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

Göran Zemack M.D.1 and Bertil Romner M.D., Ph.D.1
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  • 1 Department of Neurosurgery, Division of Neurological Sciences, Lund University Hospital, Lund, Sweden
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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.

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  • 1.

    Aschoff A, , Kremer P, & Benesch C, et al: Overdrainage and shunt technology. A critical comparison of programmable, hydrostatic and variable-resistance valves and flow-reducing devices. Childs Nerv Syst 11:193202, 1995 Aschoff A, Kremer P, Benesch C, et al: Overdrainage and shunt technology. A critical comparison of programmable, hydrostatic and variable-resistance valves and flow-reducing devices. Childs Nerv Syst 11:193–202, 1995

    • Search Google Scholar
    • Export Citation
  • 2.

    Barnett GH, , Hahn JF, & Palmer J: Normal pressure hydrocephalus in children and young adults. Neurosurgery 20:904907, 1987 Barnett GH, Hahn JF, Palmer J: Normal pressure hydrocephalus in children and young adults. Neurosurgery 20:904–907, 1987

    • Search Google Scholar
    • Export Citation
  • 3.

    Belliard H, , Roux FX, & Turak B, et al: [The Codman Medos programmable shunt valve. Evaluation of 53 implantations in 50 patients.] Neurochirurgie 42:139146, 1996 (Fr) Belliard H, Roux FX, Turak B, et al: [The Codman Medos programmable shunt valve. Evaluation of 53 implantations in 50 patients.] Neurochirurgie 42:139–146, 1996 (Fr)

    • Search Google Scholar
    • Export Citation
  • 4.

    Black PM, , Hakim R, & Bailey NO: The use of the Codman-Medos programmable Hakim valve in the management of patients with hydrocephalus: illustrative cases. Neurosurgery 34:11101113, 1994 Black PM, Hakim R, Bailey NO: The use of the Codman-Medos programmable Hakim valve in the management of patients with hydrocephalus: illustrative cases. Neurosurgery 34:1110–1113, 1994

    • Search Google Scholar
    • Export Citation
  • 5.

    Boon AJW, , Tans JTJ, & Delwel EJ, et al: Dutch normal-pressure hydrocephalus study: randomized comparison of low- and medium-pressure shunts. J Neurosurg 88:490495, 1998 Boon AJW, Tans JTJ, Delwel EJ, et al: Dutch normal-pressure hydrocephalus study: randomized comparison of low- and medium-pressure shunts. J Neurosurg 88:490–495, 1998

    • Search Google Scholar
    • Export Citation
  • 6.

    Carmel PW, , Albright AL, & Adelson PD, et al: Incidence and management of subdural hematoma/hygroma with variable- and fixed-pressure differential valves: a randomized, controlled study of programmable compared with conventional values. Neurosurg Focus 7 (4):Article 7, 1999 Carmel PW, Albright AL, Adelson PD, et al: Incidence and management of subdural hematoma/hygroma with variable- and fixed-pressure differential valves: a randomized, controlled study of programmable compared with conventional values. Neurosurg Focus 7 (4):Article 7, 1999

    • Search Google Scholar
    • Export Citation
  • 7.

    Choux M, , Genitori L, & Lang D, et al: Shunt implantation: reducing the incidence of shunt infection. J Neurosurg 77:875880, 1992 Choux M, Genitori L, Lang D, et al: Shunt implantation: reducing the incidence of shunt infection. J Neurosurg 77:875–880, 1992

    • Search Google Scholar
    • Export Citation
  • 8.

    Czosnyka Z, , Czosnyka M, & Richards H, et al: Hydrodynamic properties of hydrocephalus shunts. Acta Neurochir Suppl 71:334339, 1998 Czosnyka Z, Czosnyka M, Richards H, et al: Hydrodynamic properties of hydrocephalus shunts. Acta Neurochir Suppl 71:334–339, 1998

    • Search Google Scholar
    • Export Citation
  • 9.

    Czosnyka Z, , Czosnyka M, & Richards HK, et al: Posture-related overdrainage: comparison of the performance of 10 hydrocephalus shunts in vitro. Neurosurgery 42:327334, 1998 Czosnyka Z, Czosnyka M, Richards HK, et al: Posture-related overdrainage: comparison of the performance of 10 hydrocephalus shunts in vitro. Neurosurgery 42:327–334, 1998

    • Search Google Scholar
    • Export Citation
  • 10.

    Davis SE, , Levy ML, & McComb JG, et al: Does age or other factors influence the incidence of ventriculoperitoneal infections? Pediatr Neurosurg 30:253257, 1999 Davis SE, Levy ML, McComb JG, et al: Does age or other factors influence the incidence of ventriculoperitoneal infections? Pediatr Neurosurg 30:253–257, 1999

    • Search Google Scholar
    • Export Citation
  • 11.

    Dietrich U, , Lumenta C, & Sprick C, et al: Subdural hematoma in a case of hydrocephalus and macrocrania. Experience with a pressure-adjustable valve. Childs Nerv Syst 3:242244, 1987 Dietrich U, Lumenta C, Sprick C, et al: Subdural hematoma in a case of hydrocephalus and macrocrania. Experience with a pressure-adjustable valve. Childs Nerv Syst 3:242–244, 1987

    • Search Google Scholar
    • Export Citation
  • 12.

    Drake JM, , Kestle JRW, & Milner R, et al: Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery 43:294305, 1998 Drake JM, Kestle JRW, Milner R, et al: Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery 43:294–305, 1998

    • Search Google Scholar
    • Export Citation
  • 13.

    Drake JM, , Tenti G, & Sivalsganathan S: Computer modeling of siphoning for CSF shunt design evaluation. Pediatr Neurosurg 21:615, 1994 Drake JM, Tenti G, Sivalsganathan S: Computer modeling of siphoning for CSF shunt design evaluation. Pediatr Neurosurg 21:6–15, 1994

    • Search Google Scholar
    • Export Citation
  • 14.

    Faulhauer K, & Schmitz P: Overdrainage phenomena in shunt treated hydrocephalus. Acta Neurochir 45:89101, 1978 Faulhauer K, Schmitz P: Overdrainage phenomena in shunt treated hydrocephalus. Acta Neurochir 45:89–101, 1978

    • Search Google Scholar
    • Export Citation
  • 15.

    Hakim S: Hydraulic and mechanical mis-matching of valve shunts used in the treatment of hydrocephalus: the need for a servo-valve shunt. Dev Med Child Neurol 15:646653, 1973 Hakim S: Hydraulic and mechanical mis-matching of valve shunts used in the treatment of hydrocephalus: the need for a servo-valve shunt. Dev Med Child Neurol 15:646–653, 1973

    • Search Google Scholar
    • Export Citation
  • 16.

    Hakim C: The Physics and Pathophysiology of the Hydraulic Complex of the Central Nervous System. The Mechanics of Hydrocephalus and Normal Pressure Hydrocephalus. Thesis. Cambridge, MA: Massachusetts Institute of Technology, 1985 Hakim C: The Physics and Pathophysiology of the Hydraulic Complex of the Central Nervous System. The Mechanics of Hydrocephalus and Normal