Ventricular shunts are mechanical devices used in the treatment of hydrocephalus, by means of which cerebrospinal fluid (CSF) is diverted from the ventricles to other low-pressure body cavities. Over the last 50 years, mechanical shunting has become the cornerstone for the treatment of hydrocephalus with shunt valves evolving from simple differential valves to complex programmable valves. The chief complications of ventricular shunting include obstruction, infections, and overdrainage causing subdural hematomas and slit-ventricle syndrome. As the number of commercially available valve designs continues to grow, each new generation aims at reducing the likelihood of complications, especially those resulting from overdrainage. Several studies aimed at establishing the superiority of any valve design have been conducted. All have highlighted the advantages and shortcomings of most models without conclusively providing evidence for choosing one over another. As a result, choices still rest on individual and institutional preferences.
Aguiar PH, Shu EB, Freitas AB, Leme RJ, Miura FK, Marino R. Jr.Causes and treatment of intracranial haemorrhage complicating shunting for pediatric hydrocephalus [review]. Childs Nerv Syst2000;16:218-221.
2.
Albright AL, Haines SJ, Taylor FHFunction of parietal and frontal shunts in childhood hydrocephalus . J Neurosurg1988;69:883-886.
Aoki N.Subdural-peritoneal shunt: one piece design with a large flushing device. Childs Nerv Syst1993;9:176-178.
5.
Aschoff A.In-vitro-tests von hydrocephalus-ventilen. PhD thesis (inaugural thesis), University of Heidelberg.
6.
Aschoff A., Kremer P., Benesch C., Fruh K., Klank A., Kunze S.Overdrainage and shunt technology: a critical comparison of programmable, hydrostatic and variable-resistance valves and flow-reducing devices. Childs Nerv Syst1995;11:193-202.
7.
Aschoff A., Kremer P., Hashemi B., Kunze S.The scientific history of hydrocephalus and its treatment. Neurosurg Rev1999;22(2-3):67-93; discussion 94-95.
8.
Barami K., Sood S., Ham S., Canady A.Chemical meningitis from bile reflux in a lumbar-gallbladder shunt . Pediatr Neurosurg1998;29:328-330.
9.
Barami K., Sood S., Ham SD, Canady AIPostural changes in intracranial pressure in chronically shunted patients . Pediatr Neurosurg2000;33(2):64-69.
10.
Beach C., Manthey DETension hydrothorax due to ventriculopleural shunting. J Emerg Med1998;16:33-36.
11.
Becker DP, Nulsen FEControl of hydrocephalus by valve-regulated venous shunt: avoidance of complications in prolonged shunt maintenance. J Neurosurg1968;28:215-226.
12.
Belliard H. , Roux FX, Turak B., Nataf F., Devaux B., Cioloca C.The Codman Medos programmable shunt valve: evaluation of 53 implantations in 50 patients [in French]. Neurochirurgie1996;42:139-145; discussion 145-146.
13.
Benzel EC, Reeves JD, Kesterson L., Hadden TASlit ventricle syndrome in children: clinical presentation and treatment . Acta Neurochir (Wien)1992;117(1-2):7-14.
14.
Bernstein RA , Hsueh W.Ventriculocholecystic shunt: a mortality report . Surg Neurol1985;23(1):31-37.
15.
Black PML , Hakim R., Bailey NOThe use of the Codman-Medos programmable Hakim valve in the management of patients with hydrocephalus: illustrative cases. Neurosurgery1994;34:1110-1113.
16.
Boockvar JA, Loudon W., Sutton LNDevelopment of the Spitz-Holter valve in Philadelphia. J Neurosurg2001;95:145-147.
17.
Borgbjerg BM , Gjerris F., Albeck MJ, Hauerberg J., Borgensen SEFrequency and causes of shunt revisions in different cerebrospinal fluid shunt types. Acta Neurochir (Wein)1995;136(3-4):189-194.
18.
Bret P., Guyotat J., Ricci AC, Mottolese C., Jouanneau E.Clinical experience with the Sophy adjustable valve in the treatment of adult hydrocephalus: a series of 147 cases. Neurochirurgie1999;45:98-108.
19.
