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Pediatric hydrocephalus: Does the shunt device pressure selection affect the outcome?
Arvind Sinha1, Anuj Sharma, Charitesh Gupta
1Department of Pediatric Surgery, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Dehra Dun, India.
Insights
This study found no significant difference in outcomes between low-pressure and medium-pressure shunts for treating pediatric hydrocephalus. Both shunt types effectively reduced the ventricle hemispheric ratio in children.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Medical Device Technology
Background:
- Hydrocephalus is a condition characterized by excess cerebrospinal fluid in the brain's ventricles.
- Ventricular shunts are commonly used to treat pediatric hydrocephalus by draining excess fluid.
- The pressure setting of shunts may influence their efficacy and complication rates.
Purpose of the Study:
- To compare the clinical efficacy of low-pressure versus medium-pressure differential pressure shunts in pediatric hydrocephalus.
- To evaluate radiological outcomes, specifically the ventricle hemispheric ratio (VHR), and the need for revision surgery.
Main Methods:
- A randomized controlled trial involving 40 pediatric hydrocephalus patients.
- Patients received either a low-pressure or medium-pressure Chhabra differential pressure VP shunt.
- Outcomes were assessed through symptomatic improvement, radiological evaluation (sonography or CT scan for VHR), and analysis of redo surgery rates.
Main Results:
- Both low-pressure and medium-pressure shunts significantly reduced the VHR postoperatively (p < 0.001 for both).
- The study observed no statistically significant difference in the incidence of shunt complications or the need for redo surgery between the two groups (p = 0.5614).
Conclusions:
- Low-pressure and medium-pressure differential pressure shunts demonstrate comparable efficacy in managing pediatric hydrocephalus.
- The choice between low- or medium-pressure shunts may not significantly impact outcomes or revision rates in this patient population.
Aim:
To compare the efficacy of low- versus medium-pressure shunts in pediatric hydrocephalus in a randomized controlled trial.
Materials And Methods:
Forty patients of pediatric hydrocephalus were randomized into two groups. The Chhabra differential pressure VP shunt (low or medium) was inserted in every patient. Postoperative follow-up was performed for symptomatic improvement and radiological evaluation (by sonography or computed tomography scan) for ventricle hemispheric ratio (VHR). Comparative analysis of pre- and postoperative VHR and need of redo surgery for shunt malformation were carried out to establish outcomes.
Results:
Nineteen patients had a low-pressure and 21 patients had a medium-pressure shunt inserted. The age of the patients ranged from 1 day to 10 years. The average preoperative VHR in group A was 55.37%, which reduced to 40% postoperatively (P = 0.00005); likewise, the pre- and postoperative VHR in group B were 61.57% and 42%, respectively, which was statistically significant (P = 0.0006). The complications of shunts and incidence of redo shunt surgery in both groups were not found to be statistically significant (P = 0.5614).
Conclusions:
The study found no significant difference in the outcome of patients with low- or medium-pressure shunt placement in pediatric hydrocephalus.
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