• Neurosurgery · Aug 2021

    Comparison Between Flow-Regulated and Gravitational Shunt Valves in the Treatment of Normal Pressure Hydrocephalus: Flow-Grav Study.

    • Pierre Scheffler, Markus Florian Oertel, and Lennart Henning Stieglitz.
    • Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
    • Neurosurgery. 2021 Aug 16; 89 (3): 413-419.

    BackgroundNormal pressure hydrocephalus (NPH) is frequently treated with ventriculoperitoneal shunt (VPS) surgery. However, VPS implantation can lead to overdrainage and complications such as headaches, hygroma, and subdural hematoma due to a siphon effect in an upright position. Gravitational valves prevent overdrainage through position-dependent adjustment of valve resistance. Flow-regulated valves that increase resistance in presence of high cerebrospinal fluid flow may provide similar protection against overdrainage and present an alternative to gravitational valves.ObjectiveTo compare gravitational and flow-regulated shunt valves in patients with symptomatic NPH.MethodsWe performed a retrospective analysis of 97 patients suffering from NPH who underwent VPS implantation with a gravitational or a flow-regulated valve. The primary endpoint was the occurrence of hygroma or subdural hematoma. Secondary endpoints were neurological outcome (Kiefer score, Stein and Langfitt score, and NPH recovery rate), frequency of valve adjustments, and reoperations.ResultsNo significant differences in the occurrence of hygroma and subdural hematoma (11.4% for flow-regulated valves vs 5.7% for gravitational valves, P = .462) or response to treatment (77.3% vs 81.1%, P = .802) were found. Patients with flow-regulated valves required fewer valve adjustments (1.12 vs 2.02, P < .001) to reach their optimal neurological outcome and underwent fewer surgical revisions (11.4% vs 28.3%, P = .047).ConclusionOur data suggest that shunt therapy in NPH patients with a flow-regulated instead of a gravitational valve is safe and effective with a comparable clinical outcome and risk of overdrainage complications. Moreover, patients with flow-regulated valves may need fewer valve adjustments and reoperations.© Congress of Neurological Surgeons 2021.

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