Abstract
Shunts with distal slit valves have been in use for almost three decades for children with hydrocephalus. Drawbacks of this device include shunt obstruction, infection and overdrainage. Onepiece shunts have been used widely for ventriculoperitoneal insertion because they are easy to place, do not need manipulation of connecting parts during surgery and rarely disconnect. Disadvantages of these shunts, however, include a relatively higher risk of distal obstruction than with the open-ended peritoneal tube and a tendency for overdrainage. With these disadvantages in mind, we hypothesized that using double-distal-slit valves could increase the survival rate of the shunt. For the past 2 years we have been using a one-piece shunt with double-distal-slit valves and an elliptical reservoir under a strict protocol. The study showed the following. (1) Among the children operated on 30.3% required shunt revisions (0.9 revisions per patient). Children with intraventricular hemorrhage-posthermorrhagic hydrocephalus had a three times higher risk of shunt revision than children with posttraumatic hydrocephalus (55.4% vs 18.8%). (2) The so-called slit-ventricle syndrome was observed in only 4 children (8.5%), who subsequently required surgical attention. Most of the children with other forms of the overdrainage phenomenon continued to do well without clinical problems. (3) Of the 155 children, 7 (4.5%) experienced infections after the initial shunt installation. (4) Of the 136 shunt revisions, 90.4% (123 procedures) were related to obstruction. Distal obstruction (47.1%) was more frequent than proximal obstruction (36.6%). (5) In 8 children, the shunt was still working through the proximal set of valves when the distal set of valves was completely obstructed. Although a perfect shunt has not yet been developed, the shunt with a double-distal-slit valve is effective in the treatment of children with hydrocephalus and could increase shunt survival time.
Similar content being viewed by others
References
Amacher AL, Wellington J (1984) Infantile hydrocephalus: long-term results of surgical therapy Child's Brain 11: 217–229
Ames RH (1967) Ventriculo-peritoneal shunts in the management of hydrocephalus. J Neurosurg 27: 525–529
Carteri A, Longatti PL, Gerosa M, et al (1979) Complications due to incongruous drainage of shunt operations. Adv Neurosurg 8: 193–203
Collman H, Maversberger W, Mohr G (1979) Clinical observations and CSF absorption studies in the slit ventricle syndrome. Adv Neurosurg 8: 183–186
Di Rocco C, Mancinelli R, Pola P Velardi F (1981) A modified slit-valve shunt prototype for the management of hydrocephalus. J Neurosurg 54: 763–766
Ekstedt J, Friden H (1980) Hydrodynamic properties of CSF shunt systems. In: Shulman K, Marmarou A, Miller R, et al (eds) Intracranial pressure IV. Springer, Berlin Heidelberg New York, pp 483–488
Engel M, Carmel PW, Chutorian AM (1979) Increased intraventricular pressure without ventriculomegaly in children with shunts: “normal volume” hydrocephalus. Neurosurgery 5: 549–552
Epstein FJ, Fleischer AS, Hochwald GM et al (1974) Subtemporal craniectomy for recurrent shunt obstruction secondary to small ventricles. J Neurosurg 41: 29–31
Epstein F, Marlin AE, Wald A (1978) Chronic headache in the shunt-dependent adolescent with nearly normal ventricular volume: diagnosis and treatment. Neurosurgery 3: 351–355
Epstein F, Lapras C, Wisoff JH (1988) “Slit-ventricle syndrome”: etiology and treatment. Pediatr Neurosci 14: 5–10
Ersahin Y, McLone DG, Storrs BB, et al (1989) Review of 3, 017 procedures for the management of hydrocephalus in children. Concepts Pediatr Neurosurg 9: 21–28
George R, Leibrock L, Epstein M (1979) Long-term analysis of cerebrospinal fluid shunt infections: a 25-year experience. J Neurosurg 51: 804–811
