Long-term follow-up and comparison of programmable and non-programmable ventricular cerebrospinal fluid shunts among adult patients with different hydrocephalus etiologies: a retrospective cohort study

Abstract

Background: Programmable valve (PV) has been shown as a solution to the high revision rate in pediatric hydrocephalus patients, but it remains controversial among adults. This study is to compare the overall revision rate, revision cause, and revision-free survival between PV and non-programmable valve (NPV) in adult patients with different hydrocephalus etiologies.

Method: We reviewed the chart of all patients with hydrocephalus receiving index ventricular cerebrospinal fluid (CSF) shunt operations conducted at a single institution from January 2017 to December 2017. Patients included in the study were followed up for at least 5 years. Statistical tests including independent t-test, chi-square test, and Fisher's exact test were used for comparative analysis, and Kaplan-Meier curve using log-rank test was performed to compare the revision-free survival between the PV and NPV groups.

Results: A total of 325 patients were included in the study, of which 181 patients were receiving PVs and 144 patients receiving NPV. There were 23 patients (12.8%) with PV and 22 patients (15.3%) with NPV receiving initial revision. No significant statistical difference in the initial revision rate was observed between the two groups (p = 0.52). No survival difference was found between the PV and NPV groups. However, better revision-free survival was noted in the PV group among idiopathic normal pressure hydrocephalus (iNPH) (p = 0.0274) and post-traumatic hydrocephalus (p = 0.017).

Conclusions: The combination of the different etiologies of hydrocephalus and the features of PV and NPV results in different outcomes-revision rate and revision-free survival. PV use might be superior to NPV in iNPH and post-traumatic hydrocephalus patients. Further studies are needed to clarify the indications of PV use in adult hydrocephalus patients.

Keywords: Adult hydrocephalus; Cerebrospinal fluid shunt; Long-term outcome; Programmable valve; Shunt revision.

Fig. 1

Patient enrollment flow chart

Fig. 2

Revision-free survival curve between PVs and NPVs among different hydrocephalus etiologies. Probability of shunt revision-free survival with time in days was estimated by Kaplan-Meier survival curve analysis to compare PVs and NPVs among different hydrocephalus etiologies. p value calculated with log-rank test was labeled at the left bottom corner of each figure. No revision-free survival difference was found between PV and NPVs among all hydrocephalus etiologies (A). Revision-free survival benefit of PV compared to NPV was noted in iNPH and post-traumatic hydrocephalus patients (B, C). A trend of revision-free survival benefit of NPV compared to PV, which was not statistically significant, was noted among nontraumatic intracranial hemorrhage patients including aSAH and hypertensive ICH patients (E–G). No revision-free survival difference was noted among all the other hydrocephalus etiologies (D, H)