Clinical experience with the use of a shunt with an adjustable valve in children with hydrocephalus

Zemack, Göran; Bellner, Johan; Siesjö, Peter; Strömblad, Lars-Göran; Romner, Bertil

doi:10.3171/jns.2003.98.3.0471

Cited by 51 publications

(26 citation statements)

References 27 publications

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“…This result suggests use of a programmable valve may reduce the incidence of the most difficult shunt complications. 13,14,19,35) However, the intrinsic programmable valve malfunction rate was 11.1%, whereas no intrinsic valve malfunction occurred in non-programmable valve systems used during the same period for similar causes of hydrocephalus. 16) Further prospective, randomized evaluation will elucidate specific indications for programmable valve systems and better determine the reliability of these valves in the pediatric population.…”

Section: Discussion I Csf Shuntingmentioning

confidence: 99%

Analysis of a Nationwide Survey on Treatment and Outcomes of Congenital Hydrocephalus in Japan

Moritake

Nagai

Miyazaki

et al. 2007

Neurol. Med. Chir.(Tokyo)

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A nationwide questionnaire survey of congenital hydrocephalus in 2000 investigated the treatment and clinical outcomes for congenital hydrocephalus in Japan to evaluate the factors influencing clinical outcome. Surgical treatment was performed in 341 of 380 patients who survived the early neonatal period. Of 321 patients who had shunt operations, 295 (91.9%) underwent ventriculoperitoneal shunting and nine (2.8%) ventriculoatrial shunting. Programmable valves were used in 83 (33.6%) of the 247 patients at the first shunting and in 97 (39.3%) at the last shunting. The incidence of complications after the first shunting was 55.4% (46 of 83 patients) in the programmable and 61.6% (101 of 164) in the non-programmable valve groups. The types of shunt complication differed significantly between these groups (p º 0.001), as the incidence of shunt infection and malfunction was lower in the programmable valve group. Clinical outcome was generally better with later delivery stage during gestation (p º 0.02). The clinical outcome was statistically significantly better in term patients who underwent early shunt placement than in those who underwent late shunt placement (p º 0.05).

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Section: Discussion I Csf Shuntingmentioning

confidence: 99%

Analysis of a Nationwide Survey on Treatment and Outcomes of Congenital Hydrocephalus in Japan

Moritake

Nagai

Miyazaki

et al. 2007

Neurol. Med. Chir.(Tokyo)

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“…The readjustment rate of 36.5% is low in comparison with data from adjustable DP valves, with which rates of 53.2 and 76.9% have been reported. 12,17 Because most readjustments in DP valves are related to overdrainage, 13 the low readjustment rate with the ProGAV could be interpreted as a parameter of successful avoidance of overdrainage by the gravity unit. …”

Section: Discussionmentioning

confidence: 99%

First experiences with an adjustable gravitational valve in childhood hydrocephalus

Rohde

Haberl

Ludwig

et al. 2009

PED

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Object The goal of this report was to describe the authors' initial experiences with an adjustable gravity-assisted valve (GAV) called the ProGAV in treating childhood hydrocephalus. Methods The ProGAV was implanted in 53 children (29 boys and 24 girls, median age 7.3 years) with hydrocephalus of various origins. The ProGAV consists of a differential-pressure unit with adjustable opening pressures and a gravitational unit with a fixed opening pressure. Results The mean follow-up period was 15.2 months (range 6–44 months). The authors did not observe any valve-related complications. Four infections (7.5%) occurred, warranting the removal of the shunt. In 19 children, the opening pressure was changed at least once during the follow-up period, for underdrainage in 10, overdrainage in 8, and shunt weaning in 1, with substantial clinical improvement in 18 children. Overall, good clinical results were obtained in 47 (88.7%) of the 53 valve placements. Conclusions With an overall success rate of 88.7%, the first experiences with the ProGAV in childhood hydrocephalus are promising and justify its further use in the pediatric population.

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“…However, the occurrence of pressure changes of unknown causes 7,9) has led to the suspicion that common devices associated with low levels of magnetic induction can change the valve pressure settings. In nonhomogeneous magnetic fields, the Codman valve pressure setting can be changed at 150 gauss.…”

Section: Discussionmentioning

confidence: 99%

“…However, further adjustment of the valve's opening pressure is important to improve the outcome in pediatric patients, because the clinical status of the patient may improve after minor adjustments of less than or equal to ±20 mmH 2 O. 9) In addition, reduction in the brain compliance is suspected to occur after longtime use of shunt from infancy based on the ventricular form at the time of hydrocephalus. If the brain compliance decreased, hydrocephalus caused by a minor pressure change may result in coma.…”

Section: Discussionmentioning

confidence: 99%

Alteration of the Pressure Setting of a Codman-Hakim Programmable Valve by a Television-Case Report-

Utsuki

Shimizu

Oka

et al. 2006

Neurol. Med. Chir.(Tokyo)

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A 7-year-old girl presented in semicomatose condition. She had received a ventriculoperitoneal shunt using a Codman-Hakim programmable valve. Head computed tomography demonstrated hydrocephalus and head radiography showed that the pressure setting of the shunt valve had changed to 60 mmH 2 O from 40 mmH 2 O. The pressure setting was returned to 40 mmH 2 O, and she was discharged because her clinical symptoms and hydrocephalus improved. One month later, she lost consciousness again and was transported to our hospital. Hydrocephalus and shunt valve pressure of 50 mmH 2 O were noted, and the pressure setting was returned to 40 mmH 2 O again. She was discharged without complications. We suspected that the valve pressure was caused by close contact with a television, because the patient tended to touch a television with her head during play. The valve pressure did not change after the television was placed on a high stand out of reach. We should recognize that there are many sources of weak magnetic fields that may influence a programmable valve in everyday life.

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Clinical experience with the use of a shunt with an adjustable valve in children with hydrocephalus

Abstract: Adjustment of the valve's opening pressure further improves outcome in pediatric patients.

Cited by 51 publications

References 27 publications

Analysis of a Nationwide Survey on Treatment and Outcomes of Congenital Hydrocephalus in Japan

Analysis of a Nationwide Survey on Treatment and Outcomes of Congenital Hydrocephalus in Japan

First experiences with an adjustable gravitational valve in childhood hydrocephalus

Alteration of the Pressure Setting of a Codman-Hakim Programmable Valve by a Television-Case Report-

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