Griebel R, Khan M, Tan L (1985) CSF shunt complications: an analysis of contributory factors. Child's Nerv Syst 1: 77–80
Gruber R, Jenny P, Herzog B (1984) Experiences with the antisiphon device (ASD) in shunt therapy of pediatric hydrocephalus. J Neurosurg 61:156–162
Hahn YS, McLone DG, Raimondi AJ, et al (1983) Surgical outcome of preterm newborns with severe periventricular-intraventricular hemorrhage and post-hemorrhagic hydrocephalus. Concepts Pediatr Neurosurg 4: 66–80
Holness RO, Hoffman HJ, Hendrick EB (1979) Subtemporal decompression for the slit-ventricle syndrome after shunting in hydrocephalic children. Child's Brain 5: 137–144
Hyde-Rowan DM, Rekate HL, Nulsen FE (1982) Reexpansion of previously collapsed ventricles: the slit ventricle syndrome. J Neurosurg 56: 536–539
Ignelzi RJ, Kirsch WM (1975) Follow-up analysis of ventriculo-peritoneal and ventriculoatrial shunts for hydrocephalus. J Neurosurg 42: 679–682
Kiekens R, Mortimer W, Pothmann R, et al (1982) The slit-ventricle syndrome after shunting in hydrocephalic children. Neuropediatrics 13: 190–194
Mazza C, Pasqualin A, Da Pian R (1980) Results of treatment with ventriculoatrial and ventriculoperitoneal shunt in infantile nontumoral hydrocephalus. Child's Brain 7: 1–14
McLaurin RL, Olivi A (1987) Slitventricle syndrome: review of 15 cases. Pediatr Neurosci 13: 118–124
Mori K, Raimondi AJ (1975) An analysis of external ventricular drainage as a treatment for infected shunts. Child's Brain 1: 243–250
Nulsen FE, Spitz EB (1951) Treatment of hydrocephalus by direct shunt from ventricle to jugular vein. Surg Forum 2: 399–403
Oi S, Matsumoto S (1986) Morphological findings of postshunt slit-ventricle in experimental canine hydrocephalus: aspects of causative factors of isolated ventricles and slit-ventricle syndrome. Child's Nerv Syst 2: 179–184
Olsen L, Frykberg T (1983) Complications in the treatment of hydrocephalus in children: a comparison of ventriculoatrial and ventriculoperitoneal shunts in a 20-year material. Acta Paediatr Scand 72: 385–390
Portnoy HD, Schulte RR, Fox JL, et al (1973) Anti-siphon and reversible occlusion valves for shunting in hydrocephalus and preventing postshunt subdural hematomas. J Neurosurg 38: 729–738
Raimondi AJ, Robinson JS, Kuwawura K (1977) Complications of ventriculo-peritoneal shunting and a critical comparison of the three-piece and one-piece systems. Child's Brain 3:321–342
Renier D, Lacombe J, Pierre-Kahn A, et al (1984) Factors causing acute shunt infection: computer analysis of 1174 operations. J Neurosurg 61: 1072–1078
Sainte-Rose C, Hooven MD, Hirsch JF (1978) A new approach in the treatment of hydrocephalus. J Neurosurg 66: 213–226
Sainte-Rose C, Hoffman HJ, Hirsch JF (1989) Shunt failure. Concepts Pediatr Neurosurg 9: 7–20
Salmon JH (1978) The collapsed ventricle: management and prevention. Surg Neurol 9: 349–352
Schmidt H, Korinthenberg R, Erlemann R, et al (1987) Computed tomography changes in children with shunted hydrocephalus and intermittent cranial pressure changes. RÖFO Fortschr Geb Röntgenstr Nuklearmed 147: 403–407
Sekhar LN, Moossy J, Guthkelch AN (1982) Histological study of the obstructing agents in ventriculoperitoneal shunts. Monogr Neural Sci 8: 59–62
Venes JL (1976) Control of shunt infection: report of 150 consecutive cases. J Neurosurg 45: 311–314
Walsh JW, James HE (1982) Subtemporal craniectomy and elevation of shunt valve opening pressure in the management of small ventricle-induced cerebrospinal fluid shunt dysfunction. Neurosurgery 10: 698–703
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hahn, Y.S. Use of the distal double-slit valve system in children with hydrocephalus. Child's Nerv Syst 10, 99–103 (1994). https://doi.org/10.1007/BF00302772
Issue Date:
DOI: https://doi.org/10.1007/BF00302772