Document Detail

Adjustable vs set-pressure valves decrease the risk of proximal shunt obstruction in the treatment of pediatric hydrocephalus.
MedLine Citation:
PMID:  17106749     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: The use of programmable shunt valves has increased dramatically in the practice of pediatric hydrocephalus. Despite theoretical advantages, it remains unclear if the use of programmable vs set-pressure valves affects shunt outcome. MATERIALS AND METHODS: The clinical and radiological records of all pediatric patients undergoing ventriculoperitoneal (VP), ventriculopleural (VPl), and ventriculoatrial (VA) shunt surgery from 2001 to 2004 at an academic institution were reviewed. The association of programmable vs set-pressure valves with subsequent shunt revision was assessed by Kaplan-Meier shunt survival plots and log-rank analysis. RESULTS: A total of 279 VP, VPl, and VA shunt surgeries were performed on patients with median (interquartile range) age of 4 (1-14) years (161 male, 118 female; 158 communicating, 122 obstructive hydrocephalus). Programmable valves were used in 76 (27%) cases and set-pressure valves in 203 (73%). At mean+/-SD follow-up of 17 +/- 13 months, programmable vs set-pressure valves were associated with reduced risk of both overall shunt revision [26 (35%) vs 109 (54%); relative risk (RR) (95% CI); 0.61 (0.41-0.91), p = 0.016] and proximal obstruction [9 (12%) vs 58 (28%); RR (95% CI); 0.39 (0.27-0.80), p = 0.006]. There was no difference in distal obstruction [3 (4%) vs 11 (5%) cases], infection [6 (8%) vs 12 (6%) cases], valve obstruction [0 (0%) vs 4 (2%)], or shunt disconnection [2 (3%) vs 1 (1%)] between adjustable and set-pressure valves, respectively. CONCLUSION: In our experience, the use of programmable vales was associated with a decreased risk of proximal shunt obstruction and shunt revision. Programmable valves may be preferred in patients frequently experiencing proximal shunt failure. A prospective, controlled study is warranted to evaluate the potential value of adjustable vs set-pressure valve systems.
Matthew J McGirt; Donald W Buck; Daniel Sciubba; Graeme F Woodworth; Benjamin Carson; Jon Weingart; George Jallo
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2006-11-15
Journal Detail:
Title:  Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery     Volume:  23     ISSN:  0256-7040     ISO Abbreviation:  Childs Nerv Syst     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-01-26     Completed Date:  2007-11-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8503227     Medline TA:  Childs Nerv Syst     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  289-95     Citation Subset:  IM    
Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 8-161, Baltimore, MD 21287, USA.
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MeSH Terms
Cerebrospinal Fluid Shunts / adverse effects*,  instrumentation
Child, Preschool
Equipment Failure
Follow-Up Studies
Hydrocephalus / complications,  surgery*
Intracranial Hypertension / etiology,  prevention & control*
Postoperative Complications / etiology,  prevention & control*
Retrospective Studies
Risk Assessment
Treatment Failure

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