Die Behandlung des kindlichen Hydrocephalus mit hydrostatischen Ventilen

Zusammenfassung

Shuntkomplikationen, insbesondere bei Frühgeborenen, können nicht nur zu einer erheblich verlängerten Liegedauer der Kinder führen, sondern auch das neurologische und intellektuelle Outcome beeinflussen [18]. Dies betrifft sowohl die mechanischen Komplikationen wie Unterdrainage durch Okklusion eines Katheters [7] [15] [32] oder Dysfunktion des Ventils selbst [1] [2] [7] [30] die Überdrainage [1] [4] [5] [7] [8] [9] [14] [19] [23] [24] [29] [33] [34] als auch die entzündlichen Komplikationen [7] [15] [17] [27]. Um diese Komplikationen zu vermeiden, ist auch die Wahl eines geeigneten Shuntsystems wichtig [1] [2] [3] [4] [5] [20]. In der vorliegenden Arbeit wurden bei insgesamt 32 Kindern mit einem Hydrocephalus unterschiedlicher Genese hydrostatische Ventile, die sog. Pädi GAV-Ventile (pädiatrische gravitationsassistierte Ventile) von Miethke [21] implantiert. Neben den Okklusionen und Infektionen wurden insbesondere objektivierbare überdrainagebedingte Komplikationen wie subdurale Hygrome/Hämatome, Schlitzventrikel und sekundäre Kraniosynostosen untersucht. Kein Patient zeigte diese Komplikationen. Im Gegenteil waren die Ventrikel im postoperativen MR des Schädels bzw. im Sonogramm im Vergleich mit Kindern ohne Hydrocephalus eher etwas vergrößert, gemessen am Evans-Index und der fronto-okzipitalen Ratio (FOR). Ob mit dem Pädi GAV Ventil allerdings tatsächlich langfristig die überdrainagebedingten Folgen oder Komplikationen reduziert werden können, werden weitere Untersuchungen zeigen müssen.

Abstract

Complications of CSF-shunt systems may not only prolong hospitalization, but also influence dramatically the neurological and mental outcome of patients [18], especially of premature newborns. Shunt complications may be caused by mechanical problems such as shunt occlusion [7] [15] [32] or dysfunction of the valve itself [1] [2] [7] [30]. Another cause of shunt complications is the overdrainage [1] [4] [5] [7] [8] [9] [14] [19] [23] [24] [29] [33] [34] and, lastly, shunt infection [7] [15] [17] [27].The choice of the specific shunt system [1] [2] [3] [4] [5] [20] seems to play an important role in avoiding the above mentioned complications.

In this study 32 children with hydrocephali due to different etiologies were treated with hydrostatic valves, the so called Pädi GAV (pediatric hydrostatic valve) valves developed by Miethke [21]. In addition to mechanical occlusions and shunt infections, the overdrainage related complications, such as subdural hematomas/ fluid collections, slit ventricles and secondary craniosynostoses were taken into consideration. None of the patients showed these complications. On the contrary, postoperative MRI or the ultrasound demonstrated prominent ventricles comparing these with those of non-hydrocephalic children as measured by the Evans-Index and FOR (fronto-to-occipital ratio). Whether the overdrainage-related complications actually reduced using Pädi GAV valves will be shown by further long-term follow ups. This study aims to evaluate the initial experience with the Pädi GAV shunt system, particularly with respect to the overdrainage-related problems.

Schlüsselwörter

Hydrozephalus - Pädi GAV-Ventil (pädiatrisch gravitationsassistiertes Ventil) - Körperposition - Überdrainage - subdurale Hygrome und Hämatome

Key words

Hydrocephalus - Pädi GAV-valve (pediatric hydrostatic valve) - posture - overdrainage - subdural fluid collections and hematomas

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