Brockmeyer D. , Abtin K., Carey L., Walker MLEndoscopic third ventriculostomy: an outcome analysis. Pediatr Neurosurg1998;28:236-240.
20.
Buxton N., Punt J.Subtemporal decompression. Neurosurgery1999 ;44:513-519.
21.
Catalan G., Bilbao G., Pomposo I., Aurrecoechea J., Garibi J.Our experience with the programmable Codman-Medos valve: review of 125 shunts [in Spanish]. Rev Neurol2000;31:1136-1142.
22.
Chapman PH, Cosman ER, Arnold MAThe relationship between ventricular fluid pressure and body position in normal subjects and subjects with shunts: a telemetric study. Neurosurgery1990;26:181-189.
23.
Cohen SR, Dauser UC, Newman MH, Muraszko K.Surgical techniques of cranial vault expansion for increases in intracranial pressure in older children. J Craniofac Surg1993;4:167-176.
24.
Czonyska M. , Whitehouse H., Smielewski , P., Simac S., Pickard JDTesting of cerebrospinal compensatory reserve in shunted patients and non-shunted patients: a guide to interepretation based on an observational study. J Neurol Neurosurg Psychiatry1996;60:549-558.
25.
Czosnyka Z. , Czosnyka M., Richards H., Pickard JDHydrodynamic properties of hydrocephalus shunts . Acta Neurochir Suppl (Wien)1998;71:334-339.
26.
Czosnyka Z. , Czosnyka M., Richards HK, Pickard JDPosture-related overdrainage: comparison of the performance of 10 hydrocephalus shunts in vitro. Neurosurgery1998;42:327-333; discussion 333-334.
27.
Davis SE, Levy ML, McComb JG, Sposto R.The Delta valve: how does its clinical performance compare with two other pressure differential valves without antisiphon control?Pediatr Neurosurg2000;33(2):58-63.
28.
Davison RI, Zito J.Acute cerebrospinal fluid hydrothorax: a delayed complication of subdural pleural shunting. Neurosurgery1982;10:503-505.
29.
Drake JMVentriculostomy for treatment of hydrocephalus. Neurosurg Clin N Am1993;4:657-666.
30.
Drake JM, DaSilva M., Rutke JTFunctional obstruction of an antisiphon device by raised tissue capsule pressure . Neurosurgery1993;43:294-305.
31.
Drake JM, Kestle J., Milner R., et al. Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery1998 ;43:294.
32.
Driesen W., Elies W.Epidural and subdural hematomas as a complication of internal drainage of cerebrospinal fluid in hydrocephalus. Acta Neurochir (Wein)1974;15:89-101.
33.
Epstein F.How to keep shunts functionning, or "the impossible dream." Clin Neurosurg1985;32:608-635.
Faulkhauer K.The overdrained hydrocephalus: clinical manifestations and management. Adv Tech Stand Neurosurg1982 ;9:3-24.
36.
Foltz ELHydrocephalus: slit ventricles, shunt obstructions, and third ventricle shunts: a clinical study. Surg Neurol1993 ;40:119-124.
37.
Foltz EL, Blanks J.Symptomatic low intracranial pressure in shunted hydrocephalus. J Neurosurg1988;68:401-408.
38.
Fox JL, McCullough DC, Green RCEffect of cerebrospinal fluid shunts on intracranial pressure and on cerebrospinal fluid dynamics: a new technique of pressure measurements: results and concepts: a concept of hydrocephalus. J Neurol Neurosurg Psychiatry1973;36:302-312.
39.
Fox JL, Portnoy HD, Shulte RRCerebrospinal fluid shunts: an experimental comparison of flow rates and pressure valves in the anti-siphon valve. Surg Neurol1973;1:299-302.
40.
Fransen P.Transcutaneous pressure-adjustable valves and magnetic resonance imaging: an ex vivo examination of the Codman-Medos programmable valve and the Sophy adjustable pressure valve. Neurosurgery1998 ;42:430.
41.
Frim DM, Lathrop D.Telemetric assessment of intracranial pressure changes consequent to manipulations of the Codman-Medos programmable shunt valve. Pediatr Neurosurg2000;33:237-242.
42.
