Article
Early complications and shunt revision rate in gravitation assited shunts compared to conventional differential pressure shunts
Vergleich der Shunt-Revisionsrate von gravitationsassistierten Ventilen mit konventionellen Differenzialdruckventilen im Kindesalter
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Published: | May 4, 2005 |
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Outline
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Objective
Gravitation assisted shunts suppose to provide more protection against over drainage and related complications. In order to evaluate these shunts in our clinical routine we compare complications and revision rate of gravitation assited shunts (Aesculap Miethke, Paedi-GAV) to differential pressure shunts (Medtronic, PS Medical) in pediatric patients.
Methods
We evaluated all pediatric patients who received a complete new shunt system between July 2002 and June 2004. The follow-up is 15 months (6 months – 30 months). The patients received either a gravitation assisted shunt (n=20) or a differential pressure shunt without gravitation device (n=20). The selection of the shunt system was the decision of the operating surgeon. Age, sex, etiology of hydrocephalus and previous surgeries were evenly distributed between the 2 groups.
Results
In both groups we had 5 patients (25%) who underwent shunt revision. In the gravitation assited group there were 1 revision for obstruction of the proximal catheter and 4 revisions for assumed under drainage (wide ventricles but no true clinical evidence for shunt malfunction or increased intracranial pressure). The latter 4 patients were revised during the early phase of introduction of this new shunt system to our department. In the differential pressure group we saw 2 patients with distal catheter obstruction, 2 patients with proximal catheter obstruction and 1 patient with over drainage.
Conclusions
So far both shunt systems have the same short-term revision rate. The use of the new gravitation assited shunt has a learning curve. The larger size of the ventricles does not always correlate with the clinical status of the patient. Some of the revisions we performed might not have been necessary. We saw no over drainage with gravitation assited shunts. Further follow-up is warranted to recognize and compare long term complications and revision rates.