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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Neurosci+Rural+Pract
2016 ; 7
(1
): 48-54
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The dilemma of complicated shunt valves: How to identify patients with
posthemorrhagic hydrocephalus after aneurysmatic subarachnoid hemorrhage who will
benefit from a simple valve?
#MMPMID26933344
von der Brelie C
; Meier U
; Gräwe A
; Lemcke J
J Neurosci Rural Pract
2016[Jan]; 7
(1
): 48-54
PMID26933344
show ga
BACKGROUND: Sophisticated shunt valves provide the possibility of pressure
adjustment and antisiphon control but have a higher probability of valve
dysfunction especially in a posthemorrhagic setting. The aim of the present study
is to analyze the clinical outcome of patients with shunt dependent
posthemorrhagic hydrocephalus after aneurysmatic subarachnoid hemorrhage (SAH) in
order to identify patients who would benefit from a simple differential pressure
valve. METHODS: From 2000 to 2013, 547 patients with aneurysmatic SAH were
treated at our institution, 114 underwent ventricular shunt placement (21.1%). 47
patients with available pre- and post-operative computed tomography scans, and an
available follow-up of minimum 6 months were included. In order to measure the
survival time which a nonprogrammable differential pressure valve would have had
in an individual patient we defined the initial equalized shunt survival time
(IESS). IESS is the time until surgical revisions of fixed differential pressure
or flow-regulated valves for the treatment of over- or under-drainage as well as
re-programming of adjustable valves due to over- or under-drainage. RESULTS:
Twenty patients were treated with fixed differential pressure valves, 15 patients
were treated with flow-regulated valves, and 12 underwent ventriculoperitoneal
(VP) shunt placement with differential pressure valves assisted by a
gravitational unit. Patients who reacted with remarkable changes of the
ventricular width after the insertion of external ventricular drainage (EVD),
before shunt placement, showed a significantly longer IESS. CONCLUSIONS: Decline
of the ventricular width after EVD placement was a predictor for successful VP
shunt therapy in the later course of disease. Possibly, this could allow
identifying patients who benefit from a simple differential pressure valve or a
flow-regulated valve, and thus could possibly avoid valve-associated
complications of a programmable valve in the later course of disease.