Management of neonatal hydrocephalus: feasibility of use and safety of two programmable (Sophy and Polaris) valves.
BACKGROUND
Neonates represent a unique group of pediatric patients with special peculiarities. Hydrocephalus valves have not always been designed to meet the requirements of these small children. Few series have addressed the problem of cerebrospinal fluid shunting in newborn babies.


OBJECTIVE
We aimed (1) to evaluate the feasibility of the use of two programmable valves (Sophy and Polaris) in hydrocephalic neonates and (2) to ascertain complications and safety issues arising from their use.


METHODS
We performed a prospective study of 100 consecutive preterm and term babies (<2 months of age) given a programmable valve. Valves' settings were readjusted at different pressure levels as required. Outcomes were obtained from the records of our Outpatient Clinic.


RESULTS
The study group was formed by 60 term and 40 preterm infants (average weight 2,440 g, mean age of 25 days). Mean follow-up was 55 months. Only one fifth deaths was shunt-related. In 70 babies, no complications occurred, and hydrocephalus was successfully controlled. Proximal catheter obstruction presented in 20% and infection in 5% of cases. Several external adjustments of the valves apparently avoided several surgical shunt revisions.


CONCLUSIONS
(1) Both programmable valves (Sophy and Polaris) can be safely used for treatment of neonatal hydrocephalus, introducing some technical modifications. (2) Both valves are comparable to other shunts with regard to indications, performance, and safety. (3) The possibility of modifying their working pressure seems to constitute their main advantage. Prevention of late overdrainage syndromes with these valves needs a longer follow-up.
Martínez-Lage
Juan F
JF
Regional Service of Neurosurgery, Virgen de la Arrixaca University Hospital, El Palmar, 30120 Murcia, Spain. juanf.martinezlage@cablemurcia.com
Almagro
María-José
MJ
Del Rincón
Isabel Sanchez
IS
Pérez-Espejo
Miguel A
MA
Piqueras
Claudio
C
Alfaro
Raúl
R
Ros de San Pedro
Javier
J
D002557:Cerebrospinal Fluid Shunts / Q000379:methods*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000473:pathology / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D012984:Software; D013525:Surgical Instruments; D014056:Tomography, X-Ray