Ventriculo-peritoneal shunting devices for hydrocephalus.

Area of Science:

• Neurology
• Neurosurgery
• Medical device evaluation

Background:

• Hydrocephalus is a neurological disorder characterized by cerebrospinal fluid (CSF) accumulation, leading to increased intracranial pressure and potential brain damage.
• Ventriculo-peritoneal (VP) shunt systems are the primary treatment for hydrocephalus, with various shunt device types available.

Purpose of the Study:

• To compare the effectiveness and adverse effects of conventional versus complex VP shunt devices for CSF diversion in hydrocephalus patients.

Main Methods:

• A systematic review of randomized controlled trials (RCTs) and quasi-RCTs comparing different VP shunting devices.
• Searched multiple databases including Cochrane, MEDLINE, Embase, and LILACS up to February 2020.
• Data extraction and risk of bias assessment by two reviewers, with Synthesis Without Meta-analysis (SWiM) and GRADE used due to data scarcity.

Main Results:

• Six studies with 962 participants were included, comparing standard valves to anti-syphon, other standard, self-adjusting, or programmable pressure valves.
• Evidence for treatment failure, adverse events, and mortality was mostly of low to very low certainty.
• Comparisons between different valve types generally showed similar outcomes, but uncertainty remains due to limited high-quality data.

Conclusions:

• Standard shunt valves appear to have comparable outcomes to anti-syphon or self-adjusting valves, but the low certainty of evidence necessitates caution.
• Different types of standard valves and programmable versus non-programmable valves also showed similar outcomes.
• There is a need for high-quality RCTs evaluating newer shunt technologies and focusing on patient-important outcomes, including quality of life and cost.