Article
The combination of an adjustable differential pressure valve and the adjustable shunt assistent proSA in the treatment of complex pediatric hydrocephalus
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Authors
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C.A. Tschan
- Neurochirurgische Klinik und Poliklinik, Universitätskliniken des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar
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A. Huthmann
- Neurochirurgische Klinik und Poliklinik, Sektion Pädiatrische Neurochirurgie, Universitätsmedizin Mainz, Johannes Gutenberg-Universität
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G.R. Montibeller
- Neurochirurgische Klinik und Poliklinik, Universitätskliniken des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar
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J. Oertel
- Neurochirurgische Klinik und Poliklinik, Universitätskliniken des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar
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W. Wagner
- Neurochirurgische Klinik und Poliklinik, Sektion Pädiatrische Neurochirurgie, Universitätsmedizin Mainz, Johannes Gutenberg-Universität
| Published: | June 4, 2012 |
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Outline
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Objective: There was no adjustable gravitational unit available so far and for the first time there is the possibility of combining adjustable differential pressure valves with an adjustable gravitational valve (programmable shunt assistant). The idea was to use this new setting for the optimal treatment of special cases in pediatric hydrocephalus. There is no experience on the optimal valve setting of this new combined shunt system available so far and we present our first experiences here.
Methods: Forty children (0.4 to 18 yo.) underwent implantation of the new adjustable shunt assistant (proSA®, Aesculap/Miethke, Tuttlingen/Potsdam, Germany) in addition to the existing programmable differential pressure valve (15 cases) or in combination with the proGAV® adjustable differential pressure unit (25 cases). The initial opening pressure was chosen according to the experiences with non-adjustable shunt assistants or empiric experiences with common programmable differential pressure valves.
Results: The differential pressure valve was adapted to the horizontal position and the proSA depending on childrens' activity in the upright position. Raising the differential pressure valve only was not successful in 15 cases of overdrainage related headache. The stepwise increase of the programmable shunt assistant opening pressure was followed by reduced headaches after longer periods of upright body position. Headaches over night or before leaving the bed in the morning were treated by lowering the differential pressure valve but raising the proSA to avoid overdrainage. This adjustment of opening pressures was done in 8 cases with the help of long time telemetric ICP monitoring at home. After exact adaption of the combined shunt valves, all children were symptom-free.
Conclusions: The combination of a programmable differential pressure valve and the new adjustable shunt assistant proSA is highly effective in treating complex shunt related headaches in children. This valve combination allows a much more exact adaption of the shunt system to the children's growth and daily activities. Many re-operations can be avoided and a stepwise normalisation of overdrainage can be achieved. At this point of time, the combination of an adjustable differential pressure valve and the adjustable gravitational unit proSA seems to be the optimum for pediatric patients.
