TY - JOUR
T1 - Adjustable vs set-pressure valves decrease the risk of proximal shunt obstruction in the treatment of pediatric hydrocephalus
AU - McGirt, Matthew J.
AU - Buck, Donald W.
AU - Sciubba, Daniel
AU - Woodworth, Graeme F.
AU - Carson, Benjamin
AU - Weingart, Jon
AU - Jallo, George
PY - 2007/3/1
Y1 - 2007/3/1
N2 - 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.
AB - 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.
KW - Adjustable valve
KW - Hydrocephalus
KW - Shunt failure
KW - Valve type
UR - http://www.scopus.com/inward/record.url?scp=33846670577&partnerID=8YFLogxK
U2 - 10.1007/s00381-006-0226-0
DO - 10.1007/s00381-006-0226-0
M3 - Article
C2 - 17106749
AN - SCOPUS:33846670577
SN - 0256-7040
VL - 23
SP - 289
EP - 295
JO - Child's Nervous System
JF - Child's Nervous System
IS - 3
ER -