gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

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4 years of experience with a gravitational valve for pediatric hydrocephalus patients

4 Jahre Erfahrung mit einem Gravitations-gesteuerten Ventil für pädiatrische Hydrozephaluspatienten

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  • corresponding author A.M. Messing-Jünger - Neurochirurgische Klinik, Universitätsklinik Düsseldorf
  • S. Persits - Neurochirurgische Klinik, Universitätsklinik Düsseldorf
  • L. Wilms - Neurochirurgische Klinik, Universitätsklinik Düsseldorf
  • H.J. Steiger - Neurochirurgische Klinik, Universitätsklinik Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocFR.04.03

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2006/06dgnc020.shtml

Published: May 8, 2006

© 2006 Messing-Jünger 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

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Objective: Overdrainage is a well-known complication in pediatric hydrocephalus patients and becomes symptomatic after a latency of more than 5 years. In order to prevent slit ventricles and their related symptoms, a small valve with a gravitational mechanism has been developed. The opening pressure is dependent on the patient's position.

Methods: To evaluate the safety, technical and clinical characteristics of the valve (Paedi-GAV), a retrospective study of all pediatric patients not older than 16 years suffering from various types of hydrocephalus was performed. Indications, clinical course and complications were registered. Ventricular size was measured pre- and postoperatively. Follow up was performed at least every 6 months.

Results: Since the end of 2001 a total of 68 children between 0.1 and 15 years (mean 4.5 years) have been operated (74 valves). The chosen opening pressures were 4/19 in 21 cases and 9/19 in 46. 39 primary shunt implantations and 28 revisons were performed. Etiologies were posthemorrhagic (20), Chiari II/myelomeningocele (17) postinfectious (5), Dandy-Walker-syndrome and tumor (4 each), others (brain malformation, schizencephalic syndrome, aqueductal stenosis, posttraumatic, NF1, unclear). Mean follow-up was 16 months (1-47). Reintervention rate was 25% (healing disorder/infection 7, central dislocation/occlusion 7, underdrainage 4, suspected underdrainage 2, isolated IV. ventricle 2, overdrainage 1). In this patient group there was a significant number of risk factors regarding shunt survival (prematurity 9, posthemorrhagic HC 8, HC per magna 5, anus praeter 3). The mean time of reintervention was 4 months after primary operation. 12 months reintervention-rate was 24%. Only one reintervention became necessary after 12 months.

Conclusions: The new pediatric gravitational valve Paedi-GAV is as safe as comparable valves and easy to use and did not lead to early overdrainage, especially in premature newborns with posthemorrhagic HC (1 overdrainage in a child with a large cystic lesion of 8 cm). Long-term follow-up is necessary to answer the question whether overdrainage can be avoided permanently.