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Updated: Jan 31, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Early programmable valve malfunctions in pediatric hydrocephalus
Francesco T Mangano1, Jose A Menendez, Tracy Habrock
1Department of Neurological Surgery, St Louis Children's Hospital, Washington University, Missouri 63110, USA.
Insights
Programmable valves in pediatric hydrocephalus showed an 11.1% annual malfunction rate, unlike nonprogrammable valves. This study highlights concerns about the reliability of adjustable differential pressure valves in children.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Biomedical Engineering
Background:
- Adjustable differential pressure valves are recommended for ventriculoperitoneal (VP) shunts, but clinical reliability data are limited.
- Recent identification of malfunctioning programmable valves in pediatric shunt revisions prompted this review.
Purpose of the Study:
- To retrospectively evaluate the clinical reliability of programmable versus nonprogrammable valve shunts in pediatric patients.
- To determine the intrinsic malfunction rate of programmable valves in this cohort.
Main Methods:
- Retrospective chart analysis of 100 pediatric patients with programmable valve shunts and 89 with nonprogrammable valve shunts.
- Data collected included cause of hydrocephalus, shunt malfunction type, and cerebrospinal fluid (CSF) protein levels.
- Follow-up ranged from 1 to 26 months (mean 9.75-10.4 months).
Main Results:
- 35% of patients with programmable valves required shunt revision due to malfunction.
- The intrinsic programmable valve malfunction rate was 11.1% per year, with no intrinsic malfunctions in the nonprogrammable group.
- No significant differences in CSF protein levels or malfunction types were found between groups.
Conclusions:
- Programmable valves demonstrated a significant annualized intrinsic malfunction rate (11.1%) compared to nonprogrammable valves.
- Cerebrospinal fluid protein levels did not correlate with valve malfunction.
- Further prospective, randomized studies are needed to determine specific indications and reliability of programmable valves in pediatric hydrocephalus.
Object:
The use of adjustable differential pressure valves has been recommended to improve ventriculoperitoneal (VP) shunt performance in selected patients; however, published data are scarce regarding their clinical reliability. Recently, the identification of a number of malfunctioning programmable valves during shunt revision surgery in children prompted a retrospective review of valve performance in this patient cohort.
Methods:
The authors performed a retrospective chart analysis of 100 patients with programmable valve shunts and 89 patients with nonprogrammable valve shunts implanted at the St. Louis Children's Hospital between April 2002 and June 2004. They noted the cause of hydrocephalus, the type of shunt malfunction, and cerebrospinal fluid (CSF) protein levels. Regular clinical follow up ranged from 1 to 26 months, with a mean follow-up time of 9.75 months for patients with programmable valves and 10.4 months for patients with nonprogrammable valves. Patient ages ranged from 2 weeks to 18 years. One hundred patients had 117 programmable valves implanted, and 35 of these patients (35%) underwent shunt revision because of malfunction. The programmable valve itself malfunctioned in nine patients who had undergone shunt revision (11.1%/year of follow up). The nonprogrammable valve group had no valve malfunctions. The overall VP shunt revision rate in the nonprogrammable valve group was 20.2%. No significant differences were identified when CSF protein levels and specific malfunction types were compared within the programmable valve and nonprogrammable valve groups.
Conclusions:
In this study the authors demonstrated an annualized intrinsic programmable valve malfunction rate of 11.1%, whereas during the same period no intrinsic valve malfunctions were noted with nonprogrammable valve systems for similar causes of hydrocephalus. The CSF protein levels did not correlate with observed valve malfunction rates. Further evaluation in a prospective, randomized fashion will elucidate specific indications for programmable valve systems and better determine the reliability of these valves in the pediatric population.
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