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A multicenter prospective cohort study of the Strata valve for the management of hydrocephalus in pediatric patients.
[hydrocephalus with stenosis of the aqueduct of sylvius]
Previous
reports
suggest
that
adjustable
valves
may
improve
the
survival
of
cerebrospinal
fluid
shunts
or
relieve
shunt-related
symptoms
.
To
evaluate
these
claims
,
the
authors
conducted
a
prospective
multicenter
cohort
study
of
children
who
underwent
placement
of
Strata
valves
.
Patients
undergoing
initial
shunt
placement
(
Group
1
)
or
shunt
revision
(
Group
2
)
were
treated
using
Strata
valve
shunt
systems
.
Valves
were
adjustable
to
five
performance
level
settings
by
using
an
externally
applied
magnet
.
The
performance
levels
were
checked
using
an
externally
applied
hand
tool
and
radiography
.
Patients
were
followed
for
1
year
or
until
they
underwent
shunt
revision
surgery
.
Between
March
2000
and
February
2002
,
315
patients
were
enrolled
in
the
study
.
In
Group
1
(
201
patients
)
the
common
causes
of
hydrocephalus
were
myelomeningocele
(
16
%
)
,
aqueductal
stenosis
(
14
%
)
,
and
hemorrhage
(
14
%
)
.
The
overall
1
-
year
shunt
survival
was
67
%
.
Causes
of
shunt
failure
were
obstruction
(
17
%
)
,
overdrainage
(
1
.
5
%
)
,
loculated
ventricles
(
2
%
)
,
and
infection
(
10
.
6
%
)
.
Patients
in
Group
2
(
114
patients
)
were
older
and
the
causes
of
hydrocephalus
were
similar
.
Among
patients
in
Group
2
the
1
-
year
shunt
survival
was
71
%
.
There
were
256
valve
adjustments
.
Symptoms
completely
resolved
(
26
%
)
or
improved
(
37
%
)
after
63
%
of
adjustments
.
When
symptoms
improved
or
resolved
,
they
did
so
within
24
hours
in
89
%
of
adjustments
.
Hand
-tool
and
radiographic
readings
of
valve
settings
were
the
same
in
234
(
98
%
)
of
238
assessments
.
The
1
-
year
shunt
survival
for
the
Strata
valve
shunt
system
when
used
in
initial
shunt
insertion
procedures
or
shunt
revisions
was
similar
to
those
demonstrated
for
other
valves
.
Symptom
relief
or
improvement
following
adjustment
was
observed
in
63
%
of
patients
.
Hand
-tool
assessment
of
performance
level
settings
reliably
predicted
radiographic
assessments
.
Diseases
Validation
Diseases presenting
"externally applied hand tool"
symptom
hydrocephalus with stenosis of the aqueduct of sylvius
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