A comparison between flow-regulated and adjustable valves used in hydrocephalus during infancy

Area of Science:

• Neurosurgery
• Pediatric Neurology
• Biomedical Engineering

Background:

• Ventriculoperitoneal shunts inserted in neonates have high failure rates compared to adults.
• The performance of flow-regulated and differential pressure valves in neonatal hydrocephalus is not well understood.

Purpose of the Study:

• To compare the outcomes of adjustable and flow-regulated valves in neonatal hydrocephalus.
• To assess shunt survival, infection rates, and overdrainage in neonates receiving primary shunt procedures.

Main Methods:

• Retrospective case series of 55 neonates undergoing primary shunt procedures (August 2011-February 2018).
• Compared outcomes between adjustable (Miethke ProGav) and flow-regulated (Orbis-Sigma) valves.
• Analyzed 1-year shunt survival, infection rates, and clinical signs of overdrainage.

Main Results:

• Overall 1-year shunt survival was 34% with no significant difference between valve types.
• The primary shunt infection rate was 11%, with S. aureus most common.
• Overdrainage signs were more frequent in adjustable valves (59%) than flow-regulated valves (24%), with 2 cases of sagittal craniosynostosis.

Conclusions:

• Neonatal hydrocephalus shunts have a high failure rate.
• Flow-regulated valves may have lower rates of overdrainage.
• Adjustable differential pressure valves can be modified to treat overdrainage non-invasively.