1014. A cohort comparison analysis of fixed pressure ventriculoperitoneal shunt valves with programmable valves for hydrocephalus following non-traumatic subarachnoid hemorrhage

Authors: Eduardo Esteban Orrego Gonzalez; Eduardo Esteban Orrego Gonzalez, MD; Luis Ascanio, MD; Alejandro Enriquez Marulanda, MD; Justin Murray Moore, MD, PhD; Noah Jordan, BS; Cristopher Ogilvy, MD; Thomas Ajith, MD (Cali, Colombia)

Introduction:

Hydrocephalus after non-traumatic subarachnoid hemorrhage (SAH) is a fairly common sequela which may require the placement of ventriculoperitoneal shunts (VPS). Adjustable-pressure valves (APV) are being widely used in this situation though more expensive than differential-pressure valves (DPV). This study aims to compare outcomes between APV and DPV.

Methods:

A single-institution retrospective review of patients with non-traumatic SAH who underwent VPS placement for the treatment of hydrocephalus after SAH, between July of 2007 and December of 2016, was performed. Patients were classified according to the type of valve (APV vs. DPV). Factors that could predict the type of valve used were evaluated. In addition, we assessed outcomes which included VPS revision rate, adjustments of performance level and complications

Results:

A total of 66 patients underwent VPS placement which were equally distributed into the two groups of valves. VPS failure occurred in 11 cases (16.7%) in the entire sample, nine patients (27.3%) with a DPV and two patients (6.1%) with an APV had a VPS failure (p=0.021).  Five patients (7.56%) had complications related to overdrainage, three of them had an APV and were managed by adjusting the PL of the valve. VPS placement before discharge during the initial hospitalization (p=0.024) was statistically significant associated with the use of a differential pressure valve, while the type of external ventricular drain (EVD) failure (p=0.034) was associated with the use of an APV.

Conclusion:

Placement of a VPS before discharge was associated with the use of a DPV. Other factors did not predict the type of valve used after a SAH; rather this could be a preference of the attending. APV have a lower rate of surgical revisions in patients with hydrocephalus secondary to SAH.