A Systematic Review of Ventriculoperitoneal Shunt Valve Types and Failure Rates in Paediatric Hydrocephalus

Area of Science:

• Neurosurgery
• Paediatric Neurology
• Biomedical Engineering

Background:

• Paediatric hydrocephalus is a major cause of childhood morbidity.
• Ventriculoperitoneal (VP) shunts are the primary treatment, but valve failure leads to high revision rates.
• Comparing different VP shunt valve types is crucial for improving patient outcomes.

Purpose of the Study:

• To systematically review and compare the survival rates and complication profiles of various VP shunt valve types in paediatric hydrocephalus.
• To assess revision requirements and identify factors influencing shunt failure.
• To provide evidence-based guidance for optimal shunt valve selection in children.

Main Methods:

• Systematic literature search across major databases (PubMed, Google Scholar, Scopus, Cochrane Library).
• Inclusion of RCTs, cohort studies, systematic reviews, and meta-analyses comparing at least two VP shunt valve types in patients ≤18 years.
• Data synthesis through narrative review and random-effects meta-analysis, focusing on shunt survival and complication rates.

Main Results:

• No specific shunt valve design demonstrated consistent superiority in overall survival.
• Adjustable valves showed potential in reducing early revisions, especially in young children.
• Gravitational and flow-regulated valves mitigated overdrainage but increased underdrainage risks; obstruction was the most common failure.
• Infants and patients with post-haemorrhagic hydrocephalus exhibited higher shunt failure rates.

Conclusions:

• Current VP shunt valve technology does not offer a universally superior option for paediatric hydrocephalus.
• Individualized valve selection considering patient age, hydrocephalus aetiology, and clinical context is recommended.
• Further multicentre trials with standardized outcomes are needed to refine optimal valve choice strategies.