Flow-regulated versus differential pressure-regulated shunt valves for adult patients with normal pressure hydrocephalus

Ziebell, Morten; Wetterslev, Jørn; Tisell, Magnus; Gluud, Christian; Juhler, Marianne

doi:10.1002/14651858.cd009706

Cited by 6 publications

(6 citation statements)

References 20 publications

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“…Elaborate randomised clinical trials are needed [22] to document the various parameters in the use of a FRED in different patient groups and pathologies, which could in turn provide a better insight on the underlying physiology of these conditions.…”

Section: Discussionmentioning

confidence: 99%

Flow-regulated external lumbar drain: applications and complications

2014

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The FRED system offered better patient compliance and comfort, providing them with greater mobility, while maintaining a safer steady removal of a set amount of CSF. In opposition to the pressure-regulated systems, we describe the possible indications, advantages and disadvantages of a flow regulated device. Extensive clinical trials are needed to study the use of FRED in patients with different CSF circulation physiology, pressure and composition.

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Section: Discussionmentioning

confidence: 99%

Flow-regulated external lumbar drain: applications and complications

2014

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“…Since the introduction of shunts with valves during the 1960s, most of shunts can be classified broadly into 2 groups: differential pressure and flow-regulated valves. 11,12 This led to the emergence of comparative studies testing specific endpoints including failure rate; these reports showed no difference in failure rate across miscellaneous types of shunts, [13][14][15] which was also confirmed in a recent systemic review. 12 New shunt systems come equipped with a no-reflow valve, which is not used in traditional shunts.…”

Section: Shunt Type and Shunt Manipulationmentioning

confidence: 85%

“…11,12 This led to the emergence of comparative studies testing specific endpoints including failure rate; these reports showed no difference in failure rate across miscellaneous types of shunts, [13][14][15] which was also confirmed in a recent systemic review. 12 New shunt systems come equipped with a no-reflow valve, which is not used in traditional shunts. Neale and Falke reported that those modern shunt valves can tolerate pressures of up to 350 mmHg without any retrograde flow.…”

Section: Shunt Type and Shunt Manipulationmentioning

confidence: 85%

Laparoscopy in a Patient With a Ventriculoperitoneal Shunt: A Case Report and Literature Review

Almayouf

Alsabahi

Alburakan

et al. 2021

International Surgery

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Objective This case emphasizes the safety of laparoscopy in patients with ventriculoperitoneal shunts. Summary of background data Previously published reports have suggested possible risks associated with laparoscopy in patients with ventriculoperitoneal shunt. Methods We report a case of a 17-year-old male with a ventriculoperitoneal shunt inserted 6 years ago to manage hydrocephalus that developed after surgery for medulloblastoma. The patient presented with a 5-day history of abdominal pain. He was diagnosed as having acute biliary pancreatitis. We performed laparoscopic cholecystectomy with the ventriculoperitoneal shunt in place. Conclusion The patient had an uneventful recovery with no shunt-related complications.

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“…To date, there have been mixed results from studies comparing the two VS options, with most reports unable to demonstrate a difference in revision rates between valve types. 5,9,10,12,14,16,19 A recent meta-analysis by Li et al concluded that there was no difference in the 1-year shunt survival rate, overall complications rate, infection rate, or catheter-related complications rate. 8 They observed that programmable pressure valves were associated with fewer revision surgeries at 1 year; however, this effect was only substantiated in patients younger than 18 years.…”

Section: Discussionmentioning

confidence: 99%

Comparative durability and costs analysis of ventricular shunts

Agarwal

Kashkoush

McDowell

et al. 2019

Journal of Neurosurgery

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OBJECTIVEVentricular shunt (VS) durability has been well studied in the pediatric population and in patients with normal pressure hydrocephalus; however, further evaluation in a more heterogeneous adult population is needed. This study aims to evaluate the effect of diagnosis and valve type—fixed versus programmable—on shunt durability and cost for placement of shunts in adult patients.METHODSThe authors retrospectively reviewed the medical records of all patients who underwent implantation of a VS for hydrocephalus at their institution over a 3-year period between August 2013 and October 2016 with a minimum postoperative follow-up of 6 months. The primary outcome was shunt revision, which was defined as reoperation for any indication after the initial procedure. Supply costs, shunt durability, and hydrocephalus etiologies were compared between fixed and programmable valves.RESULTSA total of 417 patients underwent shunt placement during the index time frame, consisting of 62 fixed shunts (15%) and 355 programmable shunts (85%). The mean follow-up was 30 ± 12 (SD) months. The shunt revision rate was 22% for programmable pressure valves and 21% for fixed pressure valves (HR 1.1 [95% CI 0.6–1.8]). Shunt complications, such as valve failure, infection, and overdrainage, occurred with similar frequency across valve types. Kaplan-Meier survival curve analysis showed no difference in durability between fixed (mean 39 months) and programmable (mean 40 months) shunts (p = 0.980, log-rank test). The median shunt supply cost per index case and accounting for subsequent revisions was $3438 (interquartile range $2938–$3876) and $1504 (interquartile range $753–$1584) for programmable and fixed shunts, respectively (p < 0.001, Wilcoxon rank-sum test). Of all hydrocephalus etiologies, pseudotumor cerebri (HR 1.9 [95% CI 1.2–3.1]) and previous shunt malfunction (HR 1.8 [95% CI 1.2–2.7]) were found to significantly increase the risk of shunt revision. Within each diagnosis, there were no significant differences in revision rates between shunts with a fixed valve and shunts with a programmable valve.CONCLUSIONSLong-term shunt revision rates are similar for fixed and programmable shunt pressure valves in adult patients. Hydrocephalus etiology may play a significant role in predicting shunt revision, although programmable valves incur higher supply costs regardless of initial diagnosis. Utilization of fixed pressure valves versus programmable pressure valves may reduce supply costs while maintaining similar revision rates. Given the importance of developing cost-effective management protocols, this study highlights the critical need for large-scale prospective observational studies and randomized clinical trials of ventricular shunt valve revisions and additional patient-centered outcomes.

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Flow-regulated versus differential pressure-regulated shunt valves for adult patients with normal pressure hydrocephalus

Cited by 6 publications

References 20 publications

Flow-regulated external lumbar drain: applications and complications

Flow-regulated external lumbar drain: applications and complications

Laparoscopy in a Patient With a Ventriculoperitoneal Shunt: A Case Report and Literature Review

Comparative durability and costs analysis of ventricular shunts

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