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. 2022 Nov;164(11):2867-2873.
doi: 10.1007/s00701-022-05361-0. Epub 2022 Sep 23.

Non-adjustable gravitational valves or adjustable valves in the treatment of hydrocephalus after aneurysmal subarachnoid hemorrhage patients?

Sebastian Arts #  1   2 , Jasper Hans van Lieshout #  3 , Martine van Bilsen  2 , Cihat Karadag  3 , Thomas Beez  3 , Leonie van den Abbeele  2 , Rene Aquarius  2 , Saman Vinke  2 , Ronald H M A Bartels  2 , Erik J van Lindert  2 , Daniel Hänggi  3 , Hieronymus D Boogaarts  4
Affiliations

Non-adjustable gravitational valves or adjustable valves in the treatment of hydrocephalus after aneurysmal subarachnoid hemorrhage patients?

Sebastian Arts et al. Acta Neurochir (Wien). 2022 Nov.

Abstract

Purpose: Hydrocephalus requiring permanent CSF shunting after aneurysmal subarachnoid hemorrhage (aSAH) is frequent. It is unknown which type of valve is optimal. This study evaluates if the revision rate of gravitational differential pressure valves (G-DPVs, GAV® system (B Braun)) (G-DPV) is comparable to adjustable pressure valves (Codman Medos Hakim) (APV) in the treatment of post-aSAH hydrocephalus.

Methods: The use of a gravitational differential pressure valve is placed in direct comparison with an adjustable pressure valve system. A retrospective chart review is performed to compare the revision rates for the two valve systems.

Results: Within the registry from Radboud University Medical Center, 641 patients with a SAH could be identified from 1 January 2013 until 1 January 2019, whereas at the Heinrich Heine University, 617 patients were identified, totaling 1258 patients who suffered from aSAH. At Radboud University Medical Center, a gravitational differential pressure valve is used, whereas at the Heinrich Heine University, an adjustable pressure valve system is used. One hundred sixty-six (13%) patients required permanent ventricular peritoneal or atrial shunting. Shunt dysfunction occurred in 36 patients: 13 patients of the 53 (25%) of the gravitational shunt cohort, and in 23 of the 113 (20%) patients with an adjustable shunt (p = 0.54). Revision was performed at a mean time of 3.2 months after implantation with the gravitational system and 8.2 months with the adjustable shunt system. Combined rates of over- and underdrainage leading to revision were 7.5% (4/53) for the gravitational and 3.5% (4/113) for the adjustable valve system (p = 0 .27).

Conclusion: The current study does not show a benefit of a gravitational pressure valve (GAV® system) over an adjustable pressure valve (CODMAN ® HAKIM®) in the treatment of post-aSAH hydrocephalus. The overall need for revision is high and warrants further improvements in care.

Keywords: Adjustable valve; Aneurysmal subarachnoid hemorrhage; Gravitational valve; Hydrocephalus.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of included patients
Fig. 2
Fig. 2
Shunt survival
See this image and copyright information in PMC

References

    1. Adil SM, Liu B, Charalambous LT, Kiyani M, Gramer R, Swisher CB, Verbick LZ, McCabe A, Parente BA, Pagadala P, Lad SP. Healthcare economics of hydrocephalus after aneurysmal subarachnoid hemorrhage in the United States. Transl Stroke Res. 2019;10:650–663. doi: 10.1007/s12975-019-00697-9. - DOI - PubMed
    1. de Oliveira JG, Beck J, Setzer M, Gerlach R, Vatter H, Seifert V, Raabe A (2007) Risk of shunt-dependent hydrocephalus after occlusion of ruptured intracranial aneurysms by surgical clipping or endovascular coiling: a single-institution series and meta-analysis. Neurosurgery 61:924–933; discussion 933–924. 10.1227/01.neu.0000303188.72425.24 - PubMed
    1. Germanwala AV, Huang J, Tamargo RJ. Hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurg Clin N Am. 2010;21:263–270. doi: 10.1016/j.nec.2009.10.013. - DOI - PubMed
    1. Hayhurst C, Beems T, Jenkinson MD, Byrne P, Clark S, Kandasamy J, Goodden J, Nandoe Tewarie RD, Mallucci CL. Effect of electromagnetic-navigated shunt placement on failure rates: a prospective multicenter study. J Neurosurg. 2010;113:1273–1278. doi: 10.3171/2010.3.JNS091237. - DOI - PubMed
    1. Hertel F, Zuchner M, Decker C, Schill S, Bosniak I, Bettag M. The Miethke dual switch valve: experience in 169 adult patients with different kinds of hydrocephalus: an open field study. Minim Invasive Neurosurg. 2008;51:147–153. doi: 10.1055/s-2008-1065337. - DOI - PubMed

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