Article
Utilisation of an adjustable gravitational shunt-assistant for first-line hydrocephalus treatment in preterm neonates and infants below one year of age
Die Verwendung programmierbarer Gravitationseinheiten für die Hydrocephalus-Primärtherapie bei Frühgeborenen und Säuglingen
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Authors
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Hans Christoph Bock
- Universitätsmedizin Göttingen, Neurochirurgie, Schwerpunkt Pädiatrische Neurochirurgie, Göttingen, Deutschland
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Hans-Christoph Ludwig
- Universitätsmedizin Göttingen, Neurochirurgie, Schwerpunkt Pädiatrische Neurochirurgie, Göttingen, Deutschland
| Published: | May 8, 2019 |
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Outline
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Objective: Shunt treatment for hydrocephalus in children should aim for sustainable flexibility in regard to perspective pressure level adjustment during advancing physical development. Gravitation-assisted shunt valves are designed to prevent hydrostatic overdrainage frequently observed in the long course of shunt-treated hydrocephalus. We retrospectively investigated the implication, safety and feasibility for an adjustable gravitational-unit combined with a fixed differential-pressure (DP) valve for neonates and infants primary shunted within the first 10 months of life.
Methods: We used our prospective institutional Paediatric Hydrocephalus and Shunt Registry to analyse clinical course of neonates and infants who received VP-shunt insertion in the early postnatal phase, equipped with a fixed DP-valve and a programmable gravitational unit activated in upright body position. Only patients with a minimum follow-up of 24 months after initial shunt insertion were considered for further statistical analysis regarding VP-shunt surgical setting, type and number of shunt complications, shunt- and valve survival, initial pressure setting and utilization of the adjustment option for the gravitational unit.
Results: 53 patients received VP-shunt insertion between 0 and 10 months postpartum (mean 1.2±3.0months) with a mean follow-up of 48 months. Thirty-six patients (68%) presented with history of prematurity (gestational age 23–36 weeks, mean 29.2 weeks). Hydrocephalus was related to perinatal IVH (66%), spina bifida (13%), cns-malformation (8%), congenital aqueductal stenosis (11%) or unknown etiology (2%). Pressure level adjustment was performed in 27% of all patients after 12 months, in 40% after 24 months and in 60% at the time of last clinical follow-up since initial shunt insertion.
Conclusion: The combination of a fixed DP-valve with an adjustable gravitational unit was feasible in a highly vulnerable subgroup of hydrocephalic infants. The adjustment option for the gravitational unit showed increasing implication over time and was beneficial even during the very early developmental stage of limited autonomous mobility.
