• Jorge Tirado-Caballero, Mónica Rivero-Garvia, Gloria Moreno-Madueño, Emilio Gómez-González, and Javier Marquez-Rivas.
• Service of Neurosurgery, University Hospital Virgen del Rocío, Seville, Spain; Group of Applied Neuroscience, Institute of Biomedicine of Seville, Seville, Spain; Neurosurgery Department, Hospital 12 de Octubre, Madrid, Spain. Electronic address: jtiradocaballero@gmail.com.
• World Neurosurg. 2021 Feb 1; 146: 90-94.

ObjectiveShunt overdrainage is a potential complication in pediatric hydrocephalus. The addition of adjustable gravitational units to previous shunt systems has been proposed as effective management for this problem. These devices have been traditionally implanted over the occipital bone. We propose chest implantation as an easier, safer, and more stable alternative in the pediatric population, especially in those cases with parieto-occipital shunts.MethodsThis study comprises a retrospective analysis from a unicentric case series of pediatric patients affected by overdrainage and managed with adjustable gravitational valves implanted in the chest. The device implantation technique is described in detail and takes no more than 15 minutes.ResultsThirty-seven patients met the criteria. The mean age of implantation was 9.62 years. The mean follow-up in the series was 38 months. The mean number of pressure adjustments was 2.48. The mean "deviation angle" of the device to the longitudinal body axis was 5.8°. The complications per year of shunt were <0.02 with no disconnection of the catheters in any case during follow-up.ConclusionsIn our experience, chest implantation for adjustable gravitational devices was a suitable shunt modification in pediatric patients suffering from overdrainage.Copyright © 2020 Elsevier Inc. All rights reserved.

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