McDowell MM, Chiang MC, Agarwal N, Friedlander RM, Wecht DA. Exclusive use of fixed pressure valves for cerebrospinal fluid diversion in a modern adult cohort.
Heliyon 2018;
4:e01099. [PMID:
30627679 PMCID:
PMC6312827 DOI:
10.1016/j.heliyon.2018.e01099]
[Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/25/2018] [Accepted: 12/24/2018] [Indexed: 11/23/2022] Open
Abstract
Background
There is extensive debate on the role of fixed pressure shunts in the adult population. Most studies assessing fixed pressure valves do not consider the potential for changes in technique and management of shunts. We sought to examine the natural history of fixed pressure.
Methods
We conducted a retrospective chart review of 169 patients undergoing shunt placement by the senior author Daniel Wecht (DW). The etiology of shunt placement, shunt failure rates, and outcome data was assessed for each patient.
Results
Overall, 126 patients underwent initial shunt placement. Thirty-three (26.2%) patients required at least one shunt revision during follow-up. The most common cause of first time revision was mechanical shunt malfunction (13, 39.4%), followed by infection (7, 21.2%), and shunt migration (6, 18.2%). Three patients (9.1%) required revision due to misplaced catheters. Underdrainage or overdrainage of shunts each resulted in revisions for 2 (6.1%) patients. The mean follow-up length was 28.1 ± 6.1 months.
Conclusion
Fixed pressure shunts failed primarily because of shunt malfunction and occurred most commonly in patients developing hydrocephalus as a result of hemorrhage or normal pressure hydrocephalus (NPH). The overall failure rate between these two groups was proportionally equivalent. Both overdrainage or underdrainage were found to be rare indications for revision.
Collapse