Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
-
Cerebrospinal fluid shunt failure remains a common and at times overwhelming problem in pediatric patients with hydrocephalus. Two new shunt valve designs, the Orbis-Sigma (Cordis Corporation, Miami, Florida) and the Delta valve (PS Medical, Goletta, California), have flow/pressure characteristics dramatically different from those of standard differential pressure valves which have been used for over three decades. Both new designs reduce the siphoning effect in the upright position, and have been reported to reduce shunt failure rates in uncontrolled series, allegedly due to reduction in shunt overdrainage. ⋯ For this reason a randomized trial is required to determine efficacy, and a standard differential pressure valve is required as the control design. A significant reduction in early shunt failure would dramatically improve the morbidity and mortality of pediatric hydrocephalic patients, as well as providing substantial savings to the health care system. Failure to determine any difference would focus attention on other issues surrounding shunt surgery, such as patient characteristics or surgical technique.