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66th Annual Meeting of the German Society of Neurosurgery (DGNC)
Friendship Meeting with the Italian Society of Neurosurgery (SINch)

German Society of Neurosurgery (DGNC)

7 - 10 June 2015, Karlsruhe

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The risk of a shunt dysfunction may be higher with gravitational non-programmable valves

Meeting Abstract

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  • Dino Saban - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • Daniela Pierscianek - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • Nicolai El Hindy - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • Anna Bohrer - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • Ulrich Sure - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • Oliver Müller - Klinik für Neurochirurgie, Universitätsklinikum Essen

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocP 171

doi: 10.3205/15dgnc569, urn:nbn:de:0183-15dgnc5699

Published: June 2, 2015

© 2015 Saban et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: The use of ventriculoperitoneal shunts in the management of hydrocephalus is not devoid of risks, and consequently the dysfunction of a shunt is very often the main concern after implantation. Many different valves offering different mechanisms of action are available, and the choice of the model is assigned to the neurosurgeon. Evidence or guidelines beyond expert opinions regarding the usage of a certain valve for the treatment of a defined hydrocephalic condition are lacking. The aim of this study is to give an overview on the probability of a shunt dysfunction due to a primary valve malfunction.

Method: Between October 2008 and December 2013, 472 shunts were primarily implanted for various hydrocephalic disorders at our institution. Of these, 291 were differential pressure valves (slit valve unishunts (Integra Unishunt® or Hakim precision valves), 24 were gravitational valves (eg PediGav®), and 147 were programmable valves (Hakim Medos progr. Valve, and Certas®). Gravitational non-programmable valves only represented a minority of implanted devices (24 valves or 5,1% of all primarily implanted devices) and were mostly implanted in a pediatric population.

Results: Overall rate of shunt revisions due to a primary valve malfunctioning was 3.4% (16/472). Surprisingly, non-programmable gravitational valves represented a very high percentage of all valve failures (50% = 8/16, or 30% referring to the implanted gravitational valves only). In addition, 3 programmable differential pressure valves and further, non-programmable differential pressure valves had to be replaced. Malfunctioning of the programmable differential pressure valves mainly occurred after repeated MRI examinations.

Conclusions: From our data we suggest that reliable functioning of the shunt valves is still a matter of great concern. We were surprised to find that gravitational, fixed-staged pressure valves had an unexpectedly high rate of failure. This might be due to the fact that these valves were mainly implanted in young infants and siblings, who are prone to a higher rate of shunt failures in general. Furthermore, the MRI safety in some programmable valves should be increased due to the growing demand for this examination in the general population.