OBJECTIVE Compared to fixed pressure valves (FPV), adjustable pressure valves (APV) might reduce the rates of over/underdrainage necessitating revision surgery after shunt placement. But due to higher implant costs and valve vulnerability, the use APV in neurosurgery is still limited. The aim of this study was to evaluate the clinical utility of APV in patients with aneurysmal subarachnoid hemorrhage (aSAH). MATERIAL AND METHODS All consecutive aSAH patients undergoing ventriculoperitoneal shunt (VPS) placement at our institution between 2003 and 2016 were eligible. Rates and the risk factors for shunt valve dysfunction and over/underdrainage were evaluated. RESULTS A total of 189 patients were included in the final analysis. FPV were implanted in the majority of patients (173/91.5 %). Revision surgery due to over/underdrainage was performed in 8 (4.6 %) cases with FPV and in no case with APV. Higher patients' age (>65 years, p = 0.011; aOR 10.36) and bone flap reimplantation following decompressive craniectomy (p = 0.044; aOR 6.53) independently predicted the need for revision surgery for over/underdrainage. There was no difference in the occurrence of valve dysfunction between the two valve types (1 [6.3 %] APV, 12 [6.9 %] FPV), p > 0.99). Patients requiring revision surgery for over/underdrainage had a higher risk for unfavorable outcome at 6 months follow-up (mRS>3, p = 0.009; aOR = 8.0). CONCLUSION APV is a valuable option for aSAH individuals undergoing VPS implantation to reduce the need for revision surgery for over/underdrainage. Particularly, elderly patients and those requiring bone flap reimplantation might benefit from APV.

中文翻译：

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蛛网膜下腔出血后慢性脑积水的可调压力阀：值得吗？

目标 与固定压力阀 (FPV) 相比，可调压力阀 (APV) 可能会降低分流放置后需要进行翻修手术的过度/不足引流率。但由于植入物成本较高和瓣膜易损性，APV在神经外科中的使用仍然有限。本研究的目的是评估 APV 在动脉瘤性蛛网膜下腔出血 (aSAH) 患者中的临床效用。材料和方法 2003 年至 2016 年期间在我们机构接受脑室腹腔分流术 (VPS) 安置的所有连续 aSAH 患者均符合条件。评估了分流阀功能障碍和引流过度/不足的发生率和危险因素。结果最终分析共纳入189例患者。大多数患者 (173/91.5 %) 植入了 FPV。8 例 (4.6 %) 的 FPV 病例（4.6 %）因引流过度/不足而进行了翻修手术，而 APV 病例均未进行。较高的患者年龄（> 65 岁，p = 0.011；aOR 10.36）和去骨瓣减压术后骨瓣再植（p = 0.044；aOR 6.53）独立预测需要因过度引流/引流不足而进行翻修手术。两种瓣膜类型之间瓣膜功能障碍的发生率没有差异（1 [6.3 %] APV，12 [6.9 %] FPV），p > 0.99）。因过度引流/引流不足而需要进行翻修手术的患者在 6 个月的随访中出现不良结果的风险较高（mRS>3，p = 0.009；aOR = 8.0）。结论 APV 是接受 VPS 植入的 aSAH 个体的一个有价值的选择，以减少因过度/不足引流而进行翻修手术的需要。特别，