Valved or valveless ventriculoperitoneal shunting in the treatment of post- XXXX @entity1276 : a population-based consecutive cohort study.

@entity1 @entity1276 @entity548 @entity281 @entity5033
BACKGROUND: @entity281 and obstruction are major complications for @entity5033 in @entity1 with post- @entity548 @entity1276 . 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 @entity5033 at our department for adult @entity1 with post- @entity548 @entity1276 and @entity548 cerebrospinal fluid at the time of shunt insertion. METHODS: All adult @entity1 (>18  years old) treated for post- @entity548 @entity1276 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 @entity1 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 @entity1 receiving a valveless shunt (p   =   0.004). @entity1 with valveless shunts had a lower rate of @entity281 (5.1  % vs 14.3  %, p   =   0.02), but a higher rate of overdrainage (10.3  % vs 2.6  %, p   =   0.04). CONCLUSION: The use of a valveless shunting for @entity1 with post- @entity548 @entity1276 results in shorter duration of neurosurgical hospitalisation and lower rate of @entity281 , 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 @entity1 category, with careful follow-up ensuring that these are substituted by a valve-bearing system if necessary.
