Ventriculoperitoneal shunt of continuous flow vs valvular shunt for treatment of hydrocephalus in adults.
BACKGROUND
Shunting for hydrocephalus is the neurosurgical procedure most frequently associated with long-term complications. We developed an alternative to valvular shunts based on a simple shunt procedure whose functioning depends on a peritoneal catheter with a highly precise cross-sectional internal diameter of 0.51 mm. Preliminary studies have shown that the shunt of continuous flow (SCF) is superior to valvular shunts for the treatment of hydrocephalus in adults. Here, we show the long-term performance of the SCF in adult patients with hydrocephalus secondary to a comprehensive variety of neurological disorders.


METHODS
In a 5-year period, ventriculoperitoneal shunting was performed on 307 patients with hydrocephalus; 114 of them were treated with the SCF and 193 controls were treated with a conventional valvular shunt. Patients were followed from 1 to 5 years after surgery; endpoint observation was considered at surgical reintervention because of shunt failure.


RESULTS
At the end of the observation period (44 +/- 17 months), the failure rate of the shunting device was 14% for the SCF and 46% for controls (P < .0002). Shunt endurance was 88% in patients with SCF and 60% in controls. Along the study, signs of overdrainage developed in 40% of patients treated with valvular shunt, but they were not observed in patients with SCF.


CONCLUSIONS
The design of the SCF was calculated according to the mean rates of cerebrospinal fluid production; it takes simultaneous advantage of the intraventricular pressure and the siphon effect and complies with the principle of uninterrupted flow, maintaining a fair equilibrium that prevents under- and overdrainage. The SCF is a simple, inexpensive, and effective treatment for hydrocephalus in adults.
Sotelo
Julio
J
Divisions of Research and Neurosurgery, National Institute of Neurology and Neurosurgery of Mexico, CP 14269 Mexico City, Mexico. jsotelo@servidor.unam.mx
Arriada
Nicasio
N
López
Miguel Angel
MA
D000293:Adolescent; D000328:Adult; D000368:Aged; D002552:Cerebral Ventricles / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D002555:Cerebrospinal Fluid / Q000502:physiology; D015170:Cerebrospinal Fluid Pressure / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery*; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000150:complications; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control*; D011187:Posture / Q000502:physiology; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D013525:Surgical Instruments / Q000009:adverse effects* / Q000592:standards; D013995:Time; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods