gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

May overdrainage be prevented using gravitational shunts in children?

Kann eine Überdrainage bei Kindern durch die Benutzung von Schwerkraftventilen verhindert werden?

Meeting Abstract

Suche in Medline nach

  • corresponding author R. Eymann - Universitätskliniken des Saarlandes, Klinik für Neurochirurgie
  • Y. Komenda - Universitätskliniken des Saarlandes, Klinik für Neurochirurgie
  • W. I. Steudel - Universitätskliniken des Saarlandes, Klinik für Neurochirurgie
  • M. Kiefer - Universitätskliniken des Saarlandes, Klinik für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc10.05.-16.07

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Veröffentlicht: 4. Mai 2005

© 2005 Eymann et al.
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Overdrainage may be related to >40% of paediatric shunt failures resulting in shunt disasters for the rest of life. Objective was to evaluate whether this may be reduced with paediatric gravitational shunts.


Within the last 6 years 58 hydrocephalic children of various etiologies (23% MMC, 26% posthemorrhagic, 32% congenital mixed origin) received a PAEDI-GAV as the first treatment. Pre- and postoperatively (6 weeks, thereafter yearly) ventricular size (FOHR-Index) and head growth were assessed. Statistics: U-, Spearman-, Wilcoxen-test, a <0.005.


About ¾ of the children were <1 year of age at the time of the first shunt insertion and 40% were <4 weeks old. Mean FOHR decreased (preoperatively 0.67±0,12; postoperatively: 0.51±0,12) clearly (p = 0.000). After shunt insertion a physiological head growth along the 50th percentile occurred normally. However nearly all children with post-hemorrhagic hydrocephalus dropped gradually at values below the 3th percentile with increasing age. Comparing pre- and postoperative FOHR of post-hemorrhagic and non-post-hemorrhagic hydrocephalus however there is no difference (p=0,176) of the ventricular shrinking with children with or without post-hemorrhagic hydrocephalus and slit ventricles occurred not in any child. Accordingly the drop below the 3th percentile in post-hemorrhagic hydrocephalus is not the result of overdrainage, but the result of reduced head growth due to irreversible brain tissue lost because of the bleeding. Using the Kaplan-Meier method up to 70% of the shunts were still functioning after maximally 75 months. Overall complication rate was 33%. The total infection rate appears high (21%), but fits to typically mentioned values with that age distribution. 50% of the infections were secondary to wound healing disturbances, when using filaments for skin closure. Since histoacrylat-glue was used instead, wound-healing disturbances, - and secondary shunt infections - did not occur anymore. Overdrainage occurred in 3% and underdrainage in 2% of the patients.


The PAEDI-GAV prevents overdrainage very effectively. Microcephalus in post-hemorrhagic hydrocephalus may not be seen mistakenly as overdrainage. Using skin glue for closure instead of filaments the PAEDI-GAV may be inserted even in premature children, because of its small size. Despite the small outer dimensions CSF pathway within the device are comparatively large, what is reflected by the absence of shunt failure due to valve occlusion.