New concept for the pressure setting of a programmable pressure valve and measurement of in vivo shunt flow performed using microflow meter

Technical note

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✓ The aim of this study was to establish a standard method for determining the pressure setting of the Codman Hakim valve (CHV) in patients with hydrocephalus.

The authors' investigation was twofold. It focused on: 1) the relationships among CHV setting, intracranial pressure (ICP), intraabdominal pressure (IAP), hydrostatic pressure (HP), and perfusion pressure (PP); and 2) the shunt flow in 18 patients with normal-pressure hydrocephalus.

With the patient in a sitting position, the pressure environment around the ventriculoperitoneal shunt stabilized when PP became equal to the CHV setting. The lower the CHV setting, the lower the ICP obtained in patients in a sitting position (ICPsit) settled. This indicated the possibility of calculating the CHV setting by the equation CHV setting = HP + ideal ICPsit − IAP, where the ideal ICPsit was estimated to be between −70 and −140 mm H2O. The CHV setting was individually determined for 18 patients by using this method. The ICPsit was controlled at a level equal to the estimated ICPsit in most cases, which supported the rationality of our concept. Shunt flow was intermittent or very low when the patient assumed a supine position and between 200 and 600 µl/minute when the patient was seated.

Determining the CHV setting by using the equation CHV setting = HP + ideal ICPsit − IAP was found to be useful when directly measuring HP and IAP in patients and estimating the ideal ICPsit to be between −70 and −140 mm H2O. Postoperative shunt control performed using this method was satisfactory, and shunt complications and the number of CHV resettings were lower than in those published in previous reports.

Shunt-flow measurement performed in vivo and in real time by using a microflowmeter should be useful not only in testing the functioning of shunt systems, but also in clarifying the pathophysiology of hydrocephalus.

Article Information

Contributor Notes

Address reprint requests to: Hiroji Miyake, M.D., D.M.Sc., Department of Neurosurgery, Osaka Medical College, Daigakucho 2–7, Takatsuki City, Osaka , 569–8686, Japan.
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References
  • 1.

    Belliard HRoux FXTurak Bet al: La valve de dérivation Codman Medos programmable. Bilan de 53 implantations chez 50 patients. Neurochirurgie 42:1391451996Belliard H Roux FX Turak B et al: La valve de dérivation Codman Medos programmable. Bilan de 53 implantations chez 50 patients. Neurochirurgie 42:139–145 1996

    • Search Google Scholar
    • Export Citation
  • 2.

    Castillo MHudgins PMalko Jet al: Flow-sensitive MR imaging of ventriculoperitoneal shunts: in vitro findings, clinical applications, and pitfalls. AJNR 12:6676711991Castillo M Hudgins P Malko J et al: Flow-sensitive MR imaging of ventriculoperitoneal shunts: in vitro findings clinical applications and pitfalls. AJNR 12:667–671 1991

    • Search Google Scholar
    • Export Citation
  • 3.

    Chang HS: Detection of CSF flow in the ventriculo-peritoneal shunt using MRI. J Comput Assist Tomogr 20:4294331996Chang HS: Detection of CSF flow in the ventriculo-peritoneal shunt using MRI. J Comput Assist Tomogr 20:429–433 1996

    • Search Google Scholar
    • Export Citation
  • 4.

    Chapman PHCosman ERArnold MA: The relationship between ventricular fluid pressure and body position in normal subjects and subjects with shunts: a telemetric study. Neurosurgery 26:1811891990Chapman PH Cosman ER Arnold MA: The relationship between ventricular fluid pressure and body position in normal subjects and subjects with shunts: a telemetric study. Neurosurgery 26:181–189 1990

    • Search Google Scholar
    • Export Citation
  • 5.

    Chidiac APelissou-Guyotat ISindou M: Intérêt practique des valves à pression d'ouverture adjustable en transcutané (valve Sophy SU 8) dans le traitement des hydrocéphalies et des kystes arachoïdiens de l'adulte. Neurochirurgie 38:2912961992Chidiac A Pelissou-Guyotat I Sindou M: Intérêt practique des valves à pression d'ouverture adjustable en transcutané (valve Sophy SU 8) dans le traitement des hydrocéphalies et des kystes arachoïdiens de l'adulte. Neurochirurgie 38:291–296 1992

    • Search Google Scholar
    • Export Citation
  • 6.

    Culter RWPPage LGalicich Jet al: Formation and absorption of cerebrospinal fluid in man. Brain 91:7077201968Culter RWP Page L Galicich J et al: Formation and absorption of cerebrospinal fluid in man. Brain 91:707–720 1968

    • Search Google Scholar
    • Export Citation
  • 7.

