title: Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 5: Effect of valve type on cerebrospinal fluid shunt efficacy.
abstract: OBJECTIVE
  The objective of this systematic review was to examine the existing literature to compare differing shunt components used to treat hydrocephalus in children, find whether there is a superior shunt design for the treatment of pediatric hydrocephalus, and make evidence-based recommendations for the selection of shunt implants when placing shunts.
  
  
  METHODS
  Both the US National Library of Medicine PubMed/MEDLINE database and the Cochrane Database of Systematic Reviews were queried using MeSH headings and key words chosen to identify publications comparing the use of shunt implant components. Abstracts of these publications were reviewed, after which studies meeting the inclusion criteria were selected. An evidentiary table was compiled summarizing the selected articles and quality of evidence. These data were then analyzed by the Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force to consider evidence-based treatment recommendations.
  
  
  RESULTS
  Two hundred sixty-nine articles were identified using the search parameters, and 43 articles were recalled for full-text review. Of these, 22 papers met the study criteria for a comparison of shunt components and were included in the evidentiary table. The included studies consisted of 1 Class I study, 11 Class II studies, and 10 Class III studies. The remaining 21 articles were excluded.
  
  
  CONCLUSIONS
  An analysis of the evidence did not demonstrate a clear advantage for any specific shunt component, mechanism, or valve design over another.
  
  
  CONCLUSIONS
  There is insufficient evidence to demonstrate an advantage for one shunt hardware design over another in the treatment of pediatric hydrocephalus. Current designs described in the evidentiary tables are all treatment options.
  
  
  METHODS
  Level I, high degree of clinical certainty.
  
  
  CONCLUSIONS
  There is insufficient evidence to recommend the use of a programmable valve versus a nonprogrammable valve. Programmable and nonprogrammable valves are both options for the treatment of pediatric hydrocephalus.
  
  
  METHODS
  Level II, moderate degree of clinical certainty.
authors.forename: Lissa C
authors.initials: LC
authors.lastname: Baird
authors.affiliation: Division of Pediatric Neurological Surgery, Goryeb Children's Hospital, Morristown, New Jersey
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Mazzola
authors.affiliation: Department of Neurosurgery, University of California, San Francisco, California
authors.forename: Kurtis I
authors.initials: KI
authors.lastname: Auguste
authors.affiliation: Department of Neurosurgery, University of Tennessee Health Science Center|6Le Bonheur Children's Hospital, Memphis, Tennessee; and.
authors.forename: Paul
authors.initials: P
authors.lastname: Klimo
authors.affiliation: Department of Neurological Surgery, Saint Louis University, St. Louis, Missouri
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Flannery
mesh_terms: D002557:Cerebrospinal Fluid Shunts / Q000295:instrumentation*; D002648:Child; D004867:Equipment Design; D019317:Evidence-Based Medicine; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D014481:United States
keywords: AANS = American Association of Neurological Surgeons; CNS = Congress of Neurological Surgeons; antisiphon device; cerebrospinal fluid shunt; hydrocephalus; practice guidelines; programmable valve