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Purpose: Hydrocephalus remains the most frequently encountered pathological entity that is referred to pediatric neurosurgeons. The implantation of a ventriculoperitoneal shunt constitutes the most commonly used treatment modality to manage this entity. The purpose of our study was centered on the comparison of two different adjustable shunt systems, namely Codman Medos-Hakim and pro-GAV 2.0 (without and with anti-siphon device respectively), on the basis of their long-term need for a revision, due to obstruction (malfunction).

Methods: Seven hundred and seventy-eight patients undergoing primary shunt implantation between 2013 and 2023 were analyzed for 1-year revision rate, as well as 5-year revision rate, observing patient age, sex, etiology of hydrocephalus, and underlying cause of revision.

Results: All aforementioned data were recorded to all of the participants of our survey. The female patients that were included were 202, whereas their male counterparts were 248. The total number of patients that underwent revision after primary shunt implantation were 113, regardless of the type of the initial valve mechanism. Overall, 99 patients underwent revision surgery after primary implantation. Pro-GAV valve was implanted in 311 patients, and pro-GAV 2.0 valves were implanted in 139 patients. Our preliminary results suggest that there was a significant difference between the two shunt valves concerning 1-year revision rate, as well as 5-year revision-free survival. Most notably, the statistical difference between the two valve systems was more pronounced when the comparison was based on the long-term functionality (5year survival) of the different valve systems.

Conclusion: Based on the parameters that were compared to our patient population, it seems that the long-term efficacy of the Pro-GAV 2.0 valve system is superior to the corresponding long -term functionality of the Medos-Hakim valvular system. Based on the fact that the main differentiating factor between these two shunt systems is based on the presence or no of an anti-siphon device, we could support the hypothesis that the incorporation of an anti-siphon device increases the revision-free survival of any shunt system. According to the target variables we analyzed there is a significant difference between the two shunt valves.