Article
Valve pressure adjustment of cerebrospinal fluid shunt – longitudinal analysis of 891 patients
Ventildruckeinstellung bei Liquorshunt – longitudinale Analyse von 891 Patient:innen
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Authors
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Victoria Schön
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Österreich
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Aleksandrs Krigers
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Österreich
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Christian F. Freyschlag
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Österreich
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Claudius Thomé
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Österreich
| Published: | May 25, 2022 |
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Outline
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Objective: The implantation of a CSF shunt is one of the most common interventions in neurosurgery.
However, there is a high frequency of necessary reinterventions e.g., surgical revisions, change of valve pressure or radiological examinations. Several surgical techniques, shunt valves and settings have been used in the past years.
Our goal was to point out the clinical and technical (valve and shunt specific characteristics) aspects which could have an influence on the necessity of intervention.
Methods: We have longitudinally analysed 891 patients between 2000 and 2019 which were treated surgically or as outpatients because of a hydrocephalus with a CSF shunt at our department. Interventions were defined as any change in valve setting or revision surgery. The clinical and technical data (e.g. valve specifications) as well as the follow-ups were retrospectively collected and analysed using integrated linear regression and cox regression.
Results: 454 (51 %) male and 437 % (49 %) female patients with a median age of 48 years (IqR: 5 – 65), with 600 (67 %) ventriculoperitoneal shunts (VP) and 238 (27 %) ventriculoatrial shunts, 339 (56.9 %) programmable and 257 (43.1 %) non-programmable were analysed. The median follow-up was 40 months (IqR: 5 – 167).
The median interval between interventions was 20 months (IqR: 5 – 53). The average time until the first intervention was 57 days (IqR: 10 – 443). Concerning the cases showing a low necessity for interventions, the optimal valve pressure was 119 mm H2O (SE 4) for programmable valves and 78 mm H2O (SE 2) for non-programmable valves. In the long-term follow-up the valve pressure without intervention was influenced by the type of the shunt placement (VA or VP), the programmability of the valve and the variability of the pressure stages. Age, gender, height and weight had no impact on the pressure setting. In the largest group of the cohort – adults with VP- shunt and programmable valve – the likelihood of remaining without any change of pressure setting was only influenced by age.
Conclusion: Programmable valves in younger patients with VP-shunt require a higher initial pressure setting. Gender, height and weight showed no significant influence.
