gms | German Medical Science

65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Shunt-valve adjustment assisted by telemetric long-term ICP monitoring

Meeting Abstract

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  • Michael Heckelmann - Neurochirurgische Klinik, Universitätskliniken des Saarlandes, Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar
  • Sebastian Antes - Neurochirurgische Klinik, Universitätskliniken des Saarlandes, Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar
  • David Breuskin - Neurochirurgische Klinik, Universitätskliniken des Saarlandes, Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar
  • Joachim Oertel - Neurochirurgische Klinik, Universitätskliniken des Saarlandes, Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar
  • Christoph A. Tschan - Neurochirurgische Klinik, Universitätskliniken des Saarlandes, Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMO.04.02

doi: 10.3205/14dgnc014, urn:nbn:de:0183-14dgnc0142

Published: May 13, 2014

© 2014 Heckelmann 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: Shunt treated patients are prone to develop symptomatic over- or underdrainage. To deal with these complications, adjustable valves have been developed. The technical progress in shunt systems with combined adjustable differential pressure and adjustable gravitational valves causes a new clinical challenge to determine the optimal valve settings. Since telemetric long-term ICP monitoring is possible, it constitutes a new tool which can be utilized to optimize the shunt valve adjustments to the individual pathology.

Method: In a total of 104 patients (mean age 55 ± 23.8 years, range 1–91 years) hydrocephalus was diagnosed by telemetric long-term ICP monitoring (Raumedic Neurovent P-tel, Raumedic Helmbrechts, Germany). Etiologies were NPH (50%) BIH (9.3%) occlusive hydrocephalus (12%) congenital (10.2%) malresorptive hydrocephalus (6.5%) Chiari malformation (4.8%) posttraumatic (4.8%) and postinfectious (3.8%). All these 104 patients were treated with the new proSA shunt system (Aesculap/Miethke, Tuttlingen/Potsdam, Germany), consisting of combined adjustable differential and adjustable gravitational valves. The settings of the shunt valves were optimized by ongoing telemetric ICP measurement. The differential pressure valve was adjusted according the horizontal body position represented by telemetric overnight monitoring. The gravitational valve was adjusted according to the measurements in the vertical body position.

Results: The data analysis of 25,000 hours of telemetric ICP monitoring and clinical observation revealed a trend towards “normalized” ICP in the horizontal body position with a mean of +5 mmHg (range 0–10 mmHg) and in a vertical body position with a mean of -5 mmHg (range –10 to 0 mmHg). More negative ICP values than –10mmHg correlated with clinical symptoms of overdrainage. In the 104 patients, a total of 305 valve adjustments were performed. On the average 2.9 adjustments per patient were necessary to achieve the best clinical outcome.

Conclusions: The telemetric long-term ICP monitoring is very helpful in understanding and optimizing the valve settings. The disappearance of clinical symptoms was found to be dependent on the “normalized” ICP in horizontal and vertical body position. Therefore, there is a need for both, adjustable differential pressure and gravitational valves, in order to achieve nearly physiological drainage conditions.