A comparison of survival rate and overdrainage rate between pressure-regulated and flow-regulated ventriculoperitoneal shunt valves for the management of hydrocephalus in the first year of life

Abstract Introduction Ventriculoperitoneal shunts are a common treatment of hydrocephalus in the first year of life; shunts can be fitted with pressure- regulated valves or flow-regulated valves. Currently, there is limited evidence suggesting which valve system is more appropriate in this population. Literature suggests that shunt survival and failure rates across both shunt systems is largely equal; however, a previous study in 2020 at Sheffield Children’s Hospital suggested that flow-regulated OSV II valves were less likely than pressure-regulated ProGAV 2.0 valves to cause overdrainage in neonates. We sought to test the hypotheses that for shunts inserted in the first year of life there is no difference in survival rate between pressure-regulated and flow-regulated valves, and that flow-regulated valves are less likely to cause overdrainage. Methods A retrospective case series of primary ventriculoperitoneal shunt insertions in the first year of life at Sheffield Children’s Hospital was carried out. The total sample size was 61. 20 patients were fitted with Miethke ProGAV 2.0 programmable pressure-regulated valves, and 41 patients were fitted with Orbis-Sigma OSV II flow-regulated valves. Of the 61 patients, 34 had the same shunt system throughout their first year, and were assessed for overdrainage through head circumference measurements. Results The mean 6 month shunt survival was 45% for the Miethke ProGAV 2.0 valves and 71% for the OSV II valves ( p = 0.089). Mean shunt survival at 1 year was 30% and 54% for ProGAV 2.0 and OSV II valves, respectively ( p = 0.134). The overall overdrainage rate at 1 year was 35%, with no significant difference between the ProGAV 2.0 valves and OSV II valves. Conclusion Our findings corroborate previous research demonstrating the lack of a significant difference in shunt survival between the pressure-regulated and flow-regulated valve systems in this age group. However, we were unable to demonstrate any significant difference in overdrainage rates between the valve systems in the first year of life.