gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Gravitational valves. A personal 25-year experience in 401 patients

Schwerkraft-Ventile – Erfahrungen in 25 Jahren mit 401 Patienten

Meeting Abstract

  • corresponding author A. Aschoff - Neurochirurgische Universitätsklinik Heidelberg
  • R. Wirtz - Neurochirurgische Universitätsklinik Heidelberg
  • B. Hashemi - Neurochirurgische Kliniken Singen
  • P. Kremer - Hamburg-Haidberg
  • A. Unterberg - Neurochirurgische Universitätsklinik Heidelberg
  • M. Halatsch - Neurochirurgische Universitätsklinik Heidelberg

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocDO.03.03

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2007/07dgnc021.shtml

Veröffentlicht: 11. April 2007

© 2007 Aschoff et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: The first gravitational valve, the Cordis-Hakim-Lumbar (CHL) was patented in 1975. In 1980 the author assisted two implantations in LP-shunts, but similar to all contemporary neurosurgeons he did not recognize the technical brealthrough. In spite of a brilliant concept, the CHL flopped, probably due to the exclusive design for the rare lumbar shunts (transversal connectors) and a round valve body with a strong tendency to rotate in the lumbar fat and resulting dysfunctions. The initiator of the first large series in the USA died in an aircrash; his encouraging study was never published.

In 1989, the CHL was tested with excellent results by Richard and us. As the first we proposed the combination with adjustable valves on 91 and implanted a modified CHL with a Medos-P in 83. We conceived the idea of longitudinal valve bodies,which stimulated the development of Cordis GCA and Miethke ShuntAssistant (94). Independently the Chhabra Z-Flow, the Sophysa AS and the Affeld-valve, a precursor of the Miethke Dual-Switch, were developed.

Methods: Retrospective study on 401 patients treated with Cordis Hakim-Lumbar or -GCA, Miethke ShuntAssistant, -DualSwitch, -Paedi/GAV and ProGAV. Follow-up since 1984

Results: Overdrainage was dramatically reduced: Only 9/401 patients developed subdural hematomas (2.2%), 5 of them after a significant head trauma; 3 required surgical evacuation only. Of the 95 NPH-patients only one (1.1%) showed hygromas. – The rate of infections, catheter problems and valve dysfunctions met standard experiences.

Conclusions: Gravitational valves have largely solved the problems of overdrainage. However, residual problems such as the adaptation to the growth of children or high abdominal counter pressure in adipose patients with resulting underdrainage require further improvements, especially adjustable g-valves. The current state-of-the-art is the crossover between adjustable and gravitational valves.