Shunt options for normal pressure hydrocephalus: a comparison of complications, overdrainage rates and neurological outcomes between integra low flow regulated and Codman Hakim programmable shunts

Abstract

Aims: Shunt surgery is the most commonly performed treatment for idiopathic normal pressure hydrocephalus, and shunt systems with different operating principles are employed. This study aimed to retrospectively compare programmable ventriculoperitoneal shunts and flow-regulated shunts in terms of complications, overdrainage rates, and neurological outcomes. Methods: Between January 2020 and May 2022, 44 patients who underwent shunt operation with a diagnosis of idiopathic normal pressure hydrocephalus at our clinic were retrospectively analyzed. Patients were categorized into two groups: the programmable ventriculoperitoneal shunt and the flow-regulated shunt group. Demographic characteristics, complications, rates of insufficient drainage/overdrainage, and surgical outcomes were compared. Results: There were 26 patients in the programmable ventriculoperitoneal shunt group and 18 patients in the flow-regulated shunt group. In the programmable ventriculoperitoneal shunt group, 14 patients (53.8%) required 27 shunt setting adjustments owing to excessive or inadequate drainage. Subdural effusion was observed in five patients (19.2%), and shunt revision was performed in one patient (3.8%). Subdural effusion was observed in two (11.1%) patients in the flow-regulated shunt group. One of these patients (5.5%) underwent shunt revision. There was no significant difference between the groups in terms of the development of subdural effusion and need for shunt revision (p>0.05). The rate of improvement in at least one of the symptoms was 53.8% in the programmable ventriculoperitoneal shunt group at the 1st-month postoperative outpatient follow-up. In the flow-regulated shunt group, this rate was 72.2% and there was no statistically significant difference. Both groups showed similar clinical improvement at the 1-year follow-up. Conclusion: There was no difference between the groups in terms of neurological outcomes and the need for shunt revision. However, the use of flow-regulated shunts has demonstrated earlier rates of clinical improvement without the need for reprogramming.