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Arts S, van Lieshout JH, van Bilsen M, Karadag C, Beez T, van den Abbeele L, Aquarius R, Vinke S, Bartels RHMA, van Lindert EJ, Hänggi D, Boogaarts HD. Non-adjustable gravitational valves or adjustable valves in the treatment of hydrocephalus after aneurysmal subarachnoid hemorrhage patients? Acta Neurochir (Wien) 2022; 164:2867-2873. [PMID: 36149501 PMCID: PMC9613573 DOI: 10.1007/s00701-022-05361-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/03/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Hydrocephalus requiring permanent CSF shunting after aneurysmal subarachnoid hemorrhage (aSAH) is frequent. It is unknown which type of valve is optimal. This study evaluates if the revision rate of gravitational differential pressure valves (G-DPVs, GAV® system (B Braun)) (G-DPV) is comparable to adjustable pressure valves (Codman Medos Hakim) (APV) in the treatment of post-aSAH hydrocephalus. METHODS The use of a gravitational differential pressure valve is placed in direct comparison with an adjustable pressure valve system. A retrospective chart review is performed to compare the revision rates for the two valve systems. RESULTS Within the registry from Radboud University Medical Center, 641 patients with a SAH could be identified from 1 January 2013 until 1 January 2019, whereas at the Heinrich Heine University, 617 patients were identified, totaling 1258 patients who suffered from aSAH. At Radboud University Medical Center, a gravitational differential pressure valve is used, whereas at the Heinrich Heine University, an adjustable pressure valve system is used. One hundred sixty-six (13%) patients required permanent ventricular peritoneal or atrial shunting. Shunt dysfunction occurred in 36 patients: 13 patients of the 53 (25%) of the gravitational shunt cohort, and in 23 of the 113 (20%) patients with an adjustable shunt (p = 0.54). Revision was performed at a mean time of 3.2 months after implantation with the gravitational system and 8.2 months with the adjustable shunt system. Combined rates of over- and underdrainage leading to revision were 7.5% (4/53) for the gravitational and 3.5% (4/113) for the adjustable valve system (p = 0 .27). CONCLUSION The current study does not show a benefit of a gravitational pressure valve (GAV® system) over an adjustable pressure valve (CODMAN ® HAKIM®) in the treatment of post-aSAH hydrocephalus. The overall need for revision is high and warrants further improvements in care.
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Affiliation(s)
- Sebastian Arts
- grid.10417.330000 0004 0444 9382Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands ,grid.10417.330000 0004 0444 9382Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Jasper Hans van Lieshout
- grid.411327.20000 0001 2176 9917Department of Neurosurgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Martine van Bilsen
- grid.10417.330000 0004 0444 9382Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Cihat Karadag
- grid.411327.20000 0001 2176 9917Department of Neurosurgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Thomas Beez
- grid.411327.20000 0001 2176 9917Department of Neurosurgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Leonie van den Abbeele
- grid.10417.330000 0004 0444 9382Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Rene Aquarius
- grid.10417.330000 0004 0444 9382Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Saman Vinke
- grid.10417.330000 0004 0444 9382Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Ronald H. M. A. Bartels
- grid.10417.330000 0004 0444 9382Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Erik J. van Lindert
- grid.10417.330000 0004 0444 9382Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Daniel Hänggi
- grid.411327.20000 0001 2176 9917Department of Neurosurgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Hieronymus D. Boogaarts
- grid.10417.330000 0004 0444 9382Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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