17 years of experience with shunt systems in normal pressure hydrocephalus - From differential pressure to gravitational valves
Objective: Complication rate of shunting for normal pressure hydrocephalus (NPH) has significantly improved over the last decades. Especially the use of overdrainage protection has reduced the incidence of subdural hematoma and collections. However, gravitational valves were associated with other co...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-04-01
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| Series: | World Neurosurgery: X |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590139724000243 |
| _version_ | 1827261715964755968 |
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| author | Julian Zipfel Cristina Kohlmann-Dell’Acqua Susan Noell Leonidas Trakolis |
| author_facet | Julian Zipfel Cristina Kohlmann-Dell’Acqua Susan Noell Leonidas Trakolis |
| author_sort | Julian Zipfel |
| collection | DOAJ |
| description | Objective: Complication rate of shunting for normal pressure hydrocephalus (NPH) has significantly improved over the last decades. Especially the use of overdrainage protection has reduced the incidence of subdural hematoma and collections. However, gravitational valves were associated with other complications of shunt dysfunction. We present our 17 years of experience with patients with normal pressure hydrocephalus who changed from a differential pressure valve to a gravitational valve system. Methods: We retrospectively identified all patients with the diagnosis of normal pressure hydrocephalus, in whom primary shunt implantation was performed between 2004 and 2020. Shunt implantation was performed as per our internal standard. Review of imaging, charts and patient reports was performed. Results: In total, 409 patients were included in the analysis. Mean age was 73.0 ± 7.1years. Between 2004 and 2010, predominantly Hakim valves (n = 100, 24.4%) were implanted, whilst from 2009 until 2020, proGAV valves (n = 296, 72.4%) were used. Mean follow-up was 8.9 ± 4.5 years. Initial subjective improvement of symptoms was reported in 69.9%, whilst this number decreased at the last follow-up to 29.8%. No significant differences were observed between the valves in the frequency of surgery for subdural hematoma. Shunt assistant implantation was performed in 17% of patients with Hakim valve, in 9.5% of patients with proGAV, a shunt assistant was added. Shunt obstruction was significantly higher in proGAV valves (p < 0.001). Conclusions: Our findings confirm the observation of frequent overdrainage in shunts without anti-siphon/gravitational component. Gravitational valves on the other hand may be associated with more obstruction. |
| first_indexed | 2024-03-07T16:53:05Z |
| format | Article |
| id | doaj.art-74de198877764d29aafd978f14ce7507 |
| institution | Directory Open Access Journal |
| issn | 2590-1397 |
| language | English |
| last_indexed | 2025-03-22T03:02:47Z |
| publishDate | 2024-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | World Neurosurgery: X |
| spelling | doaj.art-74de198877764d29aafd978f14ce75072024-05-01T05:09:51ZengElsevierWorld Neurosurgery: X2590-13972024-04-012210029317 years of experience with shunt systems in normal pressure hydrocephalus - From differential pressure to gravitational valvesJulian Zipfel0Cristina Kohlmann-Dell’Acqua1Susan Noell2Leonidas Trakolis3Department of Neurosurgery, University Hospital Tuebingen, Germany; Centre for Clinical Studies, Neuropsychiatric Study Centre, University Hospital Tuebingen, GermanyDepartment of Neurosurgery, University Hospital Tuebingen, Germany; Centre for Clinical Studies, Neuropsychiatric Study Centre, University Hospital Tuebingen, GermanyDepartment of Neurosurgery, University Hospital Tuebingen, GermanyDepartment of Neurosurgery, University Hospital Tuebingen, Germany; Corresponding author. Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.Objective: Complication rate of shunting for normal pressure hydrocephalus (NPH) has significantly improved over the last decades. Especially the use of overdrainage protection has reduced the incidence of subdural hematoma and collections. However, gravitational valves were associated with other complications of shunt dysfunction. We present our 17 years of experience with patients with normal pressure hydrocephalus who changed from a differential pressure valve to a gravitational valve system. Methods: We retrospectively identified all patients with the diagnosis of normal pressure hydrocephalus, in whom primary shunt implantation was performed between 2004 and 2020. Shunt implantation was performed as per our internal standard. Review of imaging, charts and patient reports was performed. Results: In total, 409 patients were included in the analysis. Mean age was 73.0 ± 7.1years. Between 2004 and 2010, predominantly Hakim valves (n = 100, 24.4%) were implanted, whilst from 2009 until 2020, proGAV valves (n = 296, 72.4%) were used. Mean follow-up was 8.9 ± 4.5 years. Initial subjective improvement of symptoms was reported in 69.9%, whilst this number decreased at the last follow-up to 29.8%. No significant differences were observed between the valves in the frequency of surgery for subdural hematoma. Shunt assistant implantation was performed in 17% of patients with Hakim valve, in 9.5% of patients with proGAV, a shunt assistant was added. Shunt obstruction was significantly higher in proGAV valves (p < 0.001). Conclusions: Our findings confirm the observation of frequent overdrainage in shunts without anti-siphon/gravitational component. Gravitational valves on the other hand may be associated with more obstruction.http://www.sciencedirect.com/science/article/pii/S2590139724000243Normal pressure hydrocephalusShuntOverdrainage |
| spellingShingle | Julian Zipfel Cristina Kohlmann-Dell’Acqua Susan Noell Leonidas Trakolis 17 years of experience with shunt systems in normal pressure hydrocephalus - From differential pressure to gravitational valves World Neurosurgery: X Normal pressure hydrocephalus Shunt Overdrainage |
| title | 17 years of experience with shunt systems in normal pressure hydrocephalus - From differential pressure to gravitational valves |
| title_full | 17 years of experience with shunt systems in normal pressure hydrocephalus - From differential pressure to gravitational valves |
| title_fullStr | 17 years of experience with shunt systems in normal pressure hydrocephalus - From differential pressure to gravitational valves |
| title_full_unstemmed | 17 years of experience with shunt systems in normal pressure hydrocephalus - From differential pressure to gravitational valves |
| title_short | 17 years of experience with shunt systems in normal pressure hydrocephalus - From differential pressure to gravitational valves |
| title_sort | 17 years of experience with shunt systems in normal pressure hydrocephalus from differential pressure to gravitational valves |
| topic | Normal pressure hydrocephalus Shunt Overdrainage |
| url | http://www.sciencedirect.com/science/article/pii/S2590139724000243 |
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