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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

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Programmable valves for chronic hydrocephalus following subarachnoid haemorrhage – Is it worthwhile?

Programmierbare Ventile bei chronischem Hydrocephalus nach Subarachnoidalblutungen – Ist es sinnvoll?

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  • presenting/speaker Marvin Darkwah Oppong - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Leonie Droste - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Daniela Pierscianek - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Karsten Henning Wrede - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Laurèl Rauschenbach - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Philipp Dammann - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Annika Herten - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Ulrich Sure - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Ramazan Jabbarli - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV231

doi: 10.3205/20dgnc228, urn:nbn:de:0183-20dgnc2284

Published: June 26, 2020

© 2020 Darkwah Oppong 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: Chronic hydrocephalus is a common complication following aneurysmal subarchnoid hemorrhage (aSAH) and is routinely treated with implantation of a ventriculoperitoneal shunt (VPS). Compared to fixed-pressure valves (FPV), adjustable-pressure valves (APV) might reduce the rates of over/underdrainage necessitating revision surgery. However, due to higher implant costs and vulnerability, the clinical utility of APV in neurosurgery is still the matter of debate. The aim of this study was to analyze the pros and cons of APV use in patients with aSAH.

Methods: From a large single center retrospective aSAH database containing over 900 patients treated between 2003 and 2016, all cases undergoing VPS placement for chronic hydrocephalus were eligible for this study. Multiple clinical and radiographic factors were tested for their influence on the need for revision surgery in case of shunt valve dysfunction or over/under drainage. Independent predictors were tested using multivariate analysis. Clinical outcome was analyzed at six months follow-up with mRS >3 defined as poor outcome.

Results: A total of 189 patients were included to the final analysis. FPV were implanted in the majority of patients (173/91.5%). Revision surgery due to over/underdrainage had to be performed in 8 (4,6%) cases with FPV and in no case with APV. Higher patients’ age (>65 years, p=0.011; OR 10.36) and bone flap replacement following decompressive craniectomy (p=0.044; OR 6.53) independently predicted the need for revision surgery for over/under drainage. There was no difference in the occurrence of valve dysfunction between the two valve types (1 [6,3%] APV, 12 [6.9%] FPV), p>0.99). Patients requiring revision surgery for over/under drainage had a higher risk for poor outcome at six months follow-up (p=0.009).

Conclusion: In patients with aSAH and VPS placement, use of APV might reduce the need for revision surgery for over/under drainage, which is also associated with the functional outcome of SAH. Therefore, APV is a valuable option for aSAH individuals undergoing VPS implantation, particularly for elderly patients and those requiring decompressive craniectomy.