Comparative study of two customary cerebrospinal fluid shunting systems in early childhood hydrocephalus

Smely, Christian; Velthoven, Vera Van

doi:10.1007/bf01411406

Cited by 5 publications

(6 citation statements)

References 27 publications

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“…Regarding shunt treatment, the Orbis-Sigma showed better survival (p = 0.009) and less overdrainage (p = 0.007), although valve obstruction occurred earlier than in the differential pressure group. This had been previously reported by other groups and is in line with its high-resistance valve concept (22).…”

Section: Scientific Evidence and Recommendationssupporting

confidence: 91%

Shunt Technology in Pediatric Neurosurgery: Current options and Scientific Evidence

2020

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Introduction: Hydrocephalus is the most common neurosurgical condition among children worldwide and shunt diversion of the cerebral-spinal fluid (CSF) has been widely available. The aim of the present study was to perform a systematic review on types and models of shunt devices available and critically evaluate scientific evidence in favor of the usage of specific technologies. Methods: Searches of the PubMed database were performed for relevant articles published from until March 2020. Appropriate keywords were used to identify all studies, including: “shunt”, “technology”, “hydrocephalus”, “children”, “pediatric”. The indications and scientific evidence in favor of the usage of specific shunt technology for the treatment of hydrocephalus according to age, underlying pathology and other features of specific patients were discussed under the light of the current literature. Results: A total of 178 peer-reviewed papers were found. Out of them, only 21 matched our inclusion criteria and were finally selected. The papers were reviewed and described technology discussed below. A summary of the main types of shunts commercially available worldwide, including their respective working mechanism and construction was also included. Conclusion:Shunt technology has evolved during the last decades and continues to be intensively developed. Despite of the huge arsenal of different types of shunt systems currently available on the market, the treatment of hydrocephalus remains challenging. Investment in research, education and training, as well as prospective randomized multicentric controlled trials evaluating the role of specific valves in the treatment of individual group of hydrocephalic pediatric patients are urgently needed.

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Section: Scientific Evidence and Recommendationssupporting

confidence: 91%

Shunt Technology in Pediatric Neurosurgery: Current options and Scientific Evidence

2020

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“…Smely and Van Velthoven (1997) conducted a retrospective cohort review in which they compared 66 infants who underwent placement of a ventriculoperitoneal Cordis Orbis-Sigma valve system with 53 patients who underwent placement of a ventriculoatrial Codman Holter Valve shunt system. 41 Forty-eight percent of patients with the Orbis-Sigma valve required one or more revisions while 98.1% of patients with the Holter Valve required 1 or more revisions (p < 0.001). The difference in distal placement of the shunt system is a confounding factor when comparing valve types in this study.…”

Section: Resultsmentioning

confidence: 95%

“…The investigators did not find a significant difference in shunt survival between the 3 valve types in either the short-term (Drake 1998 5 ) or extended 19 follow-up. Eleven Class II studies 4,11,15,21,23,24,27,33,36,41,44 in which differing valve types were compared also failed to demonstrate a superior valve when shunt survival was assessed. Jain et al 15 (2000) conducted a prospective cohort study in which they compared shunts using a standard differential pressure valve with a Delta (Medtronic) flowregulating valve.…”

Section: Resultsmentioning

confidence: 99%

Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 5: Effect of valve type on cerebrospinal fluid shunt efficacy

