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

Paediatric hydrocephalus remains a significant cause of morbidity, primarily managed by ventriculoperitoneal (VP) shunts. Despite technological advances, shunt valves frequently fail, resulting in high revision rates. This systematic review aims to evaluate and compare shunt valve types in paediatric hydrocephalus, assessing survival rates, complication profiles, and revision requirements. A systematic search was conducted using PubMed, Google Scholar, Scopus, and Cochrane Library databases. Eligible studies included randomised controlled trials (RCTs), cohort studies, systematic reviews, and meta-analyses comparing at least two valve types (adjustable, fixed-pressure, gravitational, anti-siphon, or flow-regulating) in patients aged ≤18 undergoing initial VP shunt insertion. Data were synthesised narratively and, where appropriate, via random-effects meta-analysis, using shunt survival as the primary outcome. Secondary outcomes included types of shunt failure, revision rates, time to first revision, and the influence of patient-related factors. Fourteen studies met the inclusion criteria, comprising one meta-analysis, three systematic reviews, two RCTs, and eight observational studies. No valve design consistently demonstrated superior overall shunt survival (RR 1.12, 95% CI: 0.91-1.36, I² = 69%). Adjustable valves reduced early revisions, particularly in young patients with dynamic cerebrospinal fluid (CSF) physiology. Gravitational and flow-regulated valves lowered overdrainage complications but increased underdrainage risks. Obstruction was the predominant failure type across valve types. Higher failure rates occurred in infants and those with post-haemorrhagic hydrocephalus. No single shunt valve type emerged as universally superior. Valve selection should be individualised based on patient age, aetiology, and clinical context. Future multicentre trials using standardised outcomes are needed to guide optimal valve choice.