Experiences with hydrostatic valves in the treatment of hydrocephalus in infancy and childhood

Introduction: The choice of the specific valve seems to be very important in the treatment of the childish hydrocephalus. In this study 53 children were treated with hydrostatic valves. The experiences with these valves over a period of 7 years are demonstrated here.

Methods: Hydrostatic valves were inserted in 24 premature babies and in 29 children with hydrocephali of different etiology. The follow up of the children was every six months or later every 12 months. The examination consisted of a clinical and a radiological part, i.e. a NMR of the brain. The Evans-Index and the FOR were measured with respect to the width of the ventricles.

Results: At the premature babies 7 revisions of the shunt systems were necessary, two due to the occlusion of the central catheter, two due to an infection, two peripheral atrial catheters were changed into peritoneal catheters and one central catheter was occluded due to slit-ventricles. At the other children 9 shunt revisions were necessary; 4 due to a dysfunction of the central catheter, 1 due to an inappropriate drainage, 2 due to an overdrainage with clinical symptoms, 1 due to sudural hygromas and 1 due to slit ventricles without clinical symptoms. The Evans-Index and the FOR were mostly constant. Only at few children these values decreased. Thus, a shunt revision was necessary in 4 children due to clinical relevant overdrainages, i.e.in 7.5%.

Conclusions: Also using hydrostatic valves symptoms of overdrainage are possible which make shunt revisions necessary. This percentage, however, could be decreased inserting an adjustable hydrostatic valve.