Effectiveness of Programmable Valves for Hydrocephalus: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

XU Hao ,  WANG Zhanxiang , CHEN Donghan , ZHANG Shaolin , GUO Jianfeng , TAN Guowei , CHEN Sifang , ZHU Hongwei

Neurosurgery Department, The First Affiliated Hospital of Xiamen University, Xiamen 361022, China;

Corresponding author：

WANG Zhanxiang, Email: wangzx@xmbrain.com

Keywords：

Hydrocephalus; Ventriculoperitoneal shunt; Programmable valve; Standard valve; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.20130015

Video：

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Objective 　To systematically review the clinical effectiveness and safety of programmable valves (PV) vs. standard valves (SV) for hydrocephalus.
Methods 　Literature search was conducted in PubMed, The Cochrane Library, EMbase, CNKI, CBM, VIP and WanFang Data to collect both randomized controlled trials (RCTs) and non-randomized concurrent controlled trials on hydrocephalus treated by PV and SV published from January 1992 to January 2012. According to the inclusion criteria, two reviewers independently screened articles, extracted data, and evaluated and cross-checked the quality of the included studies. Then meta-analysis was performed using RevMan 5.0 software.
Results 　A total of 11 non-randomized concurrent controlled trials involving 1,485 participants were included. The results of meta-analysis showed that, compared with SV, PV was superior in overall effective rate (RR=1.14, 95%CI 1.03 to 1.27, P=0.01), 2-year survival rate (RR=1.25, 95%CI 1.04 to 1.51, P=0.02), secondary surgery rate (RR=0.53, 95%CI 0.39 to 0.73, P lt;0.001), overall complications rate (RR=0.62, 95%CI 0.51 to 0.76, P lt;0.001), and over-drainage/ under-drainage rates (RR=0.42, 95%CI 0.21 to 0.83, P=0.01). But there were no significant differences in 1-year survival rate (RR=1.04, 95%CI 0.91 to 1.19, P=0.55), postoperative infection rate (RR=1.08, 95%CI 0.73 to 1.60, P=0.71) and valve related complication rate (RR=0.80, 95%CI 0.56 to 1.21, P=0.20) between the two groups.
Conclusion 　Current evidence suggests that PV is superior to SV in increasing the effective rate, decreasing complications, and prolonging the long-term survival rate. Because of the limitation of quantity and quality of the included studies, more high quality, multicenter and double-blind RCTs are needed to prove whether PV can be clinically recommended as a preferred drainage surgery or not.

Citation： XU Hao,WANG Zhanxiang,CHEN Donghan,ZHANG Shaolin,GUO Jianfeng,TAN Guowei,CHEN Sifang,ZHU Hongwei. Effectiveness of Programmable Valves for Hydrocephalus: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2013, 13(1): 78-85. doi: 10.7507/1672-2531.20130015 Copy

