Management with a programmable pressure valve of subdural hematomas caused by a ventriculoperitoneal shunt: Case report

Kamano, Shuji; Nakano, Yukiteru; Imanishi, T.; Hattori, Mitsuo

doi:10.1016/0090-3019(91)90050-j

Cited by 35 publications

(16 citation statements)

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“…The ability to treat a shunt-related complication, such as a subdural fluid collection, by reprogramming the valve to a higher setting is an advantage over nonprogrammable valves, and it enables the opening pressure to be slowly lowered once the fluid collection is resorbed. Our findings correspond with those obtained in the treatment of subdural hematomas, [3,15,33] hygromas, [1,29] or both [20,32] by raising the opening pressure alone, without having to ligate the shunt. The treatment of subdural fluid collections by surgical drainage and ligation of the shunt while at the same time reprogramming the valve has also been reported elsewhere.…”

Section: Shunt-related Complicationssupporting

confidence: 90%

“…Furthermore, fine tuning or titrating the opening pressure more precisely than the traditional low-, medium-, or high-pressure settings offered by nonprogrammable valves optimizes treatment; this has also been reported by other authors. [15,33] Retrospectively, we estimate that in at least one third of patients in whom pressure adjustments were made, valve exchange would have been necessary if nonprogrammable valves had routinely been used.…”

Section: Valve Pressure Programmingmentioning

confidence: 99%

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Seven-year clinical experience with the Codman Hakim programmable valve: a retrospective study of 583 patients

Zemack¹,

Romner²

1999

FOC

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A retrospective study was undertaken to assess the value of the Codman Hakim programmable valve in the treatment of 583 patients (421 adults and 162 children) with hydrocephalus of various causes (379), normal-pressure hydrocephalus (NPH) (174), an arachnoidal cyst (14), and pseudotumor cerebri (16). In all patients the programmable valve was implanted (the valve can be noninvasively adjusted to settings in the range of 30-200 mm H2O). In 73% of the cases this was their first shunt implantation. Ninety-two percent of the shunts drained to the peritoneal cavity and 8% to the atrium. In 42% of the cases valve pressure adjustment was required at least once (mean number of adjustments 1.2, maximum 23). The authors present reprogramming statistics, and strategies for reprogramming are discussed. In 65% of the cases in which pressure adjustments were required, reprogrammings improved the patients' clinical status. The overall infection rate was 8.5% (56 of 660 valve implantations). Valve malfunction, blockage, or reprogramming difficulty occurred in 17 cases, and nontraumatic subdural fluid collections were demonstrated in 30 cases (13 of which were treated by valve pressure reprogramming alone). Of the patients undergoing first-time shunt placement, 21.5% eventually underwent shunt revision at least once, and a total of 318 revisions were performed during the 7-year follow-up period. At follow up, 97% of children and 90% of adults had improved. In conclusion, catheter-related complications and shunt-related infections were the main reasons for revision and the major cause of shunt failure. Few incidents of valve malfunction were observed. The Hakim Codman programmable valve is of value in the treatment of hydrocephalus of all causes, especially in the treatment of patients with NPH, pseudotumor cerebri, arachnoidal cyst, aqueductal stenosis, traumatic hydrocephalus, and intraventricular hemorrhage.

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Section: Shunt-related Complicationssupporting

confidence: 90%

Section: Valve Pressure Programmingmentioning

confidence: 99%

Seven-year clinical experience with the Codman Hakim programmable valve: a retrospective study of 583 patients

Zemack¹,

Romner²

1999

FOC

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“…As has also been observed by other authors, fine-tuning or titrating the opening pressure more precisely than the traditional low-, medium-, or high-pressure settings offered by nonadjustable valves optimizes treatment by allowing for adaptation and evaluation 9,18,20) . Therefore, we usually adjusted by 20-30-mmH2O scales, and we consider this protocol to be safe.…”