Frim DM, Lathrop D., Chwals WJIntraventricular pressure dynamics in ventriculocholecystic shunting: a telemetric study. Pediatr Neurosurg2001 ;34:73-76.
43.
Fukuhara T. , Vorster SJ, Luciano MGCritical shunt-induced subdural hematoma treated with combined pressure-programmable valve implantation and endoscopic third ventriculostomy. Pediatr Neurosurg2000;33(1):37-42.
44.
Gjerris F.Hydrocephalus in adults. In: Black , Kaye, eds. Operative neurosurgery. London: Churchill Livingstone;2000 : 1235-1247.
45.
Gruber R., Jenny P., Herzog B.Experiences with the antisiphon device (ASD) in shunt therapy for pediatric hydrocephalus. J Neurosurg1984;61:156-162.
46.
Hakim S.Hydraulic and mechanical mismatching of valve shunts used in the treatment of hydrocephalus: the need for a servo valve shunts. Dev Med Child Neurol1973;15:646-653.
47.
Heilman CB, Cohen AREndoscopic ventricular fenestration using a saline torch. J Neurosurg1991;74:224-229.
48.
Hoffman HJ, Harwood-Nash D., Gilday DLPercutaneous third ventriculostomy in the treatment of communicating hydrocephalus . Neurosurgery1980;7:313-321.
49.
Hoppe-Hirsch E., Sainte-Rose C., Renier D., Hirsch JFPericerebral collections after shunting. Childs Nerv Syst1987;3(2):97-102.
50.
Horton D., Pollay M.Fluid flow performance of a new siphon-control device for ventricular shunts . J Neurosurg1990;72:926-932.
51.
Hyde-Rowan MD, Rekate HL, Nulsen FEReexpansion of previously collapsed ventricles: the slit ventricles syndrome. J Neurosurg1982;56:536-539.
52.
Ignelski RJ , Kirsch WMFollow-up analysis of ventriculoperitoneal and ventriculoatrial shunts for hydrocephalus. J Neurosurg1975;42:679-682.
53.
James HE, Bruce DAVentriculoperitoneal shunts for hydrocephalus: a focus group discussion on the selection of shunt systems in pediatrics: a report of the Pediatric Neurosurgery Research Group meeting, December 1992. Childs Nerv Syst1995;11:449-451; discussion 452.
54.
Jordan KTCerebrospinal fluid shunts [review]. Emerg Med Clin North Am1994;12:779-786.
55.
Kamano S., Nakano Y., Imanashi T., Hato M.Management with a programmable pressure valve of SDH caused by a ventriculoperitoneal shunt: case report. Surg Neurol1991;35:381-383.
56.
Kay AD, Fisher AD, O'Kane C., Richards HK, Pickard JDA clinical audit of the Hakim programmable valve in patients with complex hydrocephalus. Br J Neurosurg2000 ;14:535-542.
57.
Keen J.Casey Holter and the Spitz-Holter valve. Eur J Pediatr Surg1992;2(suppl 1):5-6.
Kestle J., Drake J., Milner R., et al. Long-term follow-up data from the Shunt Design Trial. Pediatr Neurosurg2000;33:230-236.
60.
Kestle J., Milner R., Drake J.The shunt design trial: variation in surgical experience did not influence shunt survival. Pediatr Neurosurg1999;30:283-287.
61.
Ketoff JA, Klein RL, Maukkassa KFVentricular cholecystic shunts in children. J Pediatr Surg1997;32:181-183.
62.
Keucher TR, Measly J. Jr.Long-term results after ventriculoatrial and ventriculoperitoneal shunting for infantile hydrocephalus. J Neurosurg1979 ;50:179-186.
63.
Kremer P., Aschoff A., Kunze S.Risks of using anti-siphon devices. Childs Nerv Syst1994;10:231-235.
64.
Kuffer F., Strub D.Ein ligaturfreier Konnekor fur Hydrocephalus-Ventile (Voschlag zu einem neuen Ventil). Z Kinderchir1971;9:293-301.
65.
La Fay H.A father's last-chance invention saves his son . Readers Digest1957 Jan.
66.
