Article
Single-centre experiences with high pressure levels of 10/40 cmH2O and 15/50 cm H2O in GAV shunts from 2002–2018
Erfahrungen mit schwerkraftassoziierten Shuntventilen GAV 10/40 und GAV 15/50 im Zeitraum von 2002-2018
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Authors
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Tilmann Schweitzer
- Neurochirurgische Klinik und Poliklinik des Universitätsklinikums Würzburg, Sektion Pädiatrische Neurochirurgie, Würzburg, Deutschland
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Stefan Rückriegel
- Neurochirurgische Klinik und Poliklinik des Universitätsklinikums Würzburg, Sektion Pädiatrische Neurochirurgie, Würzburg, Deutschland
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Jürgen Krauß
- Neurochirurgische Klinik und Poliklinik des Universitätsklinikums Würzburg, Sektion Pädiatrische Neurochirurgie, Würzburg, Deutschland
| Published: | May 8, 2019 |
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Outline
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Objective: There is an ongoing discussion about the best shunt design in the treatment of various forms of hydrocephalus in children. Over-drainage can cause several problems, such as subdural hematoma, slit-ventricles, isolated fourth-ventricle or secondary craniosynostosis. Gravity assisted valves have different opening pressures according to a vertical or horizontal position of the body. We report on our experiences with implanted gravity assisted valves (GAV) with high-pressure levels of 10/40 cm H2O and 15/50 cm H2O in the years 2002–2018.
Methods: Over a 17-year period we analyzed the course of the children that were treated with a GAV 10/40 or GAV 15/50 shunt device. Diagnosis and regular follow-up ultrasound, head circumference, clinic, medical imaging (e.g. ultrasound if possible, MRI etc) were analysed.
Results: From 2002–2018, 249 shunt devices with a pressure level of 10/40 cm H2O and 49 devices with a pressure level of 15/50 cm H2O were implanted. As our analysis covers the whole year 2018 the analysis is not exact yet.
These higher pressure valves account for a very low number of ventricle collapse (1 bilateral, 2 unilateral) in the group of GAV 10/40 and none in the group of 15/50. A down grading due to underdrainage was needed in 6 children – mainly preterms with enlarged ventricles and low compliance.
Conclusion: Choosing the right pressure level has a significant impact on the long-term success of a shunt device. In preterms with a high compliance, the chosen level of 10/40 cm H2O might lead to underdrainage in very few cases. In all other infants and children higher pressure levels chosen by us result in extremely few cases of overdrainage thereby avoiding some possible severe secondary complications of implanted shunt devices.
