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Review
. 2021 Nov;37(11):3485-3495.
doi: 10.1007/s00381-021-05326-1. Epub 2021 Aug 17.

Infant hydrocephalus: what valve first?

Benjamin J Hall #  1   2 , Conor S Gillespie #  3   4 , Geraint J Sunderland  1   5 , Elizabeth J Conroy  6 , Dawn Hennigan  1 , Michael D Jenkinson  7   5 , Benedetta Pettorini  1 , Conor Mallucci  1
Affiliations
Review

Infant hydrocephalus: what valve first?

Benjamin J Hall et al. Childs Nerv Syst. 2021 Nov.

Abstract

Purpose: To review the use of different valve types in infants with hydrocephalus, in doing so, determining whether an optimal valve choice exists for this patient cohort.

Methods: We conducted (1) a literature review for all studies describing valve types used (programmable vs. non-programmable, valve size, pressure) in infants (≤ 2 years) with hydrocephalus, (2) a review of data from the pivotal BASICS trial for infant patients and (3) a separate, institutional cohort study from Alder Hey Children's Hospital NHS Foundation Trust. The primary outcome was any revision not due to infection.

Results: The search identified 19 studies that were included in the review. Most did not identify a superior valve choice between programmable and non-programmable, small compared to ultra-small, and differential pressure compared to flow-regulating valves. Five studies investigated a single-valve type without a comparator group. The BASICS data identified 391 infants, with no statistically significant difference between gravitational and programmable subgroups. The institutional data from our tertiary referral centre did not reveal any significant difference in failure rate between valve subtypes.

Conclusion: Our review highlights the challenges of valve selection in infant hydrocephalus, reiterating that the concept of an optimal valve choice in this group remains a controversial one. While the infant-hydrocephalic population is at high risk of valve failure, heterogeneity and a lack of direct comparison between valves in the literature limit our ability to draw meaningful conclusions. Data that does exist suggests at present that there is no difference in non-infective failure rate are increasing in number, with the British valve subtypes in infant hydrocephalus, supported by both the randomised trial and institutional data in this study.

Keywords: Choice; Hydrocephalus; Infant; Selection; Shunt; Valve.

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Conflict of interest statement

No conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Kaplan–Meier survival estimates for non-gravitational vs. gravitational valves implanted in the BASICS trial
Fig. 2
Fig. 2
Kaplan–Meier survival estimates for non-programmable vs. programmable valves implanted in the BASICS trial
Fig. 3
Fig. 3
Kaplan–Meier survival estimates for the various valve types (NGNP/NGP/GNP/GP) implanted in the BASICS trial
Fig. 4
Fig. 4
Kaplan–Meier survival estimates for non-programmable vs. programmable valves implanted in the Institutional Alder Hey cohort
Fig. 5
Fig. 5
Kaplan–Meier survival estimates for non-programmable vs. programmable valves implanted in the Institutional Alder Hey cohort (with shunts surviving < 90 days excluded)
See this image and copyright information in PMC

References

    1. Tully HM et al (2014) Infantile hydrocephalus: a review of epidemiology, classification, and causes. Eur J Med Genet. 10.1016/j.ejmg.2014.06.002 - PMC - PubMed
    1. Patwardhan RV et al (2005) Implanted Ventricular shunts in the United States: the billion-dollar-a-year cost of hydrocephalus treatment. Neurosurgery 56(1):139–44. 10.1227/01.neu.0000146206.40375.41 - PubMed
    1. Lim J et al (2018) The cost of hydrocephalus: a cost-effectiveness model for evaluating surgical techniques. J Paediatr Neurosurg 23(1):109–118. 10.3171/2018.6.PEDS17654 - PubMed
    1. Merkler AE et al (2017) The rate of complications after ventriculoperitoneal shunt surgery. World Neurosurg. 10.1016/j.wneu.2016.10.136 - PMC - PubMed
    1. Mallucci CL et al (2019) Antibiotic or silver versus standard ventriculoperitoneal shunts (BASICS): a multicentre, single-blinded, randomised trial and economic evaluation. The Lancet. 10.1016/S0140-6736(19)31603-4 - PMC - PubMed