gms | German Medical Science

64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

The new proSA-Shuntsystem for modern treatment of hydrocephalus

Meeting Abstract

Search Medline for

  • Christoph A. Tschan - Neurochirurgische Klinik und Poliklinik, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar
  • Sebastian Antes - Neurochirurgische Klinik und Poliklinik, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar
  • Joachim Oertel - Neurochirurgische Klinik und Poliklinik, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocMI.02.08

doi: 10.3205/13dgnc299, urn:nbn:de:0183-13dgnc2998

Published: May 21, 2013

© 2013 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

Text

Objective: The proSA-Shuntsystem is the first that combines an adjustable differential with an adjustable gravitational valve. The system allows individual settings of the opening pressure for the horizontal (0–20 cm H2O) and the vertical (0–40 cm H2O) body position. This study presents a 3-year-experience with the new system.

Method: Between January 2010 and November 2012 a total of 285 patients (mean age: 47.3y, range 0.25 to 87y) underwent implantation of the proSA-Shuntsystem. The shunt combination consists of a pumpable control reservoir, an adjustable differential pressure valve and an adjustable gravitational valve in series. 82 proSA-Shuntsystems were individually adjusted under long-term telemetric ICP monitoring, both in hospital and at home. The system was implanted in normal pressure hydrocephalus (39%), malresorptive hydrocephalus (33%), occlusive hydrocephalus (20%) and benign intracranial hypertension (8%). One hundred forty-nine proSA-Shuntsystems were used for first-time shunt, the other 136 were applied within shunt revision surgery.

Results: The opening level of the differential pressure valve was postoperatively adjusted averagely 2.3 times. The gravitational valve was adjusted 3.4 times. In complex cases the settings of the valves had to be changed up to 17 times. By using telemetric ICP monitoring optimal and individually adapted pressure settings could be realized. Therefore, differential pressure valve settings referred to overnight ICP monitoring whereas the gravitational valve adjustments were adapted to ICP values in the upright body position. Subsequently, performed valve settings directly correlate to the patients’ ICP, their clinical improvement and the pump function of the control reservoir. The newly implanted shunt system had to be revised 49 times: dislocation of the abdominal catheter (n=27), shunt infection (n = 12), valve occlusions (n = 5), ventricle catheter misplacement (n = 4) and loss of valve adjustability (n = 1). The overall shunt infection rate was 4.2 %.

Conclusions: The new proSA-Shuntsystem is a stable and safe valve combination. It enables postoperative valve adjustments, both in the vertical and horizontal body position. Thus, an ideal valve setting according to the patient’s individual needs is possible. In addition, the long-term telemetric ICP monitoring proved the adjustability of both valves being an important feature in modern treatment of hydrocephalus.