gms | German Medical Science

Objective: Ventriculoperitoneal shunt placement is performed worldwide as a standard therapy for childhood hydrocephalus. In clinical practice, complications such as infection and shunt malfunction related to underdrainage or overdrainage are still a major concern.

Methods: A programmable valve (ProGAV 2.0 Miethke-Aesculap) with an integrated gravitational antisiphon device was implanted over a 1-year period in 22 children (14 boys and 8 girls) with hydrocephalus of various origins (intraventricular hemorrhage (n=4), tumor and aqueductal stenosis (n=9), infection (n=2), myelomeningocele (n=2), peudotumor cerebri (n=2), and post traumatic (n=3)). The initial opening pressure of the adjustable unit was set at 6 cm H2O.

Results: Age ranged from 3 months to 16 years at the time of surgery (mean age: 3.9 years; median: 11 months). The new valve was used as a replacement for a valve implanted earlier in 8 patients with valve dysfunction. The mean follow-up period was 5.6 months (range 2–12 months). We did not observe any valve-related complications, but 2 children had proximal catheter dysfunction and 3 had infections. In 9 of the 22 patients, 19 opening-pressure changes were necessary. The opening pressure was increased in 5 children with symptoms of overdrainage and decreased in 4 children with symptoms of underdrainage. Symptoms were abolished accordingly in all instances.

Conclusion: Our results show that the new programmable pediatric valve type is safe and has a reliable performance in hydrocephalic children. The valve design technology also provides protection against painful readjustment. A prospective larger trial is needed to compare the performance of different valve designs in childhood hydrocephalus.