Lissa C Baird, Catherine A Mazzola1, Kurtis I Auguste2, Paul Klimo3,4, Ann Marie Flannery5. 1. Division of Pediatric Neurological Surgery, Goryeb Children's Hospital, Morristown, New Jersey 2. Department of Neurosurgery, University of California, San Francisco, California 3. Department of Neurosurgery, University of Tennessee Health Science Center 4. 6Le Bonheur Children's Hospital, Memphis, Tennessee; and. 5. Department of Neurological Surgery, Saint Louis University, St. Louis, Missouri
Abstract
OBJECT: 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. RECOMMENDATION: 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. STRENGTH OF RECOMMENDATION: Level I, high degree of clinical certainty. RECOMMENDATION: 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. STRENGTH OF RECOMMENDATION: Level II, moderate degree of clinical certainty.
OBJECT: 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. RECOMMENDATION: 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. STRENGTH OF RECOMMENDATION: Level I, high degree of clinical certainty. RECOMMENDATION: 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. STRENGTH OF RECOMMENDATION: Level II, moderate degree of clinical certainty.
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Keywords:
AANS = American Association of Neurological Surgeons; CNS = Congress of Neurological Surgeons; antisiphon device; cerebrospinal fluid shunt; hydrocephalus; practice guidelines; programmable valve
Authors: Luis Garegnani; Juan Va Franco; Agustín Ciapponi; Virginia Garrote; Valeria Vietto; Santiago Adalberto Portillo Medina Journal: Cochrane Database Syst Rev Date: 2020-06-16
Authors: Ulrich-Wilhelm Thomale; Andreas Schaumann; Florian Stockhammer; Henrik Giese; Dhani Schuster; Stefanie Kästner; Alexander Sebastian Ahmadi; Manolis Polemikos; Hans-Christoph Bock; Leonie Gölz; Johannes Lemcke; Elvis Hermann; Martin U Schuhmann; Thomas Beez; Michael Fritsch; Berk Orakcioglu; Peter Vajkoczy; Veit Rohde; Georg Bohner Journal: Neurosurgery Date: 2018-08-01 Impact factor: 4.654