Gravitational Shunt Complications After a Five-Year Follow-Up

Abstract

G-valves demonstrate sufficient long-term performance over multiple years, and real shunt-related complications are rare. The frequency of revision due to overdrainage is low (4.5%).

Performance of fixed-pressure valve with antisiphon device SPHERA® in hydrocephalus treatment and overdrainage prevention

“…All these complications are severe, require reoperation, and may cause death 2,3,[7][8][9][10][11][12][13] . Currently, there is a consensus that, whenever possible and indicated, one should avoid VS implantation when a high complication rate is identified in the long-term (mean of 60 months) of up to 51% of cases; in these cases, ventricular neuroendoscopic procedures are given preference 12,[14][15][16][17] . To prevent infectious complications, the institutional adoption of protocols, such as first described by Choux, is what shows the most positive impact and control of these complications.…”

“…However, such mechanism should be implemented strictly in the vertical position to work properly. It has a rate of general complications identified in the long-term follow-up (mean of 60 months) of up to 21% of cases, of which 5% are related to hypodrainage 12 . The individual's physiological characteristics also make it difficult to determine not only the vertical level of CSF in…”

Shunting with gravitational valves—can adjustments end the era of revisions for overdrainage-related events?

“…Our results concerning the incidence of overdrainage are consistent with those reported in recent studies of other adjustable differential pressure valves, 5,7,15,25 but they reflect a relatively high rate of valve adjustments due to overdrainage (15.6%), especially compared with other series combining adjustable valves and hydrostatic devices. 8,12,20,22 Except for the pseudotumor cases, all types of hydrocephalus had overdrainage with an apparent preponderance for hypertensive and especially congenital hydrocephalus (Fig. 2).…”

PROSAIKA: A prospective multicenter registry with the first programmable gravitational device for hydrocephalus shunting

“…Gravitational devices with fixed opening pressures have proved their role in the prevention of CSF overdrainage in ventriculoperitoneal (vp) shunts [4][5][6][7]. However, the selection of the optimal opening pressure of the gravitational device for the individual patient remains difficult and patient-valve mismatch does occur [12].…”