Little JR, Rhoton AL Jr, Mellinger JFComparison of ventriculoperitoneal and ventriculoatrial shunts for hydrocephalus in children. Mayo Clin Proc1972;47:396-401.
67.
Lumenta CB, Roosen N., Dietrich U.Clinical experience with a pressure-adjustable valve SOPHY in the management of hydrocephalus. Childs Nerv Syst1990;6:270-274.
68.
Lundar T., Langmoen IA, Hovind KHFatal cardiopulmonary complications in children treated with ventriculoatrial shunts. Childs Nerv Syst1991;7:215-217.
Lund-Johansen M., Svendsen F., Wester K.Shunt failures and complications in adults as related to shunt type, diagnosis, and the experience of the surgeon . Neurosurgery1994;35:839-844; discussion 844.
71.
Major O., Fedorcsak I., Sipos L., et al. Slit-ventricle syndrome in shunt operated children. Acta Neurochir (Wien)1994;127(1-2):69-72.
72.
Martinez-Lage J., Torres J., Campillo H., et al. Ventriculo-pleural shunting with new technology valves. Childs Nerv Syst2000;16:867-871.
Miwa K., Kondo H., Sakai N.Pressure changes observed in Codman-Medos programmable valves following magnetic exposure and filliping. Childs Nerv Syst2001 ;17:150-153.
75.
Miyake H., Ohta T., Kajimoto Y., Nagao K.New concept for the pressure setting of a programmable pressure valve and measurement of in vivo shunt flow performed using a microflowmeter: technical note. J Neurosurg2000;92:181-187.
76.
Novelli PM, Reigel DHA closer look at the ventriculo-gallbladder shunt for the treatment of hydrocephalus . Pediatr Neurosurg1997;26:197-199.
77.
Nulsen FE, Spitz EBTreatment of hydrocephalus by direct shunt from ventricle to jugular vein . Surg Forum1953;2:399-403.
78.
O'Reilly G. , Williams B.The Sophy valve and the el-Shafei shunt system for adult hydrocephalus. J Neurol Neurosurg Psychiatry1995;59:621-624.
79.
Ortler M., Kostron H., Felber S.Transcutaneous pressure-adjustable valves and magnetic resonance imaging: an ex vivo examination of the Codman-Medos programmable valve and the Sophy adjustable pressure valve. Neurosurgery1997 ;40:1050-1057; discussion 1057-1058.
80.
Pedersen PH , Waaler PE, Wester K.Dysfunction of Holter mini elliptical valves caused by minor head trauma. Dev Med Child Neurol1992;34(1):66-68.
81.
Pollack IF, Albright AL, Adelson PDA randomized, controlled study of a programmable shunt valve versus a conventional valve for patients with hydrocephalus. Neurosurgery1999;45:1399-1408; discussion 1408-1411.
82.
Portnoy HD, Amirjamshidi A., Hoffman HJ, et al. Shunts: which one, and why?Surg Neurol1998;49(1):8-13.
83.
Portnoy HD, Schulte RR, Fox JL, Croissant PD, Tripp L.Anti-siphon and reversible occlusion valves for shunting in hydrocephalus and preventing post-shunting subdural hematomas. J Neurosurg1973;38:729-738.
84.
Post EMShunt systems. In: Wilkins RH, Rengachary SS, eds. Neurosurgery. 2nd ed. New York: McGraw-Hill ; 1996:3645-3653.
85.
Puca A., Anile C., Maira G., Rossi G.Cerebrospinal fluid shunting for hydrocephalus in the adult: factors related to shunt revision. Neurosurgery1991 ;29:822-826.
86.
Pudenz RHThe surgical treament of hydrocephalus-a historical review. Surg Neurol1981;15:15-25.
87.
Rajaraman V. , Schlenk R., Schulder M.Beware of the ventriculogallbladder shunt . Pediatr Radiol2000;30:274-275.
88.
Reinprecht A., Czech T., Dietrich W.Clinical experience with a new pressure adjustable valve. Acta Neurochir (Wein)1995;134:119-124.
89.
Rekate HLClassification of slit-ventricle syndromes using intracranial pressure monitoring . Pediatr Neurosurg1993;19:15-20.
90.
