• James Kelbert, Kristin Nosova, Ashley Kern, Rachel Russell, Annie Pico, James Mamaril-Davis, Amna Hussein, Ganesh Murthy, Giovanni Barbagli, and Robert W Bina.
• Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, Arizona, USA. Electronic address: jkelbert@arizona.edu.
• World Neurosurg. 2024 Dec 6; 194: 123450123450.

BackgroundIdiopathic normal pressure hydrocephalus is classically recognized by the triad of gait disturbance, cognitive dysfunction, and urinary incontinence. Since ventricular shunting may be affected by valve type, we conducted a meta-analysis to assess the relationship between valve characteristics and outcomes.MethodsEnglish language studies that reported valve types, outcomes, and associated complications were included. Data were extracted and analyzed using R, version 4.3.2.ResultsThirteen studies were included. With gravitational valves, meta-analysis yielded 0.04 [0.02, 0.07] for subdural effusions (SDEs), 0.00 [0.00, 0.00] for surgical SDEs, 0.06 [0.03, 0.09] for proximal revisions, and 0.06 [0.03, 0.09] for distal. With differential pressure valves (DPVs) with antisiphon control, meta-analysis showed an incidence of 0.10 [0.07, 0.13] for SDEs, 0.02 [0.01, 0.04] for surgical SDEs, 0.03 [0.01, 0.05] for proximal and 0.04 [0.02, 0.07] for distal revisions. With DPVs without antisiphon control, there was an incidence of 0.17 [0.11, 0.23] for SDEs, 0.11 [0.06, 0.19] for surgical SDEs, 0.00 [0.00, 0.02] for proximal shunt revisions, and 0.05 [0.02, 0.10] for distal shunt revisions. With flow regulated valves, there was an incidence of 0.05 [0.01, 0.12] for SDEs, 0.01 [0.00, 0.05] for surgical SDEs, 0.06 [0.02, 0.11] for proximal revisions, and 0.01 [0.00, 0.05] for distal.ConclusionsGravitational valves and NPVs are associated with fewer SDEs while DPVs with and without ASDs are associated with more while there were no differences in proximal or distal revisions.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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