Gravitational Shunt Complications After a Five-Year Follow-Up
Gravitational shunts (G-valves) for ventriculo-peritoneal (VP) shunting have been available since 1996. We analyzed shunt complications in patients with a complete minimum follow-up of 5 years.
- PDF / 654,332 Bytes
- 6 Pages / 595.276 x 790.866 pts Page_size
- 47 Downloads / 142 Views
Abstract Introduction Gravitational shunts (G-valves) for ventriculoperitoneal (VP) shunting have been available since 1996. We analyzed shunt complications in patients with a complete minimum follow-up of 5 years. Material and Methods Between 1996 and 2002, we implanted 282 VP G-valves in various forms of adult chronic hydrocephalus, of which 130 provided a complete data set with an annual follow-up. Adjustable and non-adjustable G-valves were used: the Miethke Dual-Switch valve, the Miethke GAV-valve and a combination of adjustable Codman-Hakim valves with the Miethke Shunt-Assistant. In cases of supposed mechanical shunt failure, the explanted shunts were examined in a bench test. Results The total complication rate was 21%:3% shunt infections, 3% catheter dislocation/fracture, 5% underdrainage and 9% overdrainage occurred. Half of the overdrainage complications could be managed conservatively. Under drainage complications resulted from the chosen opening pressure being too high (n = 3), a secondary increase in intraperitoneal pressure (n = 2) or from “real” shunt failure in one case according to bench test results. Conclusion G-valves demonstrate sufficient long-term performance over multiple years, and real shunt-related complications are rare. The frequency of revision due to overdrainage is low (4.5%). Keywords Hydrocephalus • iNPH • shunt • gravitational shunts • complication • disconnection • dislocation • shunt infections • overdrainage • underdrainage M. Kiefer (*) Department of Neurosurgery, Saarland University Medical School, Kirrberger Street, Building: 90.1, Homburg-Saar 66421, Germany e-mail: [email protected] R. Eymann Department of Neurosurgery, Medical School, Saarland University, Kirrberger Street, Building 90, Homburg-Saar, Saarland 66421, Germany
Introduction The introduction of modern shunts in hydrocephalus therapy in the 1950s revolutionized hydrocephalus therapy. Given that they are usually necessary for the whole life of the patient, the fact that up to 50% of the shunts must be revised within 10 years after implantation (3,6,8,15) seems unacceptably high. The failure rates are obviously independent of the shunt type used (1,4,9,17), as the few existing prospective randomized trials have demonstrated. One reason for shunt revision is shunt infection that may be reduced with the usage of antibiotic-impregnated catheters (5). However, another important source of shunt failure is valve-related failure, with 30–70% of shunt revisions being due to hydraulic mismanagement (1). Classical differential pressure (DP) valves must overdrain in an upright position if their opening pressure (OP) has been chosen for sufficient drainage while lying. In contrast, when choosing a high OP to avoid overdrainage, drainage in a lying position is insufficient as demonstrated by observations of poor clinical results (1). Most measures or technical solutions to overcome this obvious paradox reduce the overdrainage rate at the cost of increased underdrainage, and vice versa. Based on the basic principl
Data Loading...
