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Overcoming CSF overdrainage with the adjustable gravitational valve proSA

  • Clinical Article - Pediatrics
  • Published:
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Abstract

Background

Despite progress in shunt valve technology, CSF overdrainage is still one of the most frequent complications in shunt-treated hydrocephalus. Particularly with regard to young and adolescent patients, treatment of manifest overdrainage is complicated by several hardly influenceable factors such as increasing height and mobility. Therefore, the aim of this study was to evaluate the therapeutic efficiency of the new adjustable gravitational valve, proSA.

Methods

Sixty-four shunt-treated young hydrocephalus patients aged 1.8–41.4 years (15.5 ± 10.5 years) suffering from clinical and/or radiological overdrainage underwent shunt revision surgery with the implantation of the new proSA valve. Clinical outcome after a 1-year follow-up period, pumping function of the valve chambers as well as the number of necessary postoperative valve adjustments were examined.

Results

Fifty-five patients completed the study as planned. All reported a significant improvement of their clinical condition; 91 % described a complete resolution in symptoms related to overdrainage. Preoperatively, more than 85 % of the valve chambers showed no or very slow refilling with CSF. After a year of proSA treatment, more than 90 % exhibited a normal valve chamber function. During the follow-up period, a total of 136 valve adjustments were necessary. None of the proSA valves had to be surgically revised.

Conclusions

The postoperative adjustability of the opening pressure level is the advantage of the new gravitational valve. The good clinical outcome is attributed to the new valve technology. The proSA appears to be a promising shunt valve to overcome overdrainage in adolescent and adult hydrocephalus patients.

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Acknowledgments

We thank Dr. Samuel Orie (Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany) for revising the manuscript with respect to English grammar and language.

Conflicts of interest

Christoph A. Tschan, Sebastian Antes and Alexandra Huthmann received some financial compensation from Aesculap Miethke AG (Tuttlingen, Germany) for attending medical conferences. The authors declare that there have been no financial donations associated with this study. There is also no financial interest in the presented technique.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany

    Christoph A. Tschan, Sebastian Antes, Sonja Vulcu & Joachim Oertel

  2. Department of Neurosurgery, Section of Pediatric Neurosurgery, University Hospital of Mainz, Mainz, Germany

    Alexandra Huthmann & Wolfgang Wagner

  3. Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Kirrberger Straße, Gebäude 90.5, 66421, Homburg, Germany

    Christoph A. Tschan

Authors
  1. Christoph A. Tschan
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  2. Sebastian Antes
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  3. Alexandra Huthmann
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  4. Sonja Vulcu
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  5. Joachim Oertel
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Corresponding author

Correspondence to Christoph A. Tschan.

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Comment

The authors analyzed the functions and complications of an adjustable gravitational valve retrospectively. The short-term follow-up of 1 year was completed in 55 of the 64 patients. The complication rate included 14 surgical revisions.

The clinical impact of CSF shunts is relevant in neurosurgical units; as relevant is the complication rate for over- or under-drainage. Therefore, technical innovations in this field—such as adjustable gravitational valves—are welcome. However, the major limitations of this retrospective study are the short follow-up and the effortless statistical analysis. This is particularly relevant for lifelong permanent implants.

Nevertheless, the article gives us a motivating perspective for the successful managment of tricky shunt-related problems. The authors should be complimented for the simple presentation of multifaceted heterogeneous data. The proSA valve appears to overcome the overdrainage problems in hydrocephalus patients.

Larger prospectictively comparative studies, a longer follow-up and a comprehensive statistical analysis are required to validate the presented data.

Alex Alfieri

Neuruppin, Germany

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Tschan, C.A., Antes, S., Huthmann, A. et al. Overcoming CSF overdrainage with the adjustable gravitational valve proSA. Acta Neurochir 156, 767–776 (2014). https://doi.org/10.1007/s00701-013-1934-3

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  • DOI: https://doi.org/10.1007/s00701-013-1934-3

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