{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T20:15:49Z","timestamp":1772828149813,"version":"3.50.1"},"reference-count":52,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Hydrocephalus in children is mostly treated with a CSF-diverting shunt system as a lifelong implant. Presently, a variety of shunt valves are available on the market, but there is a lack of evidence guiding valve type selection for the management of pediatric hydrocephalus. The aim of this study was to compare two shunt valve types in the treatment of pediatric hydrocephalus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A retrospective analysis of synchronized patient databases was conducted at two pediatric neurosurgical centers. At one center, an adjustable differential pressure (aDP) valve with a fixed gravitational unit was utilized (aDP group). At the other center, an adjustable gravitational (aG) valve was combined with a fixed differential pressure unit (aG group). Inclusion criteria were an age less than 2 years at shunt implantation and a follow-up of 3 years. Patient demographics, revision-free shunt and valve survival rates, total number of revisions per patient, and ventricle width were compared between the two institutional cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Among 227 patients eligible for study inclusion, 141 received an aDP valve and 86 received an aG valve. The two patient cohorts showed no differences in overall revision-free shunt survival rates: 59.6% in the aDP group versus 58.1% in the aG group (p = 0.42, HR 0.8, 95% CI 0.6\u20131.3). The revision-free valve survival rate was significantly lower in the aDP group than in the aG group (69.5% vs 86.0%, p = 0.01, HR 2.3, 95% CI 1.3\u20133.9), but the revision-free nonvalve shunt components survival rate was higher (85.8% vs 65.1%, p &lt; 0.001, HR 0.3, 95% CI 0.2\u20130.6). The total number of shunt revisions in the patients who underwent revision was significantly higher in the aG group (2 [IQR 1\u20132] vs 1 [IQR 0], p &lt; 0.01). At follow-up, median valve settings were higher in the aDP group than in the aG group (10 [IQR 8\u201312]\/30 [IQR 29\u201334] cmH\n                      <jats:sub>2<\/jats:sub>\n                      O vs 5 [IQR 0]\/25 [IQR 20\u201325] cmH\n                      <jats:sub>2<\/jats:sub>\n                      O for lying\/standing, respectively), which resulted in a significant, more pronounced reduction in the mean frontooccipital horn ratio as a measure of ventricle width in the aG group (\u22120.2 \u00b1 0.1 vs \u22120.13 \u00b1 0.09, p &lt; 0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Differences in valve and nonvalve component revision rates were inverted for the aDP and aG groups and may reflect subtle differences in shunt surgery strategies at the two centers. Overall, lower valve settings led to a greater reduction in ventricle width measurements. Head circumference and ventricular width may need further analysis as possible surrogate parameters for intracranial pressure\u2013guided CSF diversion and should be combined with neurodevelopmental outcome parameters in future studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.3.peds24637","type":"journal-article","created":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T23:13:38Z","timestamp":1751066018000},"page":"395-403","source":"Crossref","is-referenced-by-count":0,"title":["Adjustable differential pressure versus adjustable gravitational valves in pediatric hydrocephalus"],"prefix":"10.3171","volume":"36","author":[{"given":"Isabel","family":"Fernandes Arroteia","sequence":"first","affiliation":[{"name":"Pediatric Neurosurgery, Charit\u00e9-Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Campus Virchow Klinikum, Berlin; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans Christoph","family":"Bock","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, G\u00f6ttingen University Hospital, G\u00f6ttingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Schaumann","sequence":"additional","affiliation":[{"name":"Pediatric Neurosurgery, Charit\u00e9-Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Campus Virchow Klinikum, Berlin; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valentina","family":"Pennacchietti","sequence":"additional","affiliation":[{"name":"Pediatric Neurosurgery, Charit\u00e9-Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Campus Virchow Klinikum, Berlin; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"El-Garci","sequence":"additional","affiliation":[{"name":"Pediatric Neurosurgery, Charit\u00e9-Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Campus Virchow Klinikum, Berlin; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gesa","family":"Cohrs","sequence":"additional","affiliation":[{"name":"Pediatric Neurosurgery, Charit\u00e9-Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Campus Virchow Klinikum, Berlin; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"Schulz","sequence":"additional","affiliation":[{"name":"Pediatric Neurosurgery, Charit\u00e9-Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Campus Virchow Klinikum, Berlin; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Friederike","family":"Knerlich-Lukoschus","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, G\u00f6ttingen University Hospital, G\u00f6ttingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulrich-Wilhelm","family":"Thomale","sequence":"additional","affiliation":[{"name":"Pediatric Neurosurgery, Charit\u00e9-Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Campus Virchow Klinikum, Berlin; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Eur J Paediatr Neurol","first-page":"150","article-title":"Congenital hydrocephalus\u2014prevalence, prenatal diagnosis and outcome of pregnancy in four European regions","volume":"14","author":"Garne E","year":"2010","unstructured":"Garne E, Loane M, Addor MC, Boyd PA, Barisic I, Dolk H. Congenital hydrocephalus\u2014prevalence, prenatal diagnosis and outcome of pregnancy in four European regions. Eur J Paediatr Neurol. 2010;14(2):150\u2013155."