Programmable Shunt Valves for Pediatric Hydrocephalus: 22-Year Experience from a Singapore Children’s Hospital

Abstract

(1) Background: pediatric hydrocephalus is a challenging condition. Programmable shunt valves (PSV) have been increasingly used. This study is undertaken to firstly, to objectively evaluate the efficacy of PSV as a treatment modality for pediatric hydrocephalus; and next, review its associated patient outcomes at our institution. Secondary objectives include the assessment of our indications for PSV, and corroboration of our results with published literature. (2) Methods: this is an ethics-approved, retrospective study. Variables of interest include age, gender, hydrocephalus etiology, shunt failure rates and incidence of adjustments made per PSV. Data including shunt failure, implant survival, and utility comparisons between PSV types are subjected to statistical analyses. (3) Results: in this case, 51 patients with PSV are identified for this study, with 32 index and 19 revision shunts. There are 3 cases of shunt failure (6%). The mean number of adjustments per PSV is 1.82 times and the mean number of adjustments made per PSV is significantly lower for MEDTRONIC™ Strata PSVs compared with others (p = 0.031). Next, PSV patients that are adjusted more frequently include cases of shunt revisions, PSVs inserted due to CSF over-drainage and tumor-related hydrocephalus. (4) Conclusion: we describe our institutional experience of PSV use in pediatric hydrocephalus and its advantages in a subset of patients whose opening pressures are uncertain and evolving.

Engineering innovations in medicine and biology: Revolutionizing patient care through mechanical solutions

“…One of their key challenges is ensuring that the devices remain functional for long periods of time without the need for revision surgery [ [30] , [31] , [32] ]. Examples of shunt designs created by engineers include i) programmable shunts which have an adjustable pressure valve that can be remotely adjusted by a healthcare provider, allowing for more precise control of fluid drainage [ [28] , [29] , [33] , [34] , [35] ] ( Fig. 1 , B); ii) anti-siphon shunts which are designed to prevent fluid from flowing back into the brain, a condition known as “siphoning” [ 36 , 37 ].…”

Shunt Over-drainage, Slit Ventricle Syndrome, Programmable Valves and Anti-Siphon Devices. A Narrative Review of a Multifactorial and Intractable Problem

“…There is ongoing controversy regarding the most appropriate treatment algorithm for patients suffering from pediatric hydrocephalus [1,10,32]. A lot of literature reports exist that point out the increased failure rate which is intimately related with the insertion of a VPS estimates exist that it could reach the level of 40% during the first year after shunt insertion.…”

“…Given the inherent heterogeneity that is associated with the pathologic substrate that accompanies the cases of pediatric hydrocephalus, the individual characteristics of every patient should be taken into consideration in order to make our ultimate choice regarding the most appropriate PSV. According to a recent publication [1], there are very specific indications that render the utilization of programmable opening pressure valves as mandatory. These include all patients for whom there is uncertainty regarding the selection of the optimum opening pressure, along with a specific subgroup of patients that are prone to the development of alterations in CSF dynamics over time.…”

“…Hydrocephalus currently consists the most commonly encountered pathological entity related to neurosurgery in the pediatric population [1][2][3][4]. The affected individuals constitute a relatively large proportion of the children population that is admitted to the hospital [5].…”

The programmable valve of a ventriculoperitoneal shunt for hydrocephalus

“…Figure 1 (front cover of this edition) shows a 3-D reconstruction of a computed tomography (CT) scan of the skull of a patient who developed normal pressure hydrocephalus months after severe traumatic brain injury. 1 A programmable valve 2 was implanted as part of a right posterior parietal ventriculoperitoneal shunt using the Keen´s point (3 cm posterior, 3 cm superior to the ear's pinna). 3 On a ventriculoperitoneal shunt, the cerebrospinal fluid (CSF) flow is, due to the valve, unidirectional, and the CSF is drained from the lateral ventricle to the peritoneum.…”