Tey Min Li, Ng Lee Ping, Low David C Y, Seow Wan Tew, Low Sharon Y Y
Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
Brain Sci. 2021 Nov 22;11(11):1548. doi: 10.3390/brainsci11111548.
(1) Background: pediatric hydrocephalus is a challenging condition. Programmable shunt valves (PSV) have been increasingly used. This study is undertaken to firstly, to objectively evaluate the efficacy of PSV as a treatment modality for pediatric hydrocephalus; and next, review its associated patient outcomes at our institution. Secondary objectives include the assessment of our indications for PSV, and corroboration of our results with published literature. (2) Methods: this is an ethics-approved, retrospective study. Variables of interest include age, gender, hydrocephalus etiology, shunt failure rates and incidence of adjustments made per PSV. Data including shunt failure, implant survival, and utility comparisons between PSV types are subjected to statistical analyses. (3) Results: in this case, 51 patients with PSV are identified for this study, with 32 index and 19 revision shunts. There are 3 cases of shunt failure (6%). The mean number of adjustments per PSV is 1.82 times and the mean number of adjustments made per PSV is significantly lower for MEDTRONIC™ Strata PSVs compared with others ( = 0.031). Next, PSV patients that are adjusted more frequently include cases of shunt revisions, PSVs inserted due to CSF over-drainage and tumor-related hydrocephalus. (4) Conclusion: we describe our institutional experience of PSV use in pediatric hydrocephalus and its advantages in a subset of patients whose opening pressures are uncertain and evolving.
(1) 背景：小儿脑积水是一种具有挑战性的病症。可编程分流阀（PSV）的使用越来越广泛。本研究旨在，首先，客观评估PSV作为小儿脑积水治疗方式的疗效；其次，回顾在我们机构中其相关的患者预后情况。次要目标包括评估我们使用PSV的指征，并将我们的结果与已发表的文献进行对照。(2) 方法：这是一项经伦理批准的回顾性研究。感兴趣的变量包括年龄、性别、脑积水病因、分流失败率以及每个PSV进行调整的发生率。包括分流失败、植入物存活情况以及不同类型PSV之间效用比较的数据将进行统计分析。(3) 结果：在本研究中，确定了51例使用PSV的患者，其中32例为初次植入分流管，19例为翻修分流管。有3例分流失败（6%）。每个PSV的平均调整次数为1.82次，与其他PSV相比，MEDTRONIC™ Strata PSV每个PSV的平均调整次数显著更低（P = 0.031）。其次，调整更频繁的PSV患者包括分流管翻修病例、因脑脊液过度引流而插入PSV的病例以及与肿瘤相关的脑积水病例。(4) 结论：我们描述了我们机构在小儿脑积水中使用PSV的经验及其在一部分开放压力不确定且不断变化的患者中的优势。
