Valve pressure adjustments of cerebrospinal fluid shunts – longitudinal analysis of 614 patients

Abstract

Background The implantation of a cerebrospinal fluid (CSF) shunt is one of the most common interventions in neurosurgery. However, there is a high rate of re-interventions e.g., surgical revisions, changes of valve pressure or radiological examinations. Various operating techniques, shunt valves and settings have been used in the past decades. Our goal was to investigate the clinical and technical characteristics influencing the need for intervention. Methods 614 patients between 2000 and 2019 which were treated surgically or seen as out-patients with a CSF-shunt dependent hydrocephalus at our department were longitudinally analyzed. Interventions were defined as any change in valve pressure setting or revision surgery. The clinical and technical data were retrospectively collected and analyzed using integrated regression and cox regression. Results 289 (47.1%) male and 325 (52.9%) female patients with a median age of 61 years (IqR: 47 – 70), with 441 (71.9%) ventriculoperitoneal shunts (VP) and 150 (24.4%) ventriculoatrial shunts, 351 (57.7%) programmable and 257 (42.3%) non-programmable shunts were documented. The median follow-up was 53.9 months (CI95%: 47.5 – 60.2, range: 0 – 463). Female patients were looked after significantly longer (60.0 months, CI95% 50.9 - 69.1). The average time until the first intervention was 98 months (IqR: 81.8 – 115.2). Gender, height, weight and BMI did not influence the need for earlier intervention. In long-term follow-up, valve pressure which never needed an intervention was influenced by the type of the shunt (VA or VP) and the programmability of the valve. Gender, height, weight and BMI had no impact on the pressure setting. Conclusion The individual pressure setting with none to fewer interventions is influenced by the programmability of the CSF-shunt, the age of the patient and the shunt-type. Gender, height, weight and BMI are not clinically relevant to identify the ideal valve pressure.