Efficacy and safety of programmable shunt valves for hydrocephalus: A meta-analysis.

Objectives: Shunt implantation is an option in the treatment of hydrocephalus. However, the benefits and adverse effects of programmable shunt valves have not been well assessed.
Materials and Methods: Randomized controlled trials (RCTs) and observational studies assessing the efficacy and safety of programmable valves (PV) treatment for hydrocephalus were identified from electronic databases (PubMed, EMBASE, and Cochrane library). The meta-analysis was performed with the fixed-effect model or random-effect model according to heterogeneity.
Results: Three RCTs and eight observational studies met the inclusion criteria including 2622 subjects. Compared with non-PV, PV treatment did not have a statistically significant effect on one-year shunt survival rate [relative risk (RR), 1.06; 95% confidence interval (CI), 0.84-1.35], Substantial heterogeneity was observed between studies (P = 0.09; I ²  = 65%). PV administration significantly reduced revision rate (RR, 0.56; 95% CI, 0.45-0.69; I ²  = 29%; P = 0.23) and over- or under-drainage complications rate (RR, 0.55; 95% CI, 0.32-0.96). PV was not associated with increased rates of other adverse events, including overall complications rate, infection rate and catheter-related complications rate.
Conclusions: PV treatment is safe and may reduce the revision rate and over- or under-drainage complication rate, especially in patients aged less than 18 years with hydrocephalus. PV treatment is not associated with decreased overall complication rates in patients with hydrocephalus, but the trial sequential analysis indicate more studies are needed to confirm this result.
(Copyright © 2017. Published by Elsevier Ltd.)