1.	Nulsen FE, Becker DP. Treatment of hydrocephalus by direct shunt from ventricle to jugular vein. Surg Forum, 1952, 2(1): 399-403.
2.	Black PM, Hakim R, Olson BN. The use of the Codman-Medos programmable Hakim valve in the management of patients with hydrocephalus: illustrative cases. Neurosurgery, 1994, 34(21): 1110-1113.
3.	Deeks JJ, Dinnes J, D’Amico R, et al. Evaluating non-randomised intervention studies. Health Technol Assess, 2003, 7(27): 170-173.
4.	McGirt MJ, Buck DW 2nd, Sciubba D, et al. Adjustable vs set-pressure valves decrease the risk of proximal shunt obstruction in the treatment of pediatric hydrocephalus. Childs Nerv Syst, 2007, 23(3): 289-295.
5.	Ringel F, Schramm J, Meyer B. Comparison of programmable shunt valves vs standard valves for communicating hydrocephalus of adults: a retrospective analysis of 407 patients. Surg Neurol, 2005, 63(1): 36-41.
6.	Mpakopoulou M, Brotis AG, Gatos H, et al. Ten years of clinical experience in the use of fixed-pressure versus programmable valves: a retrospective study of 159 patients. Acta Neurochir Suppl, 2012, 113(65): 25-28.
7.	Lee WC, Seo DH, Choe IS, et al. A comparative result of ventriculoperitoneal shunt, focusing mainly on gravity-assisted valve and programmable valve. J Korean Neurosurg Soc, 2010, 48(3): 251-258.
8.	Zemack G, Romner B. Adjustable valves in normal-pressure hydrocephalus: a retrospective study of 218 patients. Neurosurgery, 2008, 62(2): 677-687.
9.	单臻, 陈昆, 黄育婵, 等. 可调压与常规非可调压分流管治疗儿童交通性脑积水疗效的比较. 中华神经医学杂志, 2011, 16(3): 299-302.
10.	李志勇, 漆松涛, 方陆雄, 等. 可调压式分流管治疗脑积水(附30例报告). 中华神经外科杂志, 2007, 10(10): 748-749.
11.	赵希敏, 刘勇, 刘霞. 正常压力脑积水的临床特征和手术治疗. 中国临床神经外科杂志, 2011, 16(9): 538-540.
12.	吴雷, 邓志锋, 刘越, 等. 使用可调压分流管治疗脑积水39例分析. 实用医学杂志, 2011, 27(18): 3385-3387.
13.	柏鲁宁, 张毅, 侯文, 等. 可调压式分流管治疗脑积水的临床观察. 山西医科大学学报, 2011, 42(3): 249-251.
14.	周煜. 可调压式脑室-腹腔分流管治疗外伤性脑积水临床研究. 山东医药, 2010, 50(4): 53-54.
15.	Zemack G, Romner B. Seven years of clinical experience with the programmable Codman Hakim valve: a retrospective study of 583 patients. J Neurosurg, 2000, 92(6): 941-948.
16.	Czosnyka Z, Czosnyka M, Copeman J, et al. A randomized, controlled study of a programmable shunt valve versus a conventional valve for patients with hydrocephalus. Neurosurgery, 1999, 45(6): 1399-1408.
17.	Hertel F, Züchner M, Decker C, et al. The Miethke dual switch valve: experience in 169 adult patients with different kinds of hydrocephalus: an open field study. Minim Invasive Neurosurg, 2008, 51(3): 147-153.
18.	Reinprecht A, Dietrich W, Bertalanffy A, et al. The Medos Hakim programmable valve in the treatment of pediatric hydrocephalus.Childs Nerv Syst, 1997, 13(11-12): 588-593.
19.	Yamashita N, Kamiya K, Yamada K. Experience with a programmable valve shunt system. J Neurosurg, 1999, 91(1): 26-31.
20.	王小平, 郭尔安, 齐巍, 等. 使用可调压分流管行脑室一腹腔分流术治疗小儿脑积水. 中华神经外科杂志, 2008, 24(11): 857-859.
21.	Allin DM, Czosnyka ZH, Czosnyka M, et al. In vitro hydrodynamic properties of the Miethke ProGAV hydrocephalus shunt. Cerebrospinal Fluid Res, 2006, 29(3): 9.
22.	Zachenhofer I, Donat M, Roessler K. The combination of a programmable valve and a subclavicular anti-gravity device in hydrocephalus patients at high risk for hygromas. Neurol Res, 2012, 34(3): 219-222.

