Received: 12 October 1999 Abstract The choice of shunt valve in the treatment of hydrocephalus in children remains controversial. We embarked on a pilot study to deter- mine the differences in outcome be- tween differential-pressure and flow-regulating valves. Prospective data collected on 50 consecutive first-time shunt insertions, per- formed between June 1993 to June 1996, was analysed. Children with tumour- related hydrocephalus and Dandy-Walker malformations as well as children who had external ventricular drainage prior to defini- tive shunt insertion were excluded from the study. The defining event was the first complication necessi- tating surgery, including obstruction, over-drainage and infection. Of the 50 children (31 males), 23 had dif- ferential pressure (medium-pres- sure) and 27 had Delta (performance level 2) valves inserted. The mean age at shunt insertion was 26.4 months. The mean follow-up was 53.8 months. The overall cumulative shunt survival at 5 years was 58.6% for the differential pressure and 58.7% for the Delta valves. The mean shunt life was 37.1 months for the differential pressure group and 34.6 months for the Delta group. This difference was not statistically significant (P=0.72, t-test). Both valves had a similar outcome with respect to obstruction (including proximal, valve, distal). The main differences between the two valves were with respect to the incidence of over-drainage and infection. Amongst the differential pressure valves, there were 4 instances of overdrainage (3 slit-ventricle syn- drome, 1 bilateral subdural collec- tion) – all occurring within the first 36 months. The Delta valve group had only one instance of over-drain- age (bilateral subdural collection). There were no infections in the dif- ferential pressure valve group, whereas 3 of the Delta valve shunts got infected, all within the first month. Whereas both shunt types seemed to have a similar overall sur- vival, there was a relatively higher incidence of over-drainage amongst the differential pressure valves. The Delta valves, on the other hand, had higher rates of infection. Similar studies with larger numbers could suggest whether the choice of shunt type will ultimately have to be a compromise accepting one or the other complication. Key words Infantile hydrocephalus · Cerebrospinal fluid shunt Child’s Nerv Syst (2000) 16:242–246 © Springer-Verlag 2000 ORIGINAL PAPER Harsh Jain Spiros Sgouros A. Richard Walsh Anthony D. Hockley The treatment of infantile hydrocephalus: “differential-pressure” or “flow-control” valves A pilot study H. Jain · S. Sgouros ( ✉ ) · A.R. Walsh A.D. Hockley Department of Neurosurgery, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH, UK e-mail: S.Sgouros@bham.ac.uk Tel.: +44-121-3338075 Fax: +44-121-3338151 S. Sgouros Institute of Child Health, Birmingham Children’s Hospital, Birmingham, UK