title: Valved or valveless ventriculoperitoneal shunting in the treatment of post-haemorrhagic hydrocephalus: a population-based consecutive cohort study.
abstract: BACKGROUND
  Implant infection and obstruction are major complications for ventriculoperitoneal shunts in patients with post-haemorrhagic hydrocephalus. In an effort to (1) reduce the incidence of these complications, (2) reduce the rate of shunt failure and (3) shorten the duration of neurosurgical hospitalisation, we have implemented valveless ventriculoperitoneal shunts at our department for adult patients with post-haemorrhagic hydrocephalus and haemorrhagic cerebrospinal fluid at the time of shunt insertion.
  
  
  METHODS
  All adult patients (>18 years old) treated for post-haemorrhagic hydrocephalus with ventriculoperitoneal shunting at our institution from 1 January 2008 to 31 December 2014 were included in this retrospective population-based consecutive cohort study. Data were collected by retrospectively reviewing medical records. We compared two different shunt modalities (valveless vs valve-regulated), analysing frequencies of complications, shunt survival and duration of neurosurgical hospitalisation.
  
  
  RESULTS
  A total of 214 patients aged 22-86 (mean age, 60.5 ± 11.5 years) were included, comprising 137 valveless and 77 valve-regulated shunts. We found no difference in the rate of surgical shunt revision (p = 0.65) or differences in time interval from insertion to first surgical revision (p = 0.31) between the two shunt modalities. The duration of neurosurgical hospitalisation was shorter for patients receiving a valveless shunt (p = 0.004). Patients with valveless shunts had a lower rate of shunt infection (5.1 % vs 14.3 %, p = 0.02), but a higher rate of overdrainage (10.3 % vs 2.6 %, p = 0.04).
  
  
  CONCLUSIONS
  The use of a valveless shunting for patients with post-haemorrhagic hydrocephalus results in shorter duration of neurosurgical hospitalisation and lower rate of shunt infection, although these advantages should be held up against the risk of overdrainage. We propose valveless shunting to be used as first-line shunting strategy in this patient category, with careful follow-up ensuring that these are substituted by a valve-bearing system if necessary.
authors.affiliation: The Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. trinehjorslev@hotmail.com.
authors.forename: Trine Hjorslev
authors.initials: TH
authors.lastname: Andreasen
authors.affiliation: The Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
authors.forename: Anders Vedel
authors.initials: AV
authors.lastname: Holst
authors.affiliation: The Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
authors.forename: Alexander
authors.initials: A
authors.lastname: Lilja
authors.affiliation: The Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Andresen
authors.affiliation: The Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.|Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Jiri
authors.initials: J
authors.lastname: Bartek
authors.affiliation: The Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
authors.forename: Vagn
authors.initials: V
authors.lastname: Eskesen
authors.affiliation: The Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
authors.forename: Marianne
authors.initials: M
authors.lastname: Juhler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D023381:Endpoint Determination; D004867:Equipment Design; D004868:Equipment Failure / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000628:therapy*; D020300:Intracranial Hemorrhages / Q000150:complications* / Q000628:therapy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects / Q000295:instrumentation*; D055815:Young Adult
keywords: Hydrocephalus; Intraventricular haemorrhage; Shunt complication; Shunt revision