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Published on: November 28, 2018
Flow control versus antisiphon valves: late results concerning slit ventricles and slit-ventricle syndrome
P Liniger1, S Marchand, G L Kaiser
1Department of Paediatric Surgery, University Hospital Inselspital, Berne, Switzerland. philipp.liniger@insel.ch
Insights
Slit ventricles (SV) develop over years in shunted hydrocephalic infants. Early SV development increases complication risk, but most patients remain asymptomatic. Valve type did not significantly impact SV or syndrome incidence.
Area of Science:
- Pediatric Neurosurgery
- Hydrocephalus Management
- Medical Device Technology
Background:
- Hydrocephalus is a common condition in infants requiring surgical intervention.
- Shunt placement is a standard treatment, but complications like slit ventricles (SV) can occur.
- Understanding the development and implications of SV is crucial for patient outcomes.
Purpose of the Study:
- To investigate the time course of slit ventricle (SV) development in infants with hydrocephalus.
- To compare the incidence of SV and slit-ventricle syndrome (SVsyndrome) between conventional and anti-siphon valves.
- To assess the long-term outcomes associated with early SV development.
Main Methods:
- Prospective follow-up of 27 infants with hydrocephalus post-ventriculoperitoneal shunt.
- Annual clinical visits and at least two postoperative CT/MRI scans for SV assessment.
- Measurement of ventricular size, parenchymal surface, and cortical mantle thickness; recording of shunt revisions.
Main Results:
- SV developed over years, with 21% occurring within 6.5 months and 48% after 6 years.
- No significant difference in SV incidence or ventricular morphology between conventional and anti-siphon valve groups.
- Early SV development (within 6.5 months) was associated with a higher risk of shunt revision and SVsyndrome.
Conclusions:
- Slit ventricles (SV) are a long-term development in shunted hydrocephalic patients.
- The majority of patients with SV remain asymptomatic, and valve type showed no significant difference in incidence.
- Early detection and potential elective valve adjustment for SV may mitigate long-term complications.
Introduction:
The aims of the study were firstly to investigate the time course of development of slit ventricles (SV) and slit-ventricle syndrome (SVsyndrome) in hydrocephalic patients shunted as infants and secondly to assess the difference in incidence of SV and SVsyndrome in 2 groups of patients - group A with a conventional valve and group B with an anti-siphon valve.
Patients And Methods:
27 infant patients with hydrocephalus received a ventriculoperitoneal shunt and were followed prospectively with annual clinic visits and at least two CT or MRI scans postoperatively. The scans were assessed for SV, and ventricular and parenchymal surface and cortical mantle thickness were measured. Revisions for shunt malfunction were recorded.
Results:
SV were more frequent than SVsyndrome and developed within 6.5 months postoperatively in 21 % of patients and 48 % after 6 years. No significant difference in incidence of SV or in the surface and cortical mantle thickness were found between the two groups. Two patients (40 %) with early development of SV developed SVsyndrome, and the relative risk for shunt revision was significantly higher in patients who developed SV early. 48 % of patients did not need emergency shunt revision during the first 9 years.
Conclusions:
SV develop over years. The majority of patients with SV remain asymptomatic. No significant difference between the two groups was found concerning SV and SVsyndrome. If SV develop early in the postoperative period, complications are more frequent in the long-term, so elective valve adjustment should be considered.
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