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Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Management of patients with normal-pressure hydrocephalus by using lumboperitoneal shunt system with the Codman Hakim
1Department of Neurosurgery, Yokohama Minami Kyosai Hospital, Yokohama, Japan.
Insights
The Codman Hakim programmable valve in lumboperitoneal shunts effectively managed normal-pressure hydrocephalus. Noninvasive pressure adjustments improved patient outcomes and addressed underdrainage symptoms.
Area of Science:
- Neurosurgery
- Neurology
- Medical Devices
Background:
- Normal-pressure hydrocephalus (NPH) presents diagnostic and therapeutic challenges.
- Lumboperitoneal (LP) shunts are used for NPH management, but optimal pressure settings are crucial.
- Programmable valves offer adjustable cerebrospinal fluid (CSF) diversion pressures.
Purpose of the Study:
- To evaluate the efficacy and safety of the Codman Hakim programmable valve in LP shunts for NPH.
- To assess the impact of adjustable valve pressures on patient outcomes and complications.
- To determine the feasibility of noninvasive pressure reprogramming in clinical practice.
Main Methods:
- A retrospective study of 32 patients with NPH managed with LP shunts utilizing the Codman Hakim programmable valve.
- Initial and final valve pressures were recorded, with reprogramming performed as needed.
- Lumboperitoneal shuntography was conducted in a subset of patients.
- Complications and clinical outcomes were documented.
Main Results:
- The mean initial valve pressure was 57.8 mm H2O, adjusted to a mean final pressure of 62.5 mm H2O in 12 patients.
- Complications occurred in 8 patients, including shunt obstruction (2), low-pressure symptoms (4), subdural effusion (1), convulsions (2), and wound infection (1).
- Noninvasive pressure adjustments successfully resolved low-pressure symptoms and subdural effusion.
Conclusions:
- The Codman Hakim programmable valve facilitates effective management of NPH via LP shunts.
- Noninvasive pressure adjustability is a significant advantage, allowing for tailored CSF diversion and improved patient outcomes.
- LP shunt systems incorporating programmable valves can be adjusted to lower pressures, potentially mitigating underdrainage issues.
Abstract:
Thirty-two patients with normal-pressure hydrocephalus were managed using the lumboperitoneal (LP) shunt system in which the Codman Hakim programmable valve was utilized. The initial opening pressure was set at 100 mm H(2)O in three cases, 80 mm H(2)O in two, 70 mm H(2)O in three cases, 50 mm H(2)O in 23, and 30 mm H(2)O in one case (mean pressure 57.8 mm H(2)O). In 12 patients the valve pressure required reprogramming. The final valve pressure was 30 mm H(2)O in four cases, 50 mm H(2)O in 19, 70 mm H(2)O in three, 80 mm H(2)O in one, 100 mm H(2)O in two, 130 mm H(2)O in one, 140 mm H(2)O in one, and 170 mm H(2)O in one case (mean 62.5 mm H(2)O). Lumboperitoneal shuntography was performed in five patients by injection of contrast medium into the prechamber. In two patients a shunt obstruction developed between the valve and the lumbar catheter. Complications occurred in eight patients. Low-pressure symptoms such as headache and vomiting were observed in four patients but disappeared after increasing the valve pressure. One patient, whose shunt pressure was set at 50 mm H(2)O developed a slight asymptomatic subdural effusion, which resolved after increasing the valve pressure to 100 mm H(2)O. Convulsions developed in two aged patients but were easily controlled with anticonvulsant medication. Surgery-related wound infection was observed in one patient. The major advantage in the use of this valve is the ability to modify the pressure noninvasively. Another important advantage of the LP shunt system in which this valve is incorporated is the lower pressure of 30 mm H(2)O that can improve symptoms caused by underdrainage of cerebrospinal fluid.
