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Long-term follow-up data from the Shunt Design Trial
1Division of Pediatric Neurosurgery, Primary Children's Medical Center, University of Utah, Salt Lake City, Utah, USA. john.kestle@hsc.utah.edu
Pediatric Neurosurgery
|January 13, 2001
Summary
This study found no significant difference in shunt survival rates between three valve types for pediatric hydrocephalus. Prolonged follow-up confirmed that no single valve is superior for initial treatment.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Biomedical Engineering
Background:
- A multicenter randomized trial previously compared new shunt valve designs against differential pressure valves.
- The initial trial did not reveal significant differences in the time to first shunt failure.
Purpose of the Study:
- To report on late complications and long-term outcomes of shunt valve performance in pediatric hydrocephalus.
- To reassess the efficacy of different shunt valve designs based on extended patient follow-up.
Main Methods:
- 344 hydrocephalic children were randomized to one of three valve types: standard differential pressure, Delta, or Sigma valve.
- Patients were followed until the first shunt failure (obstruction, overdrainage, loculation, infection) or until August 31, 1999.
Main Results:
- Overall shunt survival rates were 62% at 1 year, decreasing to 41% by 4 years.
- Shunt obstruction was the most common failure (131 cases), followed by infection (29 cases).
- Survival curves for the three valve types remained similar, showing no distinct advantage for any specific valve.
Conclusions:
- Extended follow-up did not change the initial findings of the trial.
- No single shunt valve demonstrated a clear superiority for the initial management of pediatric hydrocephalus.
