Journal ArticleDOI
Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus.
James M. Drake,John R. W. Kestle,Ruth Milner,Giuseppe Cinalli,Frederick A. Boop,Joseph H. Piatt,Stephen J. Haines,Steven J. Schiff,D. Douglas Cochrane,Paul Steinbok,Nancy MacNeil +10 more
TLDR
Cerebrospinal fluid shunt failure, predominantly from shunt obstruction and infection, remains a persistent problem in pediatric hydrocephalus.Abstract:
Objective Forty percent of standard cerebrospinal fluid shunts implanted for the treatment of pediatric hydrocephalus fail within the first year. Two new shunt valves designed to limit excess flow, particularly in upright positions, were studied to compare treatment failure rates with those for standard differential-pressure valves. Methods Three hundred-forty-four hydrocephalic children (age, birth to 18 yr) undergoing their first cerebrospinal fluid shunt insertion were randomized at 12 North American or European pediatric neurosurgical centers. Patients received one of three valves, i.e., a standard differential-pressure valve; a Delta valve (Medtronic PS Medical, Goleta, CA), which contains a siphon-control component designed to reduce siphoning in upright positions; or an Orbis-Sigma valve (Cordis, Miami, FL), with a variable-resistance, flow-limiting component. Patients were monitored for a minimum of 1 year. Endpoints were defined as shunt failure resulting from shunt obstruction, overdrainage, loculations of the cerebral ventricles, or infection. Outcome events were assessed by blinded independent case review. Results One hundred-fifty patients reached an endpoint; shunt obstruction occurred in 108 (31.4%), overdrainage in 12 (3.5%), loculated ventricles in 2 (0.6%), and infection in 28 (8.1%). Sixty-one percent were shunt failure-free at 1 year and 47% at 2 years, with a median shunt failure-free duration of 656 days. There was no difference in shunt failure-free duration among the three valves (P = 0.24). Conclusion Cerebrospinal fluid shunt failure, predominantly from shunt obstruction and infection, remains a persistent problem in pediatric hydrocephalus. Two new valve designs did not significantly affect shunt failure rates.read more
Citations
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Journal ArticleDOI
Long-Term Follow-Up Data from the Shunt Design Trial
John R. W. Kestle,James M. Drake,Ruth Milner,C. Sainte-Rose,Giuseppe Cinalli,Frederick A. Boop,Jr. Joseph H. Piatt,Stephen J. Haines,Steven J. Schiff,D. Douglas Cochrane,Paul Steinbok,N. MacNeil +11 more
TL;DR: Prolonged follow-up to date does not alter the primary conclusions of the trial: there does not appear to be one valve that is clearly the best for the initial treatment of pediatric hydrocephalus.
Journal ArticleDOI
Hydrocephalus in children
TL;DR: Advances in brain imaging, technology, and understanding of the pathophysiology should ultimately lead to improved treatment of the disorder, which should be individualised to the child.
Journal ArticleDOI
Cerebrospinal fluid shunt infection: a prospective study of risk factors
TL;DR: Three variables associated with an increased incidence of shunt infection have been identified and great care should be taken intraoperatively to avoid a postoperative CSF leak.
Journal ArticleDOI
The scientific history of hydrocephalus and its treatment.
TL;DR: There has been a renaissance of endoscopic ventriculostomy, which is widely accepted as the method of first choice in adult patients with aquired or late-onset, occlusive hydrocephalus; in other cases the preference remains controversial.
Journal ArticleDOI
Risk factors for repeated cerebrospinal shunt failures in pediatric patients with hydrocephalus
TL;DR: By performing survival analysis for repeated events, the authors examined the effects of patient characteristics, shunt hardware, and surgical details in a large cohort of patients.
References
More filters
Journal ArticleDOI
An encephalographic ratio for estimating ventricular enlargement and cerebral atrophy
TL;DR: The most frequent encephalographic abnormality in children, and perhaps also in adults, is enlargement of the lateral ventricles, and the need of a quantitative expression is felt to describe more accurately the degree of enlargement and to define with some precision the normal limits of ventricular size.
Journal ArticleDOI
Mechanical complications in shunts
Christian Sainte-Rose,J.H. Piatt,Dominique Renier,Alain Pierre-Kahn,Jean-François Hirsch,Harold J. Hoffman,Robin P. Humphreys,E B Hendrick +7 more
TL;DR: A retrospective study was conducted on 1,719 hydrocephalic patients, treated between 1974 and 1983 at the Hospital for Sick Children (Toronto) and l'Hôpital des Enfants Malades (Paris), to better understand shunt failure.
Journal ArticleDOI
Shunt implantation: reducing the incidence of shunt infection.
TL;DR: A new protocol for shunt procedures involving modifications in the immediate pre-, intra- and postoperative management of children undergoing shunt implantation was initiated, and the incidence of shunt infection decreased dramatically.
Journal Article
Treatment of hydrocephalus by direct shunt from ventricle to jugular vain.
F E Nulsen,E B Spitz +1 more
Journal ArticleDOI
Hydrocephalus: Overdrainage by ventricular shunts. A review and recommendations
Robert H. Pudenz,Eldon L. Foltz +1 more
TL;DR: The basic etiology, diagnosis, and variety of treatment modalities available are reviewed, including the need for shunt closing intracranial pressure control, and a hydrocephalus program designed to minimize theneed for long-term extracranial shunts and to maximize therapeutic intrac cranial procedures for hydrocephalu is designed.