Nonprogrammable and programmable cerebrospinal fluid shunt valves: a 5-year study

Hatlen, Timothy; Shurtleff, David B.; Loeser, John D.; Ojemann, Jeffrey G.; Avellino, Anthony M.; Ellenbogen, Richard G.

doi:10.3171/2012.1.peds10482

Cited by 35 publications

(14 citation statements)

References 35 publications

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“…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%

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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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Section: Resultsmentioning

confidence: 99%

“…Five Class II studies 11,24,27,33,36 evaluated programmable valves. Pollack et al 36 (1999) conducted a multicenter randomized controlled trial in which they compared the programmable Codman Hakim valve to the surgeon's choice of any conventional valve.…”

Section: Programmable Valvesmentioning

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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“…3,4,9,11,12,15,17,21 This is especially relevant in hydrocephalus occurring post-SAH because a medium-pressure valve in a nonprogrammable shunt may not drain low-or normal-pressure hydrocephalus. 17 We wanted to determine if this was true in our experience as well, and if programmable shunts have helped us to decrease the rate of shunt revision due to over-and underdrainage.…”

Section: Shunt Complications and Revisionsmentioning

confidence: 99%

Use of programmable versus nonprogrammable shunts in the management of hydrocephalus secondary to aneurysmal subarachnoid hemorrhage: a retrospective study with cost-benefit analysis

Lee¹,

King²,

Kumar³

et al. 2014

JNS

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Object. The choice of programmable or nonprogrammable shunts for the management of hydrocephalus after aneurysmal subarachnoid hemorrhage (SAH) remains undefined. Variable intracranial pressures make optimal management difficult. Programmable shunts have been shown to reduce problems with drainage, but at 3 times the cost of nonprogrammable shunts.Methods. All patients who underwent insertion of a ventriculoperitoneal shunt for hydrocephalus after aneurysmal SAH between 2006 and 2012 were included. Patients were divided into those in whom nonprogrammable shunts and those in whom programmable shunts were inserted. The rates of shunt revisions, the reasons for adjustments of shunt settings in patients with programmable devices, and the effectiveness of the adjustments were analyzed. A cost-benefit analysis was also conducted to determine if the overall cost for programmable shunts was more than for nonprogrammable shunts.Results. Ninety-four patients underwent insertion of shunts for hydrocephalus secondary to SAH. In 37 of these patients, nonprogrammable shunts were inserted, whereas in 57 programmable shunts were inserted. Four (7%) of 57 patients with programmable devices underwent shunt revision, whereas 8 (21.6%) of 37 patients with nonprogrammable shunts underwent shunt revision (p = 0.0413), and 4 of these patients had programmable shunts inserted during shunt revision. In 33 of 57 patients with programmable shunts, adjustments were made. The adjustments were for a trial of functional improvement (n = 21), overdrainage (n = 5), underdrainage (n = 6), or overly sunken skull defect (n = 1). Of these 33 patients, 24 showed neurological improvements (p = 0.012). Cost-benefit analysis showed $646.60 savings (US dollars) per patient if programmable shunts were used, because the cost of shunt revision is a lot higher than the cost of the shunt.Conclusions. The rate of shunt revision is lower in patients with programmable devices, and these are therefore more cost-effective. In addition, the shunt adjustments made for patients with programmable devices also resulted in better neurological outcomes.

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“…In this provocative single-institution retrospective review, Hatlen et al 1 report the long-term results of valve survival in a large group of children with programmable valves (PVs) and nonprogrammable valves (NPVs). In this 8-year analysis (with a minimum 2-year follow-up), the authors report on 616 valves, 313 of which were programmable and 303 of which were nonprogrammable.…”

mentioning

confidence: 99%

Editorial: Programmable shunts versus nonprogrammable shunts

Boop¹

2012

PED

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Nonprogrammable and programmable cerebrospinal fluid shunt valves: a 5-year study

Cited by 35 publications

References 35 publications

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

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

Use of programmable versus nonprogrammable shunts in the management of hydrocephalus secondary to aneurysmal subarachnoid hemorrhage: a retrospective study with cost-benefit analysis

Editorial: Programmable shunts versus nonprogrammable shunts

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