    Gideon PStåhlberg FThomsen Cet al: Cerebrospinal fluid flow and production in patients with normal pressure hydrocephalus studied by MRI. Neuroradiology 36:2102151994Gideon P Ståhlberg F Thomsen C et al: Cerebrospinal fluid flow and production in patients with normal pressure hydrocephalus studied by MRI. Neuroradiology 36:210–215 1994

    • Search Google Scholar
    • Export Citation
  • 8.

    Kajimoto YMatsukawa MMiyake Het al: [Intracranial pressure, intra-abdominal pressure and cerebrospinal shunt flow rate in the sitting position] in Ishii S (ed): Progress in Research on ICP. Tokyo: Chugai Pharmaceutical1995 pp 7377 (Jpn)Kajimoto Y Matsukawa M Miyake H et al: [Intracranial pressure intra-abdominal pressure and cerebrospinal shunt flow rate in the sitting position] in Ishii S (ed): Progress in Research on ICP. Tokyo: Chugai Pharmaceutical 1995 pp 73–77 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 9.

    Miyake HOhta TKajimoto Yet al: A new ventriculoperitoneal shunt with a telemetric intracranial pressure sensor: clinical experience in 94 patients with hydrocephalus. Neurosurgery 40:9319351997Miyake H Ohta T Kajimoto Y et al: A new ventriculoperitoneal shunt with a telemetric intracranial pressure sensor: clinical experience in 94 patients with hydrocephalus. Neurosurgery 40:931–935 1997

    • Search Google Scholar
    • Export Citation
  • 10.

    Oi SIto K: [True normal pressure hydrocephalus—proposal of renewal of clinical entity of NPH and definition in the real pathophysiological aspects] in Mori K (ed): [Annual Report of the Research Committee of “Intractable Hydrocephalus” 1997.] Tokyo: Ministry of Health and Welfare of Japan1998 pp 2733 (Jpn)Oi S Ito K: [True normal pressure hydrocephalus—proposal of renewal of clinical entity of NPH and definition in the real pathophysiological aspects] in Mori K (ed): [Annual Report of the Research Committee of “Intractable Hydrocephalus” 1997.] Tokyo: Ministry of Health and Welfare of Japan 1998 pp 27–33 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 11.

    Reinprecht ACzech TDietrich W: Clinical experience with a new pressure-adjustable shunt valve. Acta Neurochir 134:1191241995Reinprecht A Czech T Dietrich W: Clinical experience with a new pressure-adjustable shunt valve. Acta Neurochir 134:119–124 1995

    • Search Google Scholar
    • Export Citation
  • 12.

    Reinprecht ADietrich WBertalanffy Aet al: The Medos Hakim programmable valve in the treatment of pediatric hydrocephalus. Childs Nerv Syst 13:5885941997Reinprecht A Dietrich W Bertalanffy A et al: The Medos Hakim programmable valve in the treatment of pediatric hydrocephalus. Childs Nerv Syst 13:588–594 1997

    • Search Google Scholar
    • Export Citation
  • 13.

    Rubin RCHenderson ESOmmaya AKet al: The production of cerebrospinal fluid in man and its modification by acetazolamide. J Neurosurg 25:4304361966Rubin RC Henderson ES Ommaya AK et al: The production of cerebrospinal fluid in man and its modification by acetazolamide. J Neurosurg 25:430–436 1966

    • Search Google Scholar
    • Export Citation
  • 14.

    Sgouros SJohn PWalsh ARet al: The value of color Doppler imaging in assessing flow through ventriculo-peritoneal shunts. Childs Nerv Syst 12:4544591996Sgouros S John P Walsh AR et al: The value of color Doppler imaging in assessing flow through ventriculo-peritoneal shunts. Childs Nerv Syst 12:454–459 1996

    • Search Google Scholar
    • Export Citation
  • 15.

    Shapiro KMarmarou AShulman K: Characterization of clinical CSF dynamics and neural axis compliance using the pressure-volume index: I. The normal pressure-volume index. Ann Neurol 7:5085141980Shapiro K Marmarou A Shulman K: Characterization of clinical CSF dynamics and neural axis compliance using the pressure-volume index: I. The normal pressure-volume index. Ann Neurol 7:508–514 1980

    • Search Google Scholar
    • Export Citation
  • 16.

    Torkildsen A: A new palliative operation in cases of inoperable occlusion of the sylvian aqueduct. Acta Chir Scand 82:1171241939Torkildsen A: A new palliative operation in cases of inoperable occlusion of the sylvian aqueduct. Acta Chir Scand 82:117–124 1939

    • Search Google Scholar
    • Export Citation
  • 17.

    Yonezawa KFujita SSyose Yet al: [Efficacy and some complications of programmable pressure valve.] No Shinkei Geka 19:5395451991 (Jpn)Yonezawa K Fujita S Syose Y et al: [Efficacy and some complications of programmable pressure valve.] No Shinkei Geka 19:539–545 1991 (Jpn)

    • Search Google Scholar
    • Export Citation
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