Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L9 7AL, UK.
The University of Liverpool, Liverpool, L69 3BX, UK.
Childs Nerv Syst. 2021 Aug;37(8):2605-2612. doi: 10.1007/s00381-021-05162-3. Epub 2021 May 21.
Achieving decompression without CSF over-drainage remains a challenge in hydrocephalus. Differential pressure valves are a popular treatment modality, with evidence suggesting that incorporation of gravitational units helps minimise over-drainage. This study seeks to describe the utility of the proGAV®2.0 programmable valve in a paediatric population.
Clinical records and imaging of all patients fitted with proGAV®2.0 valves and Miethke fixed-pressure valves between 2014 and 2019 at our tertiary centre were analysed. Patient demographics, indication for shunt and valve insertion/revision and time to shunt/valve revision were collected. Ventricular linear metrics (fronto-occipital horn ratio (FOHR) and fronto-occipital horn width ratio (FOHWR)) were collected pre- and post-valve insertion. Microsoft Excel and SPSS v24 were used for data collection and statistical analysis.
Eighty-eight proGAV®2.0 valves were inserted in a population of 77 patients (n = 45 males (58%), mean age 5.1 years (IQR: 0.4-11.0 years)). A total of 102 Miethke fixed-pressure valves were inserted over the same time period. Median follow-up was 17.5 months (1.0-47.3). One (1.1%) proGAV®2.0 was revised due to over-drainage, compared to 2 (1.9%) fixed-pressure valves (p > 0.05). ProGAV®2.0 insertion resulted in a significant decrease in the mean number of revisions per patient per year (1.77 vs 0.25; p = 0.01). Overall shunt system survival with the proGAV®2.0 was 80.4% at 12 months, and mean time to revision was 37.1 months, compared to 31.0 months (95%CI: 25.7-36.3) and 58.3% in fixed-pressure valves (p < 0.01). Significant decreases were seen following proGAV®2.0 insertion in both FOHR and FOHWR, by 0.014 (95%CI: 0.006-0.023, p = 0.002) and 0.037 (95%CI: 0.005-0.069, p = 0.024) respectively.
The proGAV®2.0 provides effective decompression of hydrocephalic patients, significantly reduces the number of valve revisions per patient and had a significantly greater mean time to revision than fixed-pressure valves.
在脑积水患者中，实现减压而不导致脑脊液过度引流仍然是一个挑战。压差阀是一种流行的治疗方式，有证据表明，加入重力单位有助于最大限度地减少过度引流。本研究旨在描述 proGAV®2.0 程控阀在儿科人群中的应用效果。
分析了 2014 年至 2019 年间在我们的三级中心接受 proGAV®2.0 阀和 Miethke 定压阀植入的所有患者的临床记录和影像学资料。收集患者的人口统计学数据、分流适应证和阀植入/更换时间以及分流/阀更换时间。在阀植入前和后收集脑室线性指标（额枕角比（FOHR）和额枕角宽度比（FOHWR））。使用 Microsoft Excel 和 SPSS v24 进行数据收集和统计分析。
在 77 名患者（n=45 名男性（58%），平均年龄 5.1 岁（IQR：0.4-11.0 岁））中植入了 88 个 proGAV®2.0 阀。同一时期共植入了 102 个 Miethke 定压阀。中位随访时间为 17.5 个月（1.0-47.3）。1 个（1.1%）proGAV®2.0 因过度引流而需要更换，而固定压阀有 2 个（1.9%）（p>0.05）。proGAV®2.0 植入后，患者每年的平均修订次数显著减少（1.77 次比 0.25 次；p=0.01）。proGAV®2.0 总体分流系统 12 个月存活率为 80.4%，平均修订时间为 37.1 个月，而固定压阀为 31.0 个月（95%CI：25.7-36.3）和 58.3%（p<0.01）。proGAV®2.0 植入后，FOHR 和 FOHWR 均显著降低，分别为 0.014（95%CI：0.006-0.023，p=0.002）和 0.037（95%CI：0.005-0.069，p=0.024）。
proGAV®2.0 为脑积水患者提供了有效的减压效果，显著减少了患者的阀修订次数，且平均修订时间明显长于固定压阀。
