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Background: Sophysa SM8 is widely used by neurosurgeons in France. Published studies report shunt malfunction rates in adults between 18% and 29%. However, these studies included multiple valve types and thus entailed a serious confounding factor., Objective: To ascertain the incidence the Sophysa SM8 cerebrospinal fluid (CSF) shunt malfunctions in adults., Methods: We present a retrospective series of adult patients who underwent CSF shunt placement between 2000 and 2013 with Sophysa SM8., Results: In total, 599 patients (329 males and 270 females) were included. The mean age at surgery was 64.15 years (19-90) (SD 16.17; median 68.0). The causes of hydrocephalus were normal pressure hydrocephalus (49%), traumatic hemorrhages (26.5%), tumors (15.7%), cerebral aqueduct stenoses (3%), and arachnoid cysts (2%). The mean follow-up was 3.9 years (0-16) (SD 4.10; median 3 years). The rate of complications was 22.04% (132 of 599). Most frequent causes of complications were disconnection (25%), migration (12.9%), overdrainage (9.1%), and proximal obstruction (6.8%). In 17 cases (12.9%), no failure was diagnosed during revision. Seven infections (5.3%) were reported. The mean delay for the first revision was 1.70 years (0-13.93) (SD 2.67, median 0.35). The risk of shunt failure was 36% at 10 years. Seventeen percent of revisions occurred during the first year after shunt placement., Conclusion: Disconnections are a very frequent complication of Sophysa SM8 valve. They are related to the 2-connector system of this valve. Based on these results, we recommend using 1-piece valves., (Copyright © Congress of Neurological Surgeons 2022. All rights reserved.)

Objective: Shunt malfunctions seem more frequent in children (44 to 81%) than in adults (18 to 29%). Because of discrepancies between studies, it is not possible to affirm this disparity. The objective was to verify whether the incidence of cerebrospinal fluid (CSF) shunt malfunctions is higher in children than adults., Methods: We present a retrospective series of child and adult patients who underwent CSF shunt placement between 2000 and 2013 with a Sophysa SM8® valve., Results: 599 adults and 98 children (sex ratio 1.28) underwent CSF shunt placement. Age at first surgery ranged between 1 day of life and 90 years (mean of 55.8 years, SD 25.8, median 64.8 years). The mean follow-up was 4 years (SD 4.264, 0-16; median 3 years). The cumulative complication rate was 25.5% (178/697). Mechanical complications were disconnection (25.1%), migration (11.8%), intracranial catheter obstruction (8.9%) and malposition (8.4%). The mean delay for the first revision was 1.90 years (0-13.9), (SD 2.73, median 0.5). The probability of shunt failure was 65% at 10 years in the child group and 36% at 10 years in the adult group. Moreover, in the child group, 33% of revisions occurred during the first year after shunt placement versus 17% in the adult group. Thus, the probability of shunt failure was higher in children than in adults (log-rank test, p < 0.001)., Conclusions: This is the first retrospective study, comparing children and adults undergoing CSF shunt using the same valve, able to confirm the higher rate of complications in children.

Premature infants with severe germinal matrix intraventricular hemorrhage (IVH) are at high risk of posthemorrhagic ventricular dilation and hydrocephalus (Video 1). We report the case of a 3-month-old premature infant referred for posthemorrhagic multilocated hydrocephalus. He presented with somnolence, hypotonia, and a bulging fontanelle. His past medical history included an IVH grade III with hydrocephalus initially treated by temporary ventriculosubgaleal shunting. Magnetic resonance imaging (MRI) showed persistent hydrocephalus associated to a cyst extending anteriorly from the mesencephalon to the posterior wall of the sixth cervical vertebra, causing severe brainstem and spinal cord compression. A two-step surgery was performed, consisting of an endoscopic procedure and a ventriculo peritoneal shunt placement, to achieve hydrocephalus treatment and cyst fenestration. A right transfontanellar approach with the head flexed was chosen, using a straight 30-degree endoscope. The procedure and surgical technique are explained in a step-by-step fashion in the original conditions. A large unique fenestration was performed with no postoperative complications and improvement of the neurological status. One month later the patient presented again with symptomatic intracranial hypertension with compatible clinical and imagery findings. MRI showed cyst recurrence and hydrocephalus. We therefore revised our strategy and performed an additional procedure, which is detailed in the second part of the video (Part II: Success of Multiple Fenestrations). Our report underlines the high risk of recurrence of such cysts in post-hemorrhagic arachnoiditis. Cyst recurrence may be explained by the absence of crossing flow when a unique perforation is made., (Copyright © 2020 Elsevier Inc. All rights reserved.)