Patterns of Shunt Failure According to the Hydrodynamic Features of the Valve: Lessons from the Shunt Design Trial
In the early 1990s, two new valves came on the market for the management of hydrocephalus. They were designed to limit the tendency to overdrainage and to provide a more physiologic management of hydrocephalus. They were widely used based on reports of reduced shunt failure in uncontrolled series [3,9,10]. The Shunt Design Trial was initiated to compare the function of these valves with that of the differential pressure valves that had been on the market for many years previously. Surgeons from ten pediatric neurosurgery centers in Canada, the United States, and Europe participated in the trial and accrued patients from 1993 to 1995. A total of 344 children less than 18 years old were identified and randomized. All of them had hydrocephalus requiring a single ventriculoperitoneal shunt. Patients were only enrolled in the trial if they were undergoing their first shunt insertion; candidates for shunt revision were not included. The patients were randomized to receive the Orbis-Sigma valve (which at the time was produced by Cordis Corporation), the Delta valve, or a differential pressure valve of the surgeons’ choice (“standard” group).
KeywordsSubdural Hematoma Shunt Revision Pediatric Neurosurgery Shunt Failure Shunt Insertion
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