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Shunt failure caused by valve collapse.
T Lundar1, I A Langmoen, K H Hovind
1Department of Neurosurgery, National Hospital, University of Oslo, Oslo, Norway.
Journal of Neurology, Neurosurgery, and Psychiatry
|June 1, 1991
Summary
Mini-Holter valve failure occurred in 6% of pediatric shunt patients due to valve collapse. Replacing with adult Holter valves in infants over one month old resolved this complication.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Biomedical Engineering
Background:
- Ventriculoperitoneal (VP) and ventriculoatrial (VA) shunts are crucial for managing hydrocephalus in children.
- The Mini-Holter valve was a specific type of shunt valve used in pediatric neurosurgery.
- Shunt malfunction is a significant concern in pediatric hydrocephalus management.
Purpose of the Study:
- To report the incidence and nature of shunt failure associated with the Mini-Holter valve in pediatric patients.
- To evaluate the efficacy of switching to the adult Holter valve after Mini-Holter valve complications.
Main Methods:
- Retrospective review of 179 pediatric patients implanted with Mini-Holter VP or VA shunts over a 10-year period.
- Analysis of shunt failure events specifically attributed to Mini-Holter valve collapse (intussusception).
- Comparison of outcomes after replacing Mini-Holter valves with adult Holter valves in a subsequent cohort.
Main Results:
- Shunt failure due to Mini-Holter valve collapse occurred in 11 out of 179 children (6%), with 13 such events observed.
- Valve collapse, specifically intussusception, was identified as the cause of failure in all reported cases.
- All collapsed valves were part of ventriculoperitoneal shunt systems.
- Following the abandonment of the Mini-Holter valve and implantation of adult Holter valves in children over one month old, no valve breakdowns were reported in 102 children and 200 adults.
Conclusions:
- The Mini-Holter valve demonstrated a significant rate of failure due to collapse in pediatric shunt systems.
- Intussusception of the Mini-Holter valve is a specific mechanism leading to shunt malfunction.
- Switching to the adult Holter valve appears to be a safe and effective alternative in pediatric patients, eliminating the complication of valve collapse.