mar 2012

Purpose A series of 100 children under 2 years of age treated for hydrocephalus is described. All patients received a standard differential low-pressure (SD low) valve as the first cerebrospinal fluid (CSF) shunt treatment. The performance of this group during follow-up is analysed. Methods A retrospective cohort study was performed using the intern electronic health record from our hospital. Children younger than 2 years who underwent initial CSF shunt treatment with a SD low valve between 1998 and 2008 were eligible. Results Mean follow-up was 7 years. The majority of 81% (81 of 100) of the children did not receive an upgrade of pressure profile throughout follow-up. The first revision was done after a mean of 456 days (median, 64 days; min, 3; and max, 4,183). The 1-year survival rate of the CSF shunt in this cohort was 42%. In the relatively large group of myelomeningocele patients (37 of 100), only one patient developed symptomatic overdrainage. A total of 9% (9 of 100) of the children presented with symptoms of overdrainage. In 3% (3 out of 100) of these children, symptoms of overdrainage persisted, in spite of multiple valve mutations. During the total follow-up, 26% (26 of 100) of the patients had never received shunt revision surgery. Fifteen percent (15 of 100) of the children developed a shunt infection within the first year. Conclusions The use of SD low valves in the youngest age group is effective in the majority of children. The aetiology of myelomeningocele appears to protect the patient from symptomatic overdrainage.

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Low-pressure valves in hydrocephalic children: a retrospective analysis

G. E. Breimer D. A. Sival E. W. Hoving 0 ) Department of Neurosurgery, University Hospital Groningen (UMCG) , Hanzeplein 1, P.O. Box 30 001, 9700 RB Groningen, The Netherlands Purpose A series of 100 children under 2 years of age treated for hydrocephalus is described. All patients received a standard differential low-pressure (SD low) valve as the first cerebrospinal fluid (CSF) shunt treatment. The performance of this group during follow-up is analysed. Methods A retrospective cohort study was performed using the intern electronic health record from our hospital. Children younger than 2 years who underwent initial CSF shunt treatment with a SD low valve between 1998 and 2008 were eligible. Results Mean follow-up was 7 years. The majority of 81% (81 of 100) of the children did not receive an upgrade of pressure profile throughout follow-up. The first revision was done after a mean of 456 days (median, 64 days; min, 3; and max, 4,183). The 1-year survival rate of the CSF shunt in this cohort was 42%. In the relatively large group of myelomeningocele patients (37 of 100), only one patient developed symptomatic overdrainage. A total of 9% (9 of 100) of the children presented with symptoms of overdrainage. In 3% (3 out of 100) of these children, symptoms of overdrainage persisted, in spite of multiple valve mutations. During the total follow-up, 26% (26 of 100) of the patients had never received shunt revision surgery. Fifteen percent (15 of 100) of the children developed a shunt infection within the first year. Conclusions The use of SD low valves in the youngest age group is effective in the majority of children. The aetiology of myelomeningocele appears to protect the patient from symptomatic overdrainage. - Hydrocephalus can be defined as an active distension of the ventricular system of the brain resulting from inadequate passage of cerebrospinal fluid (CSF) from its point of production within the cerebral ventricles to its point of absorption into the systemic circulation (i.e. triventricular and communicating hydrocephalus respectively) [11]. The former is often related to an obstruction between the third and fourth ventricles while the latter does not show any morphological obstructions. The aetiology of hydrocephalus varies, and a MRI scan is important to define its cause. The overall incidence of infantile hydrocephalus is about 0.66 per 1,000 live births [8]. The most common treatment for the hydrocephalus in infants is the insertion of a CSF shunt. The alternative treatment of endoscopic third ventriculostomy (ETV) in cases of triventricular hydrocephalus is controversial in this youngest age group [3]. Therefore, CSF shunt insertion is considered standard treatment especially in young children. The adverse effects of CSF shunts are well recognized, and a shunt dysfunction is a common problem in neurosurgery. Many different types of shunts have been designed to overcome these problems, but the ideal shunt still does not exist. The shunt trial has shown that different types of valves show comparable outcomes [4, 6]. The number of different valves has been increasing ever since, but basically, these valves can be distinguished according to the differential pressure gradients: low, medium and high. In young children, there is no consensus about the best pressure gradient for valves. We describe a series of children (n 0100) who all received a standard differential low-pressure (SD low) valve as first shunt treatment. This treatment policy is based on the hypothesis that as long as the sutures of the skull have not closed, the intracranial pressure will be low. The overall characteristics of this cohort are analysed concerning aetiology and shunt survival rates. A more detailed analysis is presented of a subcategory of patients with serious overdrainage problems. The potential relationship between symptomatic overdrainage and the implantation of SD low valves is analysed and discussed. The present retrospective study was approved by the Medical Ethical Committee of University Hospital Groningen (UMCG), the Netherlands. After informed consent of the parents, we investigated a retrospective cohort of children under the age of 2 years who primary received a CSF shunt with a SD low valve. All patients were treated within the period from 1998 to 2008, at UMCG. A total of 112 patients were treated with a CSF shunt during the period of inclusion. The initial treatment of 12 patients was with a SD medium-pressure valve; these were excluded from this study. Mean follow-up was 7 years. Children from northern parts of the Netherlands are referred to our clinic. The total population of this area is about 1.7 million. All procedures were performed by a neurosurgeon or resident under supervision of a neurosurgeon. The standard treatment of hydrocephalus in this young age group has been CSF shunt implantation using a SD low valve (PS Medical Low). This valve has an opening pressure of 5 cm CSF without an ant (...truncated)


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G. E. Breimer, D. A. Sival, E. W. Hoving. Low-pressure valves in hydrocephalic children: a retrospective analysis, Child's Nervous System, 2012, pp. 469-473, Volume 28, Issue 3, DOI: 10.1007/s00381-011-1664-x