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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

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Communicating hydrocephalus: experience with 100 gravity assisted valves

Erfahrungen mit 100 gravitationsunterstützten Ventilen in der Hydrozephalusbehandlung

Meeting Abstract

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  • corresponding author U. Kehler - Neurochirurgische Klinik, Universitätsklinikum Eppendorf, Hamburg
  • N. Langer - Neurochirurgische Klinik, Universitätsklinikum Eppendorf, Hamburg
  • G. Kammler - Neurochirurgische Klinik, Universitätsklinikum Eppendorf, Hamburg
  • M. Westphal - Neurochirurgische Klinik, Universitätsklinikum Eppendorf, Hamburg

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.-16.03

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2005/05dgnc0171.shtml

Published: May 4, 2005

© 2005 Kehler 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.

Outline

Text

Objective

Since several years gravitational valves for hydrocephalus treatment are available. The main advantage of the valves is the hydrostatic compensation for the up-right body position and the potential to reduce overdrainages. The necessary amount of hydrostatic compensation depends theoretically from body height and the intraperitoneal pressure, which correlate with the body mass index (BMI). If the theoretical advantages become true in daily clinical work, it would be of large interest.

Methods

Between Oct. 2001 and Oct. 2004 we implanted 100 gravitational valves: Sixty GAV 5/30 (horizontal opening pressure 5 cm H20, vertical 30 cm H20), 13 PaediGav 4/19, 8 PaediGav 9/24 and 18 Shunt Assistants in combination with different systems. Ninety-three patients had a communicating hydrocephalus, 7 had a pseudotumor cerebri. Forty patients were females, the mean age was 56,7 years (range: 8 mos to 85 years). The follow-up ranged from 1 day (re-operation) to 32 months (mean 6 mos). Results, cumulative shunt survival curves (Kaplan-Meyer) and complications are summarized. The valve dependent complications were analyzed according to the body height and intraperitoneal pressure respectively the BMI.

Results

In 26 patients revision of the shunt was necessary because of 6 infections, 5 dislocations, 4 overdrainages (3 pseudotumor cerebri patients – mean BMI 35, range 29-37), and 11 underdrainages (mean BMI 25, range 20-32). The time between shunt surgery and revision was averagely 16 weeks (1 day: due to mal-positioning and 71 weeks). The cumulative shunt survival was 0,9 for 9 weeks, 0,8 for 6 months and respectively 0,75 for 1 year. No clear correlation was found between shunt over-/ underdrainage, body height and intraperitoneal pressure. However, 3 patients with a pseudotumor cerebri and an high BMI showed an overdrainage in spite of a rather expected underdrainage.

Conclusions

The overall complication and revision rate do not differ much from other valves. However, the overdrainage rate is lower than reported from differential pressure valves. The choice of the gravitational valve especially regarding the amount of hydrostatic compensation remains difficult. A valve with an adjustable gravitational component is needed to overcome the unknown intraperitoneal pressure and to give the surgeon the potential to readapt the shunt non-invasively.