Baird

Mazzola

Auguste

et al. 2014

PED

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Object The objective of this systematic review was to examine the existing literature to compare differing shunt components used to treat hydrocephalus in children, find whether there is a superior shunt design for the treatment of pediatric hydrocephalus, and make evidence-based recommendations for the selection of shunt implants when placing shunts. Methods Both the US National Library of Medicine PubMed/MEDLINE database and the Cochrane Database of Systematic Reviews were queried using MeSH headings and key words chosen to identify publications comparing the use of shunt implant components. Abstracts of these publications were reviewed, after which studies meeting the inclusion criteria were selected. An evidentiary table was compiled summarizing the selected articles and quality of evidence. These data were then analyzed by the Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force to consider evidence-based treatment recommendations. Results Two hundred sixty-nine articles were identified using the search parameters, and 43 articles were recalled for full-text review. Of these, 22 papers met the study criteria for a comparison of shunt components and were included in the evidentiary table. The included studies consisted of 1 Class I study, 11 Class II studies, and 10 Class III studies. The remaining 21 articles were excluded. Conclusions An analysis of the evidence did not demonstrate a clear advantage for any specific shunt component, mechanism, or valve design over another. Recommendation: There is insufficient evidence to demonstrate an advantage for one shunt hardware design over another in the treatment of pediatric hydrocephalus. Current designs described in the evidentiary tables are all treatment options. Strength of Recommendation: Level I, high degree of clinical certainty. Recommendation: There is insufficient evidence to recommend the use of a programmable valve versus a nonprogrammable valve. Programmable and nonprogrammable valves are both options for the treatment of pediatric hydrocephalus. Strength of Recommendation: Level II, moderate degree of clinical certainty.

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“…Ultimately, 16 studies involving 4.304 patients were included in the final analysis. 1,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] The search process is visually represented in Figure 1.…”

Section: Study Selectionmentioning

confidence: 99%

“…Among the 3311 reasons for shunt placement available, idiopathic normal pressure hydrocephalus (NPH) was the most common, with 664 cases (20.0%), followed by tumors with 367 cases (11.0%) and aqueductal stenosis with 234 cases (7.0%), in the company of other types of etiologies. Among the included studies, 5 focused exclusively on adult patients, 27,[32][33][34]39 9 focused on children, 1,26,30,31,[35][36][37][38]40 and 2 had both. 28,29 More information regarding baseline characteristics is depicted in Table 2.…”

Section: Baseline Characteristics Of Included Studiesmentioning

confidence: 99%

Ventriculoatrial Shunt Versus Ventriculoperitoneal Shunt: A Systematic Review and Meta-Analysis

Oliveira,

Hakim,

Semione

et al. 2023

Neurosurgery

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BACKGROUND AND OBJECTIVES: Ventriculoperitoneal shunt (VPS) is usually the primary choice for cerebrospinal fluid shunting for most neurosurgeons, while ventriculoatrial shunt (VAS) is a second-line procedure because of historical complications. Remarkably, there is no robust evidence claiming the superiority of VPS over VAS. Thus, we aimed to compare both procedures through a meta-analysis. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, the authors systematically searched the literature for articles comparing VAS with VPS. The included articles had to detail one of the following outcomes: revisions, infections, shunt-related mortality, or complications. In addition, the cohort for each shunt model had to encompass more than 4 patients. RESULTS: Of 1872 articles, 16 met our criteria, involving 4304 patients, with 1619 undergoing VAS and 2685 receiving VPS placement. Analysis of revision surgeries showed no significant difference between VAS and VPS (risk ratio [RR] = 1.10, 95% CI: 0.9-1.34; I2 = 84%, random effects). Regarding infections, the analysis also found no significant difference between the groups (RR = 0.67, 95% CI: 0.36-1.25; I2 = 74%, random effects). There was no statistically significant disparity between both methods concerning shunt-related deaths (RR = 2.11, 95% CI: 0.68-6.60; I2 = 56%, random effects). Included studies after 2000 showed no VAS led to cardiopulmonary complications, and only 1 shunt-related death could be identified. CONCLUSION: Both methods show no significant differences in procedure revisions, infections, and shunt-related mortality. The literature is outdated, research in adults is lacking, and future randomized studies are crucial to understand the profile of VAS when comparing it with VPS. The final decision on which distal site for cerebrospinal shunting to use should be based on the patient's characteristics and the surgeon's expertise.

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Comparative study of two customary cerebrospinal fluid shunting systems in early childhood hydrocephalus

Cited by 5 publications

References 27 publications

Shunt Technology in Pediatric Neurosurgery: Current options and Scientific Evidence

Shunt Technology in Pediatric Neurosurgery: Current options and Scientific Evidence

Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 5: Effect of valve type on cerebrospinal fluid shunt efficacy

Ventriculoatrial Shunt Versus Ventriculoperitoneal Shunt: A Systematic Review and Meta-Analysis

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