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

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>An analysis of the evidence did not demonstrate a clear advantage for any specific shunt component, mechanism, or valve design over another.</jats:p> <jats:p>R<jats:sc>ecommendation</jats:sc>: 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. S<jats:sc>trength of</jats:sc> R<jats:sc>ecommendation</jats:sc>: Level I, high degree of clinical certainty.</jats:p> <jats:p>R<jats:sc>ecommendation</jats:sc>: 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. S<jats:sc>trength of</jats:sc> R<jats:sc>ecommendation</jats:sc>: Level II, moderate degree of clinical certainty.</jats:p></jats:sec>

Cerebrospinal Fluid Shunting Complications in Children

“…Moreover, with respect to shunt failure rates, equipoise persists among modern shunt hardware in clinical use. Although the advent of flow-regulated valves [11, 12], anti-siphon devices [13], adjustable differential-pressure valves, and gravitational valves [14] has provided neurosurgeons with numerous options for managing patients with CSF overdrainage, no modern commercialized shunt valve has been definitively shown to reduce overall shunt failure rates [2, 3, 15–18]. Prospective comparisons between flow-controlled and pressure-dependent valves [19] as well as between programmable and nonprogrammable valves [4, 20] have demonstrated no significant differences in shunt revision rates.…”

Slit ventricle syndrome and subdural haemorrhage due to suspected overshunting in a dog with hydrocephalus internus

“…The use of programmable pressure valves is usually not possible for veterinary patients due to cost restrictions. Furthermore, the potential advantages of such valves have not been clearly demonstrated in paediatrics (Baird and others 2014). …”

Management and Outcome of Infantile Hydrocephalus in a Tertiary Health Institution in Nigeria

“…H ydrocephalus is the most common condition treated by pediatric neurosurgeons. [1] Ventriculoperitoneal shunt (VPS) remains the most common treatment for hydrocephalus world over even though it is associated with several short-and long-term complications. [2] As shunt system continues to evolve over the years to improve the outcome of the procedure; surgeons have also devised other alternative and safer techniques for the treatment of hydrocephalus.…”