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Experience with a new concept to lower non-infectious complications in infants with programmable shunts
M C Korinth1, M R Weinzierl, J M Gilsbach
1Department of Neurosurgery, University Hospital RWTH Aachen, Aachen, Germany. Marcus.Korinth@post.rwth-aachen.de
Insights
Temporary overdrainage using programmable valves in infants with hydrocephalus may reduce non-infectious complications like CSF leaks and wound breakdown, improving shunt treatment outcomes.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Biomedical Engineering
Background:
- Non-infectious complications of ventriculo-peritoneal shunts in infants are as frequent and dangerous as infectious ones.
- Complications like wound breakdown, CSF fistula, and subcutaneous CSF collection are difficult to manage in young patients.
Purpose of the Study:
- To evaluate the safety and efficacy of initial temporary overdrainage using programmable Hakim valves in neonates and infants.
- To assess the impact of this technique on non-infectious complications and overall shunt treatment success.
Main Methods:
- A cohort of 40 neonates and infants underwent de novo ventriculo-peritoneal shunt implantation with a programmable Hakim valve.
- The technique involved initial temporary overdrainage, followed by valve readjustment after wound healing.
- Patients were monitored for non-infectious complications, overdrainage symptoms, and overall outcomes for an average of 2.6 years.
Main Results:
- The technique resulted in uneventful wound healing in the initial weeks post-implantation.
- No patients exhibited signs of overdrainage, such as slit ventricle syndrome or brain collapse.
- The incidence of non-infectious complications like wound breakdown and CSF fistula was potentially reduced.
Conclusions:
- Initial temporary overdrainage with programmable valves appears to be a safe and effective method to reduce non-infectious complications in infant shunt treatment.
- This technique may optimize shunt treatment success rates and lower the general complication rate in this vulnerable age group.
Abstract:
In neonates and infants less than 1 year of age who are treated with a ventriculo-peritoneal shunt, non-infectious complications are almost as frequent and dangerous as infectious complications. While the incidence of infections can be reduced, using perioperative antibiotics, special surgical techniques and postoperative care non-infectious complications such as wound break-down, cerebrospinal fluid (CSF) fistula and subcutaneous CSF collection are preventable, but seem difficult to manage, especially in the group of patients at a susceptible age. The authors present their experience with the programmable Hakim valve in 40 neonates and infants less than 1 year of age, who were treated with de novo implantation of a ventriculo-peritoneal shunt due to various pathologies. The uneventful wound healing during the first weeks after shunt implantation, avoiding the above mentioned non-infectious complications, was supported by initial, temporary overdrainage and readjustment of the programmable valve after completed wound healing. All patients tolerated this procedure well and showed no pathological signs or symptoms of overdrainage like premature closure of cranial sutures, clinical low-pressure syndrome, slit ventricle syndrome (SVS), subdural fluid collection or brain collapse during an average follow-up period of 2.6 years (2 - 65 months). Infectious and other mechanical, non-infectious complications were analysed as well during the follow-up period. These results suggest that an initial, temporary overdrainage in infants and neonates with shunted hydrocephalus may contribute to further lower the incidence of non-infectious complications like wound break-down, CSF-fistula or subcutaneous CSF accumulation, without negative side effects. This technique could be a valuable option in the regimen of shunt-treatment of this age group in order to optimise the overall success rate and lower the general complication rate.