Valved or valveless ventriculoperitoneal shunting in the treatment of post-haemorrhagic hydrocephalus

Andreasen TH, Holst AV, Lilja A, Andresen M, Bartek J Jr, Eskesen V & Juhler M

In this retrospective clinical study on outcome in valved vs valveless shunt in adult haemorrhagic hydrocephalus we find that duration of external drainage and length of ICU stay is shortened by implanting a valveless shunt which can be implanted while the CSF is still haemorrhagic. The risk of overdrainage is encountered approximately 4 weeks later, at which point the patient should be re-evaluated to decide if the shunt should be removed, left unchanged or revised with a valve.


Implant infection and obstruction are major complications for ventriculoperitoneal shunts in patients with post-haemorrhagic hydrocephalus. 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 ventriculoperitoneal shunts at our department for adult patients with post-haemorrhagic hydrocephalus and haemorrhagic cerebrospinal fluid at the time of shunt insertion.


All adult patients (>18 years old) treated for post-haemorrhagic hydrocephalus 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.


A total of 214 patients 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 patients receiving a valveless shunt (p = 0.004). Patients with valveless shunts had a lower rate of shunt infection (5.1 % vs 14.3 %, p = 0.02), but a higher rate of overdrainage (10.3 % vs 2.6 %, p = 0.04).


The use of a valveless shunting for patients with post-haemorrhagic hydrocephalus results in shorter duration of neurosurgical hospitalisation and lower rate of shunt infection, 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 patient category, with careful follow-up ensuring that these are substituted by a valve-bearing system if necessary.

Read the full paper in Acta Neurochir (click here).