Importance of Anti-Siphon Devices in Shunt Therapy of Pediatric and Adolescent Hydrocephalus
A Slit-like ventricle (SLV) is occasionally observed on computerized tomography (CT) scans in pediatric hydrocephalus. The incidence of SLV was investigated in 64 pediatrie and adolescent patients with cerebrospinal fluid (CSF) shunts in relation to their activity of daily living (ADL) and to the presence or absence of an anti-siphon device (ASD). Patients were divided into three groups. Group A had full ADL and shunt systems with ASDs. Group B had full ADL and shunt systems without ASDs. Group C consisted of bedridden patients without ASDs in their shunt systems. All patients had hypertensive hydrocephalus. All but two had ventriculoperitoneal shunts. Medium pressure valves were inserted in all. The average follow-up period was 8.8 years. The incidence of SLV was 7.4% in group A, 53.1% in group B, 20% in group C, and 31.3% for all groups. Group A had a signicantly lower incidence of SLV than group B (X2 test, P < 0.001). One patient in group B developed slit ventricle syndrome. The CSF flow patterns through the shunt were examined using our thermosensitive technique. A rapid flow pattern was observed in most of group B. By contrast, this pattern was observed in only a few cases in group A. SLV appeared in only one out of four cases in group C despite the rapid CSF flow during positional changes.
In conclusion, ASDs in the shunt system played an important role in reducing the incidence of SLV in the treatment of pediatric hydrocephalus, but some work on the use of ASDs for treating tall adolescent patients will still be necessary because of the large hydrostatic pressure involved.
KeywordsAnti-siphon device Slit-like ventricle Hydrocephalus Ventriculoperitoneal shunt Thermistor
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