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Published on: October 17, 2013
Seven years of clinical experience with the programmable Codman Hakim valve: a retrospective study of 583 patients
Insights
The Codman Hakim programmable valve effectively manages cerebrospinal fluid (CSF) drainage in hydrocephalus patients, with most experiencing improved clinical status after adjustments. Magnetic resonance imaging requires post-procedure X-rays due to potential valve resetting.
Area of Science:
- Neurosurgery
- Biomedical Engineering
Background:
- Hydrocephalus is a condition characterized by excess cerebrospinal fluid (CSF) in the brain.
- Programmable valves offer adjustable CSF drainage, crucial for managing complex hydrocephalus cases.
Purpose of the Study:
- To evaluate the efficacy and safety of the Codman Hakim programmable valve for CSF drainage.
- To assess the valve's performance across various settings (30-200 mm H2O) and patient populations.
Main Methods:
- Retrospective analysis of 583 patients (adults and children) with diverse neurological conditions.
- Implantation of the Codman Hakim programmable valve, with subsequent pressure adjustments and monitoring for complications.
- Assessment of clinical improvement, valve survival rates, and complication incidence, including magnetic resonance imaging interference.
Main Results:
- Clinical status improved in 64.6% of patients following valve pressure adjustments.
- Magnetic resonance imaging caused unintended valve resetting in 26.8% of cases, necessitating post-imaging X-rays.
- Five-year shunt survival was 53.1% for initial implantations; common failures included catheter issues and infections.
Conclusions:
- The Codman Hakim programmable valve is a valuable tool for CSF drainage in various neurological conditions.
- Despite challenges like MRI interference, the valve's adjustability supports its use in managing hydrocephalus.
Object:
The goal of this study was to assess the value of the Codman Hakim programmable valve to settings in the range of 30 to 200 mm H2O. This valve can be adjusted noninvasively for cerebrospinal fluid (CSF) drainage.
Methods:
The authors conducted a single-center retrospective study of 583 patients (421 adults and 162 children) suffering from hydrocephalus of various causes (379 patients), normal-pressure hydrocephalus (174 patients), arachnoid cyst (14 patients), and pseudotumor cerebri (16 patients). In all cases a Codman Hakim programmable valve was implanted; in 82.8% of cases it was included during the patient's first shunt implantation. In 42.4% of the cases valve pressure adjustment was required at least once (mean number of adjustments 1.2, maximum 23). The patients' clinical status improved after 64.6% of pressure adjustments. Accidental resetting of opening pressure, other than that caused by magnetic resonance (MR) imaging, was uncommon. Because MR imaging caused resetting in 26.8% of cases in which it was used, it was deemed mandatory to obtain an x-ray film after MR imaging. Valve malfunction, blockage, or adjustment difficulties occurred in 2% of valves implanted, and nontraumatic subdural fluid collections were demonstrated in 5.1% of patients (13 of whom were treated by valve pressure adjustment alone). Five-year shunt survival was 53.1% for first-time shunt implantations. The shunt infection rate was 8.5% of valve implantations. Catheter-related complications and shunt-related infections were the main reasons for surgical revision and the major cause of shunt failure. At follow-up review, 97% of children and 90% of adults had improved.
Conclusions:
Because one cannot know in advance which case will turn out to be complicated, the authors' preference is to use the Codman Hakim programmable valve for all conditions in which CSF should be drained.
