Artikel
Complication rates of two common programmable differential pressure hydrocephalus shunt devices – a single-centre experience
Komplikationsraten von zwei verstellbaren Shuntventilen bei der Hydrozephalusbehandlung – ein monozentrischer Erfahrungsbericht
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Autoren
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Obada T. Alhalabi
- Heidelberg University Hospital, Department of Neurosurgery, Heidelberg, Deutschland
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Carola Wieckhusen
- Heidelberg University Hospital, Department of Neurosurgery, Heidelberg, Deutschland
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Klaus Zweckberger
- Heidelberg University Hospital, Department of Neurosurgery, Heidelberg, Deutschland
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Andreas W. Unterberg
- Heidelberg University Hospital, Department of Neurosurgery, Heidelberg, Deutschland
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Alexander Younsi
- Heidelberg University Hospital, Department of Neurosurgery, Heidelberg, Deutschland
| Veröffentlicht: | 4. Juni 2021 |
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Gliederung
Text
Objective: Hydrocephalus (HC) requiring cerebrospinal fluid (CSF) flow diversion is observed in a diverse spectrum of neurosurgical diagnoses. Ventriculoperitoneal (VP) shunt placement represents one of the management modalities and is generally regarded as a novice competency neurosurgical procedure. A wide range of devices with programmable or fixed-pressure valves are available on the market, with little knowledge on differences in their specific complication rates.
Methods: A single-center retrospective analysis of all consecutive adult patients with VP shunt placement over a period of four years was performed and details on demographics, shunt devices, surgeries and complications were collected. In a subgroup analysis, the complication rates of the most commonly used programmable shunt devices (Miethke® proGAV (1.0 or 2.0) valve in combination with Miethke® shunt assistant and Codman® Certas Plus valve) were statistically compared (p < 0.05 was considered significant).
Results: Between 2015–2019, 463 eligible adult VP shunt patients could be identified (230 males, 233 females, median age 59.9 (18.2–88.5) years). Non-obstructive HC after SAH or TBI was present in 31% of the patients, followed by NPH in 18% and obstructive HC in 15%. A programmable shunt device was used in the majority of cases (85%), with Miethke® devices being implanted in 349 and Codeman® devices in 46 patients. Surgical complications occurred in 24% of cases and were often related to infection (4%) or dysfunction (5%) of the shunt systems, leading to revision surgery in 122 patients. The rate of non-surgical complications (5%) including mortality (2%) was low. A comparison of Miethke® devices with the Codman® device revealed no significant difference in terms of complications. In a “clean” cohort (n=104) of only normal pressure hydrocephalus (NPH) and idiopathic intracranial hypertension (IIH) patients, however, the rate of surgical complications was significantly higher when the Codman® Certas Plus valve was used (55% vs. 19%, p=0.016).
Conclusion: Similar to data published in the literature, VP shunt placement was associated with relevant rates of complications and revision surgeries in our current analysis. A relationship between the different types of programmable shunt devices and the occurrence of surgical complications might exist.
