Adjustable vs set-pressure valves decrease the risk of proximal shunt obstruction in the treatment of pediatric hydrocephalus

Matthew J. McGirt, Donald W. Buck, Daniel Sciubba, Graeme F. Woodworth, Benjamin Solomon, Jon David Weingart, George Jallo

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)289-295
Number of pages7
JournalChild's Nervous System
Volume23
Issue number3
DOIs
StatePublished - Mar 2007

Fingerprint

Hydrocephalus
Pediatrics
Pressure
Therapeutics
Prospective Studies
Survival
Infection

Keywords

  • Adjustable valve
  • Hydrocephalus
  • Shunt failure
  • Valve type

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

Cite this

Adjustable vs set-pressure valves decrease the risk of proximal shunt obstruction in the treatment of pediatric hydrocephalus. / McGirt, Matthew J.; Buck, Donald W.; Sciubba, Daniel; Woodworth, Graeme F.; Solomon, Benjamin; Weingart, Jon David; Jallo, George.

In: Child's Nervous System, Vol. 23, No. 3, 03.2007, p. 289-295.

Research output: Contribution to journalArticle

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abstract = "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.",
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AU - Solomon, Benjamin

AU - Weingart, Jon David

AU - Jallo, George

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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.

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