1348. Using Burr Hole Valve Prevents Proximal Shunt Failure In Young Children

Authors: Chiu-Hao Hsu, MD; Meng-Fai Kuo; Sheng-Che Chou; Shih-Hung Yang; Ming-Chieh Shih (Taipei, Taiwan)

Introduction: Proximal malfunction is the most common cause of ventriculoperitoneal (VP) shunt failure in young children.This study aims to find out factors that affect the migration rate of the ventricular catheters in hydrocephalic patients that were shunted in early childhood. Methods: The medical records and imaging studies of 78 hydrocephalic children who were younger than 3-year-old were reviewed between December 2006 and April 2017. Eighteen patients were excluded due to mortality, short follow-up period (less than 1 year), and lack of imaging follow-up. The age, gender, etiology of hydrocephalus, the length of ventricular catheter, valve type (burr hole vs. non-burr hole), time to ventricular catheter migration, subsequent revision surgery, and follow-up period were analyzed. The diagnosis of a migrated ventricular catheter was made when withdrawal of the catheter tip from the ventricle with the catheter shorter than 4 mm inside the ventricle, or deviation of the ventricular catheter on a serial imaging follow-ups. Results: Sixty patients were enrolled. Eight patients had ventricular catheter migration. Seven of the 8 patients used non-burr hole valve. Six of these 7 patients needed second surgeries, which included three prophylactic revisions due to progressive migration on serial imaging studies, two revision due to ventriculomegaly and one removal of shunt due to asymptomatic disconnection. In addition to the use of burr hole valve, longer ventricular catheter length was another protective factor against migration. After treated ventricular catheter length as a confounding variable and adjusted with multivariable Poisson regression, only the use of burr hole valve remained protective factor. Conclusion: The use of burr hole valve is a protective factor against ventricular catheter migration when the shunt is inserted via frontal route. We suggest to use burr hole valve accompanying with a frontal entry point in hydrocephalic children younger than 3-year to maintain long-term shunt function.