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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.
Insights
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.
Abstract:
Shunt failure due to collapse of the Mini-Holter valve was observed 13 times in 11 out of 179 children with an implanted Mini-Holter ventriculo-peritoneal (VP) or ventriculo-atrial (VA) shunt during a 10 year period. Intussusception of the proximal or distal end of the valve thus caused a shunt failure rate of 6% of the children in this series. Two children experienced this complication twice. All collapsed valves were part of a VP shunt system. Because of this experience use of the mini valve was abandoned and an adult Holter valve was implanted in children over the age of one month. Breakdown of this particular valve has not occurred in 102 children and two hundred adults with the adult Holter shunt system.