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59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

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Cerebrospinal fluid shunting with gravitational valves in pseudotumor cerebri patients to avoid low pressure symptoms

Liquorshunts mit Schwerkraftventilen in Pseudotumor-Patienten zur Vermeidung von Symptomen der Überdrainage

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  • corresponding author J. Tilgner - Klinik für Neurochirurgie, Universitätsklinikum Heidelberg
  • A. Aschoff - Klinik für Neurochirurgie, Universitätsklinikum Heidelberg
  • A. Unterberg - Klinik für Neurochirurgie, Universitätsklinikum Heidelberg

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocP 035

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2008/08dgnc303.shtml

Published: May 30, 2008

© 2008 Tilgner et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

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Objective: Pseudotumor cerebri (PC) is a more and more common disease and makes up 3.5 - 4.1% of all shunted patients. Basic treatment includes weight reduction and azetazolamide. Data about the new options of angioplasties or stents in case of venous stenosis are controversially and are not confirmed by long-term investigation. The elegant and less-invasive lumbar shunts showed a high quote of overdrainage with low pressure headaches in the upright or even an acquired Chiari. Experiences with gravitational (g) valves, which can circumvent these problems in PC-patients, are not available in the literature.

Methods: We retrospectively reviewed 15 consecutive PC-patients with g-valves since 2000. We implanted PaediGAV (Miethke) and GCA (Integra-Cordis) valves including a shunt-assistant. In no case an adjustable valve was used due to the difficulty of adjustability in abdominal location of the valve in obese patients.

Results: 11/15 patients received a lumbar and the others a neuronavigated ventricular shunt into the peritoneum. The follow-up ranged from 4 months to 7 years (mean value: 22 months). 78% experienced a significant decrease in there headache and 72 % an improvement in there vision. Yet half the patients with visual impairment could be treated successfully with no signs of visual deficits in the follow-up and 28% of patients with headache could be totally relieved from there pain. Mortality rate was zero percent and no acquired Chiari could be observed. Two patients had a complicated post-operative course. One suffered from a complex pre-operative medical history and multiple shunt revisions. The other patient developed a moderate CSF-infection and shunt replacement was indicated. There were some minor problems, two with a tilted valve and two with a cathetershift.

Conclusions: Some reports in the literature specify a low pressure rate up to 90% in shunted PC patients. On the basis of our analysis, the above mention management avoids such rates. Furthermore our series presents a high success rate and an average morbidity rate.