Rhode V., Mayfrank L., Ramakers VT, Gilsbach JMFour-year experience with the routine use of the Hakim programmable valve in the management of patients with hydrocephalus. Acta Neurochir1998;140:1126-1134.
Sainte-Rose C., Piatt JH, Renier D., et al. Mechanical complications in shunts . Pediatr Neurosurg 1991-1992;17:2-9.
93.
Samtleben W. , Bauriedel G., Bosch T., Goetz C., Klare B., Gurland HJRenal complications of infected ventriculoatrial shunts. Artif Organs1993;17:695-701.
94.
Samuelson S. , Long DM, Chou SNSubdural hematoma as a complication of shunting procedures for normal pressure hydrocephalus. J Neurosurg1972;37:548-551.
95.
Sanders DY, Summers R., Derouen L.Symptomatic pleural collection of cerebrospinal fluid caused by a ventriculoperitoneal shunt. South Med J1997 ;90:831-832.
96.
Scott RMShunt complications. In: Wilkins, RH, Rengacharyss eds. Neurosurgery. New York, McGraw Hill. 1996:3655-3664.
97.
Sekhar LN, Moossy J., Guthkelch ANMalfunctionning ventriculoperitoneal shunts-clinical and pathological features . J Neurosurg1982;56:411-416.
98.
Serlo W., Saukkonen AL, Heikkinen E., von Wendt L.The incidence and management of the slit ventricle syndrome. Acta Neurochir (Wien)1989;99(3-4):113.
99.
Serlo W., Von Wendt L., Heikkinen ES, Heikkinen ERBall and spring or slit and core valve for hydrocephalus shunting?Ann Clin Res1986;18(suppl 47):103-106.
100.
Shellock FG , Swenpros-Curtis J.MR imaging and biomedical implants, materials and devices: an updated review. Radiology1993;180:541-550.
101.
Sindou M., Guyotat-Pelissou I., Chidiac A., Goutelle A.Transcutaneous pressure adjustable valve for the treatment of hydrocephalus and arachnoid cysts in adults: experiences with 75 cases. Acta Neurochir (Wien)1993;121(3-4):135-139.
102.
Stringel G. , Turner M., Crase T.Ventriculo-gallbladder shunts in children . Childs Nerv Syst1993 ;9:331-333.
103.
Sutcliffe JC, Battersby RDE.Do we need variable pressure shunts? Br J Neurosurg1992;6:67-70.
104.
Turner MSThe treatment of hydrocephalus: a brief guide to shunt selection [review] . Surg Neurol1995;43:314-319; discussion 319-323.
105.
Walker ML, Fried A., Petronio J.Diagnosis and treatment of the slit ventricle syndrome [review]. Neurosurg Clin N Am1993;4:707-714.
106.
Watson DAThe Delta valve: a physiologic shunt system. Childs Nerv Syst1994;10:224-230.
107.
Weiner HL, Constantini S., Cohen H., Wisoff JHCurrent treatment of hydrocephalus: comparison of flow-regulated and differential pressure valves. Neurosurgery1995;37:877-884.
108.
West CGH.Ventriculovesical shunts: technical note. J Neurosurg1980;53:858-860.
109.
West KW, Turner MK, Vane DW, Boaz J., Kalsbeck J., Grosfeld JLVentricular gallbladder shunts: an alternative procedure in hydrocephalus . J Pediatr Surg1987;22:609-612.
110.
Will B., Muller-Korbsch U., Buchholz R.Experience with the programmable Sophy SU8 valve [abstract]. Childs Nerv Syst1984;10:476.
111.
Yamashita, Kamiya K., Yamada K.Experience with a programmable valve shunt system. J Neurosurg1999;91(1):26-31.
112.
Yavuzgil O. , Ozerkan F., Erturk U., Islekel S., Atay Y., Buket S.A rare case of right atrial mass: thrombus formation and infection complicating a ventriculoatrial shunt for hydrocephalus . Surg Neurol1999 ;52(1):54-60; discussion 60-61.
113.
Zemack G., Romner B.Seven years of clinical experience with the programmable Codman Hakim valve: a retrospective study of 583 patients. J Neurosurg2000;92:941-948.
