gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Preliminary clinical results with the new Codman Certas Plus valve

Meeting Abstract

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  • Sebastian Antes - Universitätskliniken des Saarlandes, Klinik für Neurochirurgie, Homburg/Saar, Deutschland
  • Axel Stadie - Universitätskliniken des Saarlandes, Klinik für Neurochirurgie, Homburg/Saar, Deutschland
  • Joachim Oertel - Universitätskliniken des Saarlandes, Klinik für Neurochirurgie, Homburg/Saar, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 066

doi: 10.3205/17dgnc629, urn:nbn:de:0183-17dgnc6298

Published: June 9, 2017

© 2017 Antes 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

Text

Objective: CSF shunting always carries a risk of clinical complications. Despite development of adjustable and gravitational valves, the problem with over- and underdrainage is still present. The perfect balance between a sufficient CSF drainage and the complete prevention of overdrainage could not be implemented in a shunt system so far. In this series, the new adjustable Codman Certas Plus valve with an integrated anti-siphon device was tested. Main focus was on the performance and the early clinical results.

Methods: Between July and October 2015, the Certas plus valve was inserted during first-time shunting in 14 cases. Patients were postoperatively observed up to November 2016. The cohort consisted of 6 females and 8 males. The mean age was 76.6 years. Etiology of hydrocephalus was idiopathic in 8, and malresorptive in 6 patients. The intraoperative handling of the valve, the postoperative clinical course, valve adjustments and clinical complications were analyzed.

Results: Intraoperatively, no problems or restrictions during catheter or valve implantation occurred. The mean operation time was 46.2 ± 11.9 min (range: 24 – 64 min). All intended valve settings could be confirmed in the postoperative x-ray series. In all patients, a total of 10 valve adjustments for various reasons were performed. These adjustments were without any restrictions and always evaluated as very simple. During the postoperative course, 7 patients reported an improvement of former symptoms while 3 patients felt unchanged. A clinical deterioration occurred in 4 patients due to shunt-dysfunction (1/4), shunt infection (1/4) and overdrainage-associated subdural hygroma (2/4). Revision surgery with valve exchange (1/4), shunt explantation (1/4) and evacuation of subdural hygroma (2/4) followed.

Conclusion: The good intraoperative handling and the very simple adjustability represent benefits of the new valve. The occurrence of early overdrainage with subdural hygroma requires further analysis. In both patients, a low valve setting (Performance level 3) was chosen during insertion. However, this setting corresponds to a pressure level of about 80 mmH2O. The patients with an initial performance level of 4 or higher (n=9) improved or felt unchanged in the short-term course. To verify reproducibility and regularity of this phenomenon higher case numbers are required.