Article
A concept for avoiding complications in pediatric hydrocephalus
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Authors
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Ulrich-W. Thomale
- Arbeitsbereich Pädiatrische Neurochirurgie, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Deutschland
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Matthias Schulz
- Arbeitsbereich Pädiatrische Neurochirurgie, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Deutschland
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Ernst-J. Haberl
- Arbeitsbereich Pädiatrische Neurochirurgie, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Deutschland
| Published: | September 16, 2010 |
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Outline
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Objective: In pediatric hydrocephalus, the first surgery often decides on the quality of the CSF diversion. Shunt related complications are reported to be rather high. Thus decision-making for the therapeutic concept is of the utmost importance. We report the experience of our concept treating pediatric hydrocephalus.
Methods: During the period from 4/2006 to 1/2010, adjustable gravitational valves (proGAV, Miethke-Aesculap) were implanted in a total in 231 children (age: 6.2±6.6, 0–27yrs). These were either primary implants (n=110) or shunt revision procedures (n=121) to avoid overdrainage. In cases of higher infection risk, antibiotic impregnated catheters (Bactiseal, Codman) were used. This group includeded very young age under 12 months (n=50), the existence of EVD before surgery or additional use of neuroendoscopy. Revisions were performed in emergency cases with clear symptoms or in cases of minor but persisting symptoms and when imaging showed any risk for future shunt failure. In complex cases of ventricular catheter placement, neuronavigation, ultrasound or endoscopy were used. In the follow-up period, valve and shunt failure as well as the rate of infection were recorded.
Results: The mean follow-up time was 18±9months (range 1–44 months). During this period, the valve survival rate was 83,6%. Shunt survival including all necessary revisions was 63,5% during the follow-up period. Within the early period after surgery (3 months), revisions were needed in 42 cases (19 valves), which were defined as surgery-related complications, while revisions between 4 and 45 months after surgery were necessary in 24 cases (11 valves). Total rate of infection was 5.8%.
Conclusions: In our opinion, a strict concept of avoiding frequent shunt complications such as overdrainage, infection and proximal shunt obstruction, leads to a better rate of valve and shunt survival compared to series in the literature even if prophylactic revisions are performed. More studies are needed to determine the neurocognitive benefit of this concept.
