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62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

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First treatment results with the new adjustable gravitational unit ProSA in pediatric neurosurgery

Meeting Abstract

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  • C.A. Tschan - Neurochirurgische Klinik und Poliklinik, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar
  • P. Dodier - Neurochirurgische Klinik und Poliklinik, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar
  • A. Huthmann - Neurochirurgische Klinik und Poliklinik, Sektion Pädiatrische Neurochirurgie, Universitätsmedizin Mainz, Johannes Gutenberg Universität, Mainz
  • S. Vulcu - Neurochirurgische Klinik und Poliklinik, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar
  • J. Oertel - Neurochirurgische Klinik und Poliklinik, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar
  • W. Wagner - Neurochirurgische Klinik und Poliklinik, Sektion Pädiatrische Neurochirurgie, Universitätsmedizin Mainz, Johannes Gutenberg Universität, Mainz

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocDI.07.09

doi: 10.3205/11dgnc153, urn:nbn:de:0183-11dgnc1535

Published: April 28, 2011

© 2011 Tschan 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 and slit ventricle syndrome is a well-known complication in shunted pediatric hydrocephalus. There was no adjustable gravitational unit available so far.

Methods: Fourty-seven children with a first diagnosis of hydrocephalus, arrested hydrocephalus, slit ventricle syndrome or overdrainage (age range 3–18 y) underwent implantation of a new adjustable shunt assistant (ProSA, Aesculap Miethke, Tuttlingen/Potsdam, Germany) in addition to the existing shunt or in case of first shunt in combination with an adjustable differential pressure valve from May 2009 to December 2010. The initial opening pressure was chosen according to the experience with non-adjustable shunt assistants. In 15 cases, the proSA was combined with an additionally implanted adjustable differential pressure valve (proGAV). In 5 cases, the shunt valves were adjusted under long-time telemetric ICP-home monitoring.

Results: There were no infective or other operative complications as yet. In 32 cases, the valve pressure had to be adjusted after surgery, in 19 cases more than once. Fourty-three children were symptom-free, 4 children showed reduced cephalgia under ongoing fine adjustment. The ProSA was compatible with all shunt systems. Follow-up MRI-scans showed slightly wider or normalized ventricles.

Conclusions: The new adjustable shunt assistant is highly effective in avoiding overdrainage and slit ventricle syndrome, because ongoing changes in activity and growth in pediatric patients can be taken into account. Re-operations can be avoided and a stepwise normalisation of slit ventricles can be achieved. ICP-home-monitoring revealed first results of the working mechanism of the new gravitational unit under daily life conditions. At this point in time, the combination of an adjustable differential pressure valve and an adjustable gravitational unit seems to be the optimum for pediatric patients.