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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Influences of intraabdominal pressure – and the impact on valve selection for ventriculoperitoneal shunts

Meeting Abstract

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  • Yehia Chehade - Klinik für Neurochirurgie, Asklepios Klinik Altona, Hamburg
  • Uwe Kehler - Klinik für Neurochirurgie, Asklepios Klinik Altona, Hamburg

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMI.12.01

doi: 10.3205/14dgnc333, urn:nbn:de:0183-14dgnc3337

Published: May 13, 2014

© 2014 Chehade et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Ventriculo-peritoneal shunts (VP-shunts) are most often used for hydrocephalus treatment. The resulting ICP depends on the valve opening pressure, the hydrostatic pressure difference between the head and the abdomen as well as the intraabdominal pressure (IAP). However, IAP is not exactly known and may change with body position, body mass index (BMI), chronic constipation and other factors. This study is intended to provide measurements of IAP in different body positions and other determining factors with their possible relevance for shunt and valve selection in hydrocephalus patients.

Method: IAP was measured in non-hydrocephalic patients via a bladder catheter in 20 patients in different body positions (prone, supine, lateral position, sitting, standing and bended over). Only patients, who needed a temporary bladder catheter with no abdominal pathology were included.

Results: The medium IAP ranged from 10 and 15 mmHg in the horizontal position and from 20 to 25 mmHg in the upright position. In a prone position, the IAP was 40% higher than in supine position. IAP was highest in the standing position with values around 25 mmHg, in a sitting position values were around 20 mmHg. There were substantial differences in the IAP between individuals. Females had significantly lower IAPs than males. (BMI) and age were found to have no influence.

Conclusions: To choose the right valve pressure setting for a VP-Shunt, it is necessary to know the IAP. This study showed that the BMI does not influence the IAP as reported elsewhere. On the other hand, body position and sex have asubstantial impact on IAP, which is consistent with the higher rates of overdrainage reported in females. In addition there are distinct interindividual changes of IAP. All these factors make a right valve selection very difficult. This could be overcome at least partially by programmable valves. However, it is not clear whether the changes of IAP are large enough to make the use of programmable valves absolutely necessary.