},{"issue":"10","key":"b2","series-title":"Childs Nerv Syst","first-page":"1111","article-title":"Hydrocephalus in children born in 1999-2002: epidemiology, outcome and ophthalmological findings","volume":"23","author":"Persson EK","year":"2007","unstructured":"Persson EK, Anderson S, Wiklund LM, Uvebrant P. Hydrocephalus in children born in 1999-2002: epidemiology, outcome and ophthalmological findings. Childs Nerv Syst. 2007;23(10):1111\u20131118."},{"key":"b3","series-title":"Clin Epidemiol","first-page":"1721","article-title":"School performance in children with infantile hydrocephalus: a nationwide cohort study","volume":"10","author":"Schmidt LB","year":"2018","unstructured":"Schmidt LB, Corn G, Wohlfahrt J, Melbye M, Munch TN. School performance in children with infantile hydrocephalus: a nationwide cohort study. Clin Epidemiol. 2018;10:1721\u20131731."},{"issue":"11","key":"b4","series-title":"Childs Nerv Syst","first-page":"3313","article-title":"Integrated understanding of hydrocephalus\u2014a practical approach for a complex disease","volume":"37","author":"Thomale UW","year":"2021","unstructured":"Thomale UW. Integrated understanding of hydrocephalus\u2014a practical approach for a complex disease. Childs Nerv Syst. 2021;37(11):3313\u20133324."},{"issue":"4","key":"b5","series-title":"J Neurosurg Pediatr","first-page":"310","article-title":"Predicting who will benefit from endoscopic third ventriculostomy compared with shunt insertion in childhood hydrocephalus using the ETV Success Score","volume":"6","author":"Kulkarni AV","year":"2010","unstructured":"Kulkarni AV, Drake JM, Kestle JRW, Mallucci CL, Sgouros S, Constantini S. Predicting who will benefit from endoscopic third ventriculostomy compared with shunt insertion in childhood hydrocephalus using the ETV Success Score. 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Retrospective single-center historical comparative study between proGAV and proGAV2.0 for surgical revision and implant duration. Childs Nerv Syst. 2022;38(6):1155\u20131163."},{"issue":"11","key":"b16","series-title":"Childs Nerv Syst","first-page":"3497","article-title":"An adjustable gravitational valve for initial VP-shunt treatment in hydrocephalic preterm neonates and infants below 1 year of age","volume":"37","author":"Bock HC","year":"2021","unstructured":"Bock HC, von Philipp G, Ludwig HC. An adjustable gravitational valve for initial VP-shunt treatment in hydrocephalic preterm neonates and infants below 1 year of age. 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Maneuver protocol for outpatient telemetric intracranial pressure monitoring in hydrocephalus patients. Childs Nerv Syst. 2023;39(1):185\u2013195."},{"issue":"2","key":"b1","series-title":"Eur J Paediatr Neurol","first-page":"150","article-title":"Congenital hydrocephalus\u2014prevalence, prenatal diagnosis and outcome of pregnancy in four European regions","volume":"14","author":"Garne E","year":"2010","unstructured":"Garne E, Loane M, Addor MC, Boyd PA, Barisic I, Dolk H. Congenital hydrocephalus\u2014prevalence, prenatal diagnosis and outcome of pregnancy in four European regions. Eur J Paediatr Neurol. 2010;14(2):150\u2013155."},{"issue":"10","key":"b2","series-title":"Childs Nerv Syst","first-page":"1111","article-title":"Hydrocephalus in children born in 1999-2002: epidemiology, outcome and ophthalmological findings","volume":"23","author":"Persson EK","year":"2007","unstructured":"Persson EK, Anderson S, Wiklund LM, Uvebrant P. Hydrocephalus in children born in 1999-2002: epidemiology, outcome and ophthalmological findings. Childs Nerv Syst. 2007;23(10):1111\u20131118."},{"key":"b3","series-title":"Clin Epidemiol","first-page":"1721","article-title":"School performance in children with infantile hydrocephalus: a nationwide cohort study","volume":"10","author":"Schmidt LB","year":"2018","unstructured":"Schmidt LB, Corn G, Wohlfahrt J, Melbye M, Munch TN. School performance in children with infantile hydrocephalus: a nationwide cohort study. Clin Epidemiol. 2018;10:1721\u20131731."},{"issue":"11","key":"b4","series-title":"Childs Nerv Syst","first-page":"3313","article-title":"Integrated understanding of hydrocephalus\u2014a practical approach for a complex disease","volume":"37","author":"Thomale UW","year":"2021","unstructured":"Thomale UW. Integrated understanding of hydrocephalus\u2014a practical approach for a complex disease. 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Acta Neurochir (Wien). 2023;165(2):429\u2013441."},{"issue":"11","key":"b9","series-title":"Expert Rev Med Devices","first-page":"1155","article-title":"Gravitational shunt valves in hydrocephalus to challenge the sequelae of over-drainage","volume":"17","author":"Gutowski P","year":"2020","unstructured":"Gutowski P, G\u00f6lz L, Rot S, Lemcke J, Thomale UW. Gravitational shunt valves in hydrocephalus to challenge the sequelae of over-drainage. Expert Rev Med Devices. 2020;17(11):1155\u20131168."},{"issue":"3","key":"b10","series-title":"Clinical article. J Neurosurg Pediatr","first-page":"289","article-title":"Experiences with a gravity-assisted valve in hydrocephalic children","volume":"4","author":"Haberl EJ","year":"2009","unstructured":"Haberl EJ, Messing-Juenger M, Schuhmann M,  Experiences with a gravity-assisted valve in hydrocephalic children. Clinical article. 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Long-term survival rates of gravity-assisted, adjustable differential pressure valves in infants with hydrocephalus. J Neurosurg Pediatr. 2016;17(5):544\u2013551."},{"issue":"6","key":"b15","series-title":"Childs Nerv Syst","first-page":"1155","article-title":"Retrospective single-center historical comparative study between proGAV and proGAV2.0 for surgical revision and implant duration","volume":"38","author":"Brunner E","year":"2022","unstructured":"Brunner E, Schaumann A, Pennacchietti V, Schulz M, Thomale UW. Retrospective single-center historical comparative study between proGAV and proGAV2.0 for surgical revision and implant duration. 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