Abstract
(1) Background: pediatric hydrocephalus is a challenging condition. Programmable shunt valves (PSV) have been increasingly used. This study is undertaken to firstly, to objectively evaluate the efficacy of PSV as a treatment modality for pediatric hydrocephalus; and next, review its associated patient outcomes at our institution. Secondary objectives include the assessment of our indications for PSV, and corroboration of our results with published literature. (2) Methods: this is an ethics-approved, retrospective study. Variables of interest include age, gender, hydrocephalus etiology, shunt failure rates and incidence of adjustments made per PSV. Data including shunt failure, implant survival, and utility comparisons between PSV types are subjected to statistical analyses. (3) Results: in this case, 51 patients with PSV are identified for this study, with 32 index and 19 revision shunts. There are 3 cases of shunt failure (6%). The mean number of adjustments per PSV is 1.82 times and the mean number of adjustments made per PSV is significantly lower for MEDTRONIC™ Strata PSVs compared with others (p = 0.031). Next, PSV patients that are adjusted more frequently include cases of shunt revisions, PSVs inserted due to CSF over-drainage and tumor-related hydrocephalus. (4) Conclusion: we describe our institutional experience of PSV use in pediatric hydrocephalus and its advantages in a subset of patients whose opening pressures are uncertain and evolving.
Highlights
Hydrocephalus is the most prevalent neurosurgical problem encountered in the pediatric population [1,2,3]
The mean number of adjustments per programmable shunt valves (PSV) is 1.82 times and the mean number of adjustments made per PSV is significantly lower for MEDTRONICTM Strata PSVs compared with others (p = 0.031)
(4) Conclusion: we describe our institutional experience of PSV use in pediatric hydrocephalus and its advantages in a subset of patients whose opening pressures are uncertain and evolving
Summary
Hydrocephalus is the most prevalent neurosurgical problem encountered in the pediatric population [1,2,3]. Programmable shunt valves (PSV) have been increasingly used for patients with hydrocephalus. This is because incorporating a valve with an adjustable opening pressure has the advantage of enabling neurosurgeons to make non-invasive alterations in the opening pressure of the valve as the patient’s clinical course temporally changes after VPS insertion [6,7,8]. Clinical studies on the efficacy of PSV have been conflicting—some have reported no significant differences in shunt failure rates between PSV versus traditional fixed pressure valves (FPV) in children [2,9], while others have demonstrated otherwise [5,10]. There exists no definite consensus regarding which type of shunt is preferred in the pediatric population, and under what circumstances they should be considered [9,11,12,13,14,15,16,17,18,19]
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