gms | German Medical Science

Objective: The overdrainage of shunts in the treatment of pediatric hydrocephalus is – in the long-term – one of the most frequent and most challenging complications. Since many years, anti-gravity valves are available to treat overdrainage. We studied retrospectively possible differences in the course of hydrocephalus treatment when using shunt-assistants with fixed opening pressures (SA; 10 - 35 cm H₂O) versus shunt-assistants with postoperatively adjustable opening pressures (proSA; 0-40 cm H₂O) (Miethke, Potsdam, Germany).

Method: The data of 46 children, aged 0-16 years and operated on in the Department of Pediatric Neurosurgery Mainz between 2003 and 2012, were evaluated. The studied parameters were the type of shunt-assistant (SA versus proSA), the time of recovery from complaints and the frequency of necessary secondary operations.

Results: In 27 children, a shunt-assitant with fixed opening pressure (SA) and in 19 patients, a shunt-assistant with postoperatively adjustable opening pressure (proSA, both devices Miethke, Potsdam, Germany) was implanted. From the 27 children with SA, 15 (55%) had to undergo a revision surgery (change of the valve) because of ongoing slit ventricle problems. In the 19 cases with proSA, the opening pressure had to be a adjusted in the postoperative period up to 9 times per patient (average of adjustements during the first year: 2.3 per patient), but no revision surgery was necessary. The mean time until recovery from complaints was 6 years in SA patients and 2 years in proSA patients.

Conclusions: The results confirm the a priori plausibility assumption that the frequency of necessary revision surgeries and the recovery time are markedly lower when using a postoperatively adjustable shunt-assistant. In particular the reduction of secondary surgeries overweighs the primarily higher costs of adjustable shunt assitants.