Evaluating the Efficacy of Codman-Hakim Valve in Pediatric Patients: A Systematic Review and Meta-Analysis

Introduction: The Codman-Hakim valve is a programmable device used in the management of hydrocephalus, but its performance and outcomes in the pediatric population have been underexplored. Our study summarizes the findings of a systematic review of the available literature to address this gap in knowledge.

Methods: A systematic search was conducted following the PRISMA guidelines, focusing on studies involving pediatric patients who underwent Codman-Hakim valve shunt procedures. PubMed, Embase, Web of Science, and the Cochrane Library databases were searched, using keywords related to Codman-Hakim valve, pediatrics, and shunt procedures. The primary outcomes assessed were shunt revision rates, with subanalyses including valve blockage/obstruction, infection rates, and mortality. A random effects model was applied to combine the results of the analyses.

Results: The analysis of pediatric patients requiring revisions included four studies, encompassing a total of 309 Codman-Hakim valve shunts. The estimated shunt revision rate was 51% (95% CI 32% to 69%; I²=92%). Infection rates were assessed across seven studies, comprising 691 cases, with an estimated infection rate of 10% (95% CI 6% to 14%; I²=84%). The analysis of valve blockage/obstructions showed a rate of 17% (95% CI 3% to 30%; I²=95%). Remarkably, the mortality rate was found to be 0% (95% CI 0% to 1%; I²=7%).

Conclusion : Our study sheds light on the performance of Codman-Hakim valves in the pediatric population, revealing a high rate of shunt revision, a substantial risk of infection, and a significant rate of valve blockage/obstruction. Despite these complications, the observed mortality rate was minimal. These findings underscore the need for further research to optimize the outcomes of Codman-Hakim valve shunts in pediatric patients, with a particular focus on reducing revision rates. Pediatric neurosurgeons must carefully consider the potential complications when selecting shunt options for young patients with hydrocephalus.