Section: Discussionsupporting

confidence: 52%

A Pressure Adjustment Protocol for Programmable Valves

Kim

Yeo

et al. 2009

J Korean Neurosurg Soc

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Objective : There is no definite adjustment protocol for patients shunted with programmable valves. Therefore, we attempted to find an appropriate method to adjust the valve, initial valve-opening pressure, adjustment scale, adjustment time interval, and final valve-opening pressure of a programmable valve. Methods : Seventy patients with hydrocephalus of various etiologies were shunted with programmable shunting devices (Micro Valve with RICKHAM ® Reservoir). The most common initial diseases were subarachnoid hemorrhage (SAH) and head trauma. Sixty-six patients had a communicating type of hydrocephalus, and 4 had an obstructive type of hydrocephalus. Fifty-one patients had normal pressure-type hydrocephalus and 19 patients had high pressure-type hydrocephalus. We set the initial valve pressure to 10-30 mmH 2O, which is lower than the preoperative lumbar tapping pressure or the intraoperative ventricular tapping pressure, conducted brain computerized tomographic (CT) scans every 2 to 3 weeks, correlated results with clinical symptoms, and reset valve-opening pressures. Results : Initial valve-opening pressures varied from 30 to 180 mmH 2O (mean, 102 ± 27.5 mmH2O). In high pressure-type hydrocephalus patients, we have set the initial valve-opening pressure from 100 to 180 mmH 2O. We decreased the valve-opening pressure 20-30 mmH2O at every 2-or 3-week interval, until hydrocephalus-related symptoms improved and the size of the ventricle was normalized. There were 154 adjustments in 81 operations (mean, 1.9 times). In 19 high pressure-type patients, final valve-opening pressures were 30-160 mmH 2O, and 16 (84%) patients' symptoms had nearly improved completely. However, in 51 normal pressure-type patients, only 31 (61%) had improved. Surprisingly, in 22 of the 31 normal pressure-type improved patients, final valve-opening pressures were 30 mmH 2O (16 patients) and 40 mmH2O (6 patients). Furthermore, when final valve-opening pressures were adjusted to 30 mmH 2O, 14 patients symptom was improved just at the point. There were 18 (22%) major complications : 7 subdural hygroma, 6 shunt obstructions, and 5 shunt infections. Conclusion : In normal pressure-type hydrocephalus, most patients improved when the final valve-opening pressure was 30 mmH 2O. We suggest that all normal pressure-type hydrocephalus patients be shunted with programmable valves, and their initial valve-opening pressures set to 10-30 mmH 2O below their preoperative cerebrospinal fluid (CSF) pressures. If final valve-opening pressures are lowered in 20 or 30 mmH2O scale at 2-or 3-week intervals, reaching a final pressure of 30 mmH 2O, we believe that there is a low risk of overdrainage syndromes.

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“…There are case reports in the literature regarding SDH after shunt placement for NPH. 4,[8][9][10] In clinical series, this complication occurs in 5%-17% of cases. 2,12,15 Previously, this complication has been studied in relation to lumbar puncture opening pressure, 12 type of shunt valve, 15 and long-term anticoagulation therapy.…”

mentioning

confidence: 99%

Aspirin is associated with an increased risk of subdural hematoma in normal-pressure hydrocephalus patients following shunt implantation

Birkeland¹,

Lauritsen

Poulsen

2015

JNS

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obJect In this paper the authors investigate whether shunt-treated patients with normal-pressure hydrocephalus receiving aspirin therapy are at increased risk of developing subdural hematoma (SDH). Methods Records from 80 consecutive patients who had undergone implantation of a cerebrospinal fluid shunt for the treatment of normal-pressure hydrocephalus were retrospectively reviewed. results Eleven cases of symptomatic SDH occurred, all among patients receiving aspirin or clopidogrel. The 5-year survival estimate was 0.3 (p < 0.0001) for users of aspirin and the hazard ratio was 12.8 (95% CI 3.1-53). coNclusioNs Patients on an aspirin therapy regimen have a markedly increased risk of SDH after a shunt has been implanted for the treatment of normal-pressure hydrocephalus. Users of clopidogrel may have an even greater risk.

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Management with a programmable pressure valve of subdural hematomas caused by a ventriculoperitoneal shunt: Case report

Cited by 35 publications

References 1 publication

Seven-year clinical experience with the Codman Hakim programmable valve: a retrospective study of 583 patients

Seven-year clinical experience with the Codman Hakim programmable valve: a retrospective study of 583 patients

A Pressure Adjustment Protocol for Programmable Valves

Aspirin is associated with an increased risk of subdural hematoma in normal-pressure hydrocephalus patients following shunt implantation

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