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XIX Congress of the European Society for Pediatric Neurosurgery Rome, May 6-9th 2004

XIX Congress of the European Society for Pediatric Neurosurgery Rome, May 6-9th 2004 Perspectives of the Shunt Technology: iValve and DigiShunt Aschoff A, Hashemi B, Scheihing M, Unterberg A, Kremer P

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XIX Congress of the European Society for Pediatric Neurosurgery Rome, May 6-9th 2004

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  1. XIX Congress of the European Society for Pediatric Neurosurgery Rome, May 6-9th 2004 Perspectives of the Shunt Technology: iValve and DigiShunt Aschoff A, Hashemi B, Scheihing M, Unterberg A, Kremer P University of Heidelberg, Department of Neurosurgerye-mail: Alfred_Aschoff@med.uni-heidelberg.de Oral presentation on Sunday, May 9th, 2004 Selectedslides

  2. Shunt-Revisions: Quantities Misplaced catheters Hydraulic Mismanagement Infections Disconnections

  3. Ventricular Catheters - Positions Prospective, 63 EVD-catheters 23.4% Anterior horn, ipsilateral 5.8% Lateral ventricle, ipsilateral 5.8% Anterior horn, contralateral 19.3% other positions in the ventricles 2.3% extraventricular intrathecal 2.3% in the brain parenchyma Weis N, Naff N, Hanley D: Accuracy of intraventricular catheter placement ... Poster 221, AANS 2/2003 Phoenix

  4. ±3o Catheter,ideal position= all holesfree in the ventricle Tolerance for lateral deviations ±3o only!

  5. Current Quotes of Shunt-Infections Valve Patients Procedures % n % n Pollack 99 Medos P 9.8 377 Kestle 00 OSV,DP,Delta8.4 367Zemack 01 Medos P 11.4 477 8.5 660 Lundkvist 01 Medos P 11.0 122 Götz 01 Medos P 2.8 143 Richards 01 multiple *2.6/6.0 12,950 (*Erst-OP) Vougioukas 01 OSV I+II 8.6 81 Kiefer 01 G-valves 1.7 120 Cochrane 02 multiple 8.6 12,106 Hanlo 03 OSV II 8.2 557 Vinchon 03 multiple 21.7 1564 6.6

  6. 1. Sterility in theOP-theatre 2. Antibacterial surface modification of implant 3. Systemic antibiotic prophylaxis

  7. 55 rabbits, prospective, randomized Ventricular catheter ± Rifampin (covalent) ± 107 Staph. epiderm., 105 Staph. aureus - Untreated catheters: 96 % Infections of catheters & brain - Rifampin-catheters:0 % Infections of implant p<0,001 Kockro, Aschoff et al. J Med Microbiol 49 (2000):441-450

  8. Simple slit- and diaphragm- valves, Orbis-Sigma: Inaccuracies & long-term-drifts common

  9. ASD, Delta, distal slit ... : Safety deficits Instable valve bodiesReflux …

  10. Adjustable Valves: Change of Technological Leadership ? Miethke ProGAVSophysa-Polaris+ gravitational valve Codman-Medos

  11. Adjustable Valves – Present Use Treatment of self-produced complications (preferebly overdrainage) Fine tuning for individual needs Psychotherapy Training to shunt-independence

  12. Adjustable Valves and Shunt-Removal 1. Stepwise increase of valve pressure to 200-400 mmH2O 2. Shunt removal after 1/2 - 2 years In 59% (71/120) successful!Takahashi Y (2001) Withdrawal of the shunt systems - clinical use of the programmable shunt system and its effcects in hydrocephalus in children. Child´s Nerv Syst 17:472-477

  13. Adjustable Valves – Use in Future Training to shunt-independence Fine tuning for individual needs Psychotherapy Treatment of self-produced complications

  14. G- + adjustable valve adjustable alone Ball- + g-valve 1 2 3

  15. Gravitational Valves - Problems - Complicated stock-keeping in OR 6 supplementary devives (e.g. Shunt-Assistant) 6 complete g-valves (e.g. PaediGAV) - In case of growth, adipositas, pregnancy, or inadequate pressure selection is under- or (residual) overdrainage not excluded. - No individual fine-tuning

  16. Gravitational Valves- Perspectives Adjustable g-Valves Percutaneous variation - Number of “active“ balls - Balls with different weights - Variation of the cone-geometry

  17. Shunt Technology in 2005 1. Adjustable valve 50-350 mmH2OStable in MRI, X-ray control not necessary 2. + gravitational valve, adjustable between 100-350 mmH2O, stable during jogging etc. 3. +low-flow-catheter (ID Ø 0.8 mm) 4. ICP-telemetry (sensor intradural) 5. Incorporated antibiotics

  18. Shunt Technology in 2010 - 2 intracranial microtransducers - 2 extrathecal transducers - 2 gravitational chip sensors - Storage chip: ICP of last month - Telemetry - Electronically controlled valve - CPU, programmable for an “event- controlled” shunt function and training to shunt-independence

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