title: Long-term survival rates of gravity-assisted, adjustable differential pressure valves in infants with hydrocephalus.
abstract: OBJECTIVE The use of adjustable differential pressure valves with gravity-assisted units in shunt therapy of children with hydrocephalus was reported to be feasible and promising as a way to avoid chronic overdrainage. In this single-center study, the authors' experiences in infants, who have higher rates of shunt complications, are presented. METHODS All data were collected from a cohort of infants (93 patients [37 girls and 56 boys], less than 1 year of age [mean age 4.1 ± 3.1 months]) who received their first adjustable pressure hydrocephalus shunt as either a primary or secondary implant between May 2007 and April 2012. Rates of valve and shunt failure were recorded for a total of 85 months until the end of the observation period in May 2014. RESULTS During a follow-up of 54.2 ± 15.9 months (range 26-85 months), the Kaplan-Meier rate of shunt survival was 69.2% at 1 year and 34.1% at 85 months; the Kaplan-Meier rate of valve survival was 77.8% at 1 year and 56% at 85 months. Survival rates of the shunt were significantly inferior if the patients had previous shunt surgery. During follow-up, 44 valves were exchanged in cases of infection (n = 19), occlusion (n = 14), dysfunction of the adjustment unit (n = 10), or to change the gravitational unit (n = 1). CONCLUSIONS Although a higher shunt complication rate is observed in infant populations compared with older children, reasonable survival rates demonstrate the feasibility of using this sophisticated valve technology. The gravitational unit of this valve is well tolerated and its adjustability offers the flexible application of opening pressure in an unpredictable cohort of patients. This may adequately address overdrainage-related complications from early in treatment.
authors.affiliation: Pediatric Neurosurgery, Charité - Universitätsmedizin, Berlin, Germany.
authors.forename: Anna-Felicitas
authors.initials: AF
authors.lastname: Gebert
authors.affiliation: Pediatric Neurosurgery, Charité - Universitätsmedizin, Berlin, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Schulz
authors.affiliation: Pediatric Neurosurgery, Charité - Universitätsmedizin, Berlin, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Schwarz
authors.affiliation: Pediatric Neurosurgery, Charité - Universitätsmedizin, Berlin, Germany.
authors.forename: Ulrich-Wilhelm
authors.initials: UW
authors.lastname: Thomale
mesh_terms: D015170:Cerebrospinal Fluid Pressure; D002557:Cerebrospinal Fluid Shunts / Q000295:instrumentation; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006112:Gravitation; D006801:Humans; D006849:Hydrocephalus / Q000503:physiopathology / Q000601:surgery*; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects / Q000295:instrumentation*
keywords: DP = differential pressure; adjustable gravitational valve; hydrocephalus; infant; shunt survival; valve survival