Comparison of Low – Versus Medium-Pressure Shunts in Pediatric Hydrocephalus – A Study of the Children Hospitals, Lahore

  • Mian Awais Pediatric Neurosurgery Department , The Children's Hospital and Institute of Child Health Lahore
  • Akhtar Muner Department of Pediatric Neurosurgery, The Children Hospital and The institute of Child Health, Lahore
  • Laeeq-ur -Rehman Department of Pediatric Neurosurgery, The Children Hospital and The institute of Child Health, Lahore
  • Akmal Hussain
  • Ihsan Ullah
  • Lubna Ijaz Department of Pediatric Neurosurgery, The Children Hospital and The institute of Child Health, Lahore
Keywords: Hydrocephalus, shunt device pressures

Abstract

Objective:  This prospective cross-sectional study was aimed to assess the effectiveness of low-pressure vs. medium-pressure shunts in children with hydrocephalus.

Material and Methods: 52 children with different types of hydrocephalus were admitted through OPD and Surgical emergency at The Children Hospital, Lahore. All Children were gone through Ultrasonography and CT Brain plain after admission. The pediatric hydrocephalus was resolved into two groups. All patients treated with Chhabra differential pressure VP (ventriculoperitoneal) shunt in either low pressure or medium pressure. CT scans were used to assess the postoperative clinical and radiological outcomes to monitor the ventricle hemispheric ratio (VHR).

Results:  A low-pressure shunt was implanted in 26 individuals, whereas a medium-pressure shunt was implanted in 26 individuals. Patients varied in age from one day to thirteen years old. In group A, the average VHR was 57.58% preoperatively, but it dropped to 42.88% after surgery. Similarly, in group B, the pre-and postoperative VHR was 59.35% and 42.81%, respectively, which was statistically significant. In both groups, the incidence of shunt complications and redo shunt operation were not statistically significant.

Conclusion:  In this study, individuals with pediatric hydrocephalus who had a low-pressure shunt or a medium-pressure shunt had similar outcomes.

References

1. Grover S, Menon P, Samujh R, Rao KL. Congenital hydrocephalus: A comparative study on the efficacy and complications after low versus medium pressure ventriculoperitoneal shunts. J Indian Assoc Pediatr Surg. 2004; 9: 143–7.
2. Pollack IF, Albright AL, Adelson PD. A randomized controlled study of a programmable shunt valve versus a conventional valve for patients with hydrocephalus. Hakim-Medos Investigator group. J Neurosurg. 1999; 45: 1399–408.
3. Drake JM, Kestle JR, Milner R, John MR, Joseph P, Haines S, et al. Randomized trial of CSF shunt valves design in paediatric hydrocephalus. Neurosurgery, 1998; 43: 294–305.
4. Drake JM, Kestle JR, Bilting C, John MR, Haines S, Joseph P. Evolution of CSF shunt valves design in paediatric hydrocephalus. Neurosurgery, 1989; 32: 191–5.
5. Boon AJ, Trans JT, Delwel EJ. Dutch normal
pressure hydrocephalus study: Randomized comparison of low and medium pressure shunts. J Neurosurg. 1998; 88: 490–5.
6. Robinson S, Kaufman BA, Park TS. Outcome analysis of initial neonatal shunts: Does the valve makes a difference? J Paediatr Neurosurg. 2002; 37: 287–94.
7. Mc Quarrie IG, Schrer PB. Treatment of adult onset obstructive hydrocephalus with low or medium pressure CSF shunts. Neurology, 1982; 32: 1057–61.
8. Michael S, Turner MD. The treatment of hydrocephalus: A brief guide to shunt selection. Surg Neurol. 1995; 43: 314–23.
9. Larsson A, Jenson C, Bliting M, Ekohlm S, Stephensen H. Does the shunt opening pressure influence the affect of shunt surgery in normal pressure hydrocephalus. Acta Neurochir (Wien), 1992; 117: 15–22.
10. Sainte-Rose C, Piatt J, Jr, Renier D, Pierre-Kahn A, Hirsch JF, Hoffman HJ, et al. Mechanical complications in shunts. Pediatr Neurosurg. 1991; 17: 2–9.
11. Matson D, Becker DP, Nulsen FE. Control of Hydrocephalus by valve-regulated venous shunt: Avoidance of complications in prolonged shunt maintenance. J Neurosurg. 1968; 28: 376–8.
12. Warf BC. Comparison of 1-year outcome for the Chhabra and Codman-Hakim micro precision shunt systems in Uganda: A prospective study in 195 children. J Neurosurg. 2005; 102 (Suppl. 4): S358–62.
13. Appareti KE, Johnson ML. Ultrasound evaluation of neonatal brain. In: Hagen-Ansert SL, editor. Textbook of diagnostic ultrasonography. USA: C.V. Mosby, 1983: pp. 270–84.
14. Boon AJ, Tans JT, Delwel EJ, Egeler-Peerdeman SM, Hanlo PW, Wurzer HA, et al. Dutch Normal-Pressure Hydrocephalus Study: Randomized comparison of low and medium pressure shunts. J Neurosurg. 1998; 88: 490–5.
Published
2021-06-25
Section
Original Articles