1. Nulsen FE, Becker DP. Treatment of hydrocephalus by direct shunt from ventricle to jugular vein. Surg Forum, 1952, 2(1): 399-403.
2. Black PM, Hakim R, Olson BN. The use of the Codman-Medos programmable Hakim valve in the management of patients with hydrocephalus: illustrative cases. Neurosurgery, 1994, 34(21): 1110-1113.
3. Deeks JJ, Dinnes J, D’Amico R, et al. Evaluating non-randomised intervention studies. Health Technol Assess, 2003, 7(27): 170-173.
4. McGirt MJ, Buck DW 2nd, Sciubba D, et al. Adjustable vs set-pressure valves decrease the risk of proximal shunt obstruction in the treatment of pediatric hydrocephalus. Childs Nerv Syst, 2007, 23(3): 289-295.
5. Ringel F, Schramm J, Meyer B. Comparison of programmable shunt valves vs standard valves for communicating hydrocephalus of adults: a retrospective analysis of 407 patients. Surg Neurol, 2005, 63(1): 36-41.
6. Mpakopoulou M, Brotis AG, Gatos H, et al. Ten years of clinical experience in the use of fixed-pressure versus programmable valves: a retrospective study of 159 patients. Acta Neurochir Suppl, 2012, 113(65): 25-28.
7. Lee WC, Seo DH, Choe IS, et al. A comparative result of ventriculoperitoneal shunt, focusing mainly on gravity-assisted valve and programmable valve. J Korean Neurosurg Soc, 2010, 48(3): 251-258.
8. Zemack G, Romner B. Adjustable valves in normal-pressure hydrocephalus: a retrospective study of 218 patients. Neurosurgery, 2008, 62(2): 677-687.
9. 单臻, 陈昆, 黄育婵, 等. 可调压与常规非可调压分流管治疗儿童交通性脑积水疗效的比较. 中华神经医学杂志, 2011, 16(3): 299-302.
10. 李志勇, 漆松涛, 方陆雄, 等. 可调压式分流管治疗脑积水(附30例报告). 中华神经外科杂志, 2007, 10(10): 748-749.
11. 赵希敏, 刘勇, 刘霞. 正常压力脑积水的临床特征和手术治疗. 中国临床神经外科杂志, 2011, 16(9): 538-540.
12. 吴雷, 邓志锋, 刘越, 等. 使用可调压分流管治疗脑积水39例分析. 实用医学杂志, 2011, 27(18): 3385-3387.
13. 柏鲁宁, 张毅, 侯文, 等. 可调压式分流管治疗脑积水的临床观察. 山西医科大学学报, 2011, 42(3): 249-251.
14. 周煜. 可调压式脑室-腹腔分流管治疗外伤性脑积水临床研究. 山东医药, 2010, 50(4): 53-54.
15. Zemack G, Romner B. Seven years of clinical experience with the programmable Codman Hakim valve: a retrospective study of 583 patients. J Neurosurg, 2000, 92(6): 941-948.
16. Czosnyka Z, Czosnyka M, Copeman J, et al. A randomized, controlled study of a programmable shunt valve versus a conventional valve for patients with hydrocephalus. Neurosurgery, 1999, 45(6): 1399-1408.
17. Hertel F, Züchner M, Decker C, et al. The Miethke dual switch valve: experience in 169 adult patients with different kinds of hydrocephalus: an open field study. Minim Invasive Neurosurg, 2008, 51(3): 147-153.
18. Reinprecht A, Dietrich W, Bertalanffy A, et al. The Medos Hakim programmable valve in the treatment of pediatric hydrocephalus.Childs Nerv Syst, 1997, 13(11-12): 588-593.
19. Yamashita N, Kamiya K, Yamada K. Experience with a programmable valve shunt system. J Neurosurg, 1999, 91(1): 26-31.
20. 王小平, 郭尔安, 齐巍, 等. 使用可调压分流管行脑室一腹腔分流术治疗小儿脑积水. 中华神经外科杂志, 2008, 24(11): 857-859.
21. Allin DM, Czosnyka ZH, Czosnyka M, et al. In vitro hydrodynamic properties of the Miethke ProGAV hydrocephalus shunt. Cerebrospinal Fluid Res, 2006, 29(3): 9.
22. Zachenhofer I, Donat M, Roessler K. The combination of a programmable valve and a subclavicular anti-gravity device in hydrocephalus patients at high risk for hygromas. Neurol Res, 2012, 34(3): 219-222.

Chinese Journal of Evidence-Based Medicine

Effectiveness of Programmable Valves for Hydrocephalus: A Systematic Review

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