caa a22 4500 463179943 CHVBK 20180406164836.0 cr unu---uuuuu 170326e20070301xx s 000 0 eng 10.1007/s00381-006-0226-0 doi (NATIONALLICENCE)springer-10.1007/s00381-006-0226-0 Adjustable vs set-pressure valves decrease the risk of proximal shunt obstruction in the treatment of pediatric hydrocephalus [Elektronische Daten] [Matthew McGirt, Donald Buck II, Daniel Sciubba, Graeme Woodworth, Benjamin Carson, Jon Weingart, George Jallo] Introduction: The use of programmable shunt valves has increased dramatically in the practice of pediatric hydrocephalus. Despite theoretical advantages, it remains unclear if the use of programmable vs set-pressure valves affects shunt outcome. Materials and methods: The clinical and radiological records of all pediatric patients undergoing ventriculoperitoneal (VP), ventriculopleural (VPl), and ventriculoatrial (VA) shunt surgery from 2001 to 2004 at an academic institution were reviewed. The association of programmable vs set-pressure valves with subsequent shunt revision was assessed by Kaplan-Meier shunt survival plots and log-rank analysis. Results: A total of 279 VP, VPl, and VA shunt surgeries were performed on patients with median (interquartile range) age of 4 (1-14) years (161 male, 118 female; 158 communicating, 122 obstructive hydrocephalus). Programmable valves were used in 76 (27%) cases and set-pressure valves in 203 (73%). At mean±SD follow-up of 17 ± 13months, programmable vs set-pressure valves were associated with reduced risk of both overall shunt revision [26 (35%) vs 109 (54%); relative risk (RR) (95% CI); 0.61 (0.41-0.91), p = 0.016] and proximal obstruction [9 (12%) vs 58 (28%); RR (95% CI); 0.39 (0.27-0.80), p = 0.006]. There was no difference in distal obstruction [3 (4%) vs 11 (5%) cases], infection [6 (8%) vs 12 (6%) cases], valve obstruction [0 (0%) vs 4 (2%)], or shunt disconnection [2 (3%) vs 1 (1%)] between adjustable and set-pressure valves, respectively. Conclusion: In our experience, the use of programmable vales was associated with a decreased risk of proximal shunt obstruction and shunt revision. Programmable valves may be preferred in patients frequently experiencing proximal shunt failure. A prospective, controlled study is warranted to evaluate the potential value of adjustable vs set-pressure valve systems. Springer-Verlag, 2006 Hydrocephalus nationallicence Shunt failure nationallicence Adjustable valve nationallicence Valve type nationallicence McGirt Matthew Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 8-161, 21287, Baltimore, MD, USA aut Buck II Donald Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 8-161, 21287, Baltimore, MD, USA aut Sciubba Daniel Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 8-161, 21287, Baltimore, MD, USA aut Woodworth Graeme Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 8-161, 21287, Baltimore, MD, USA aut Carson Benjamin Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 8-161, 21287, Baltimore, MD, USA aut Weingart Jon Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 8-161, 21287, Baltimore, MD, USA aut Jallo George Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 8-161, 21287, Baltimore, MD, USA aut Child's Nervous System Springer-Verlag 23/3(2007-03-01), 289-295 0256-7040 23:3<289 2007 23 381 https://doi.org/10.1007/s00381-006-0226-0 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00381-006-0226-0 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- McGirt Matthew Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 8-161, 21287, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Buck II Donald Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 8-161, 21287, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Sciubba Daniel Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 8-161, 21287, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Woodworth Graeme Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 8-161, 21287, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Carson Benjamin Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 8-161, 21287, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Weingart Jon Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 8-161, 21287, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Jallo George Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 8-161, 21287, Baltimore, MD, USA aut NATIONALLICENCE 773 0- Child's Nervous System Springer-Verlag 23/3(2007-03-01), 289-295 0256-7040 23:3<289 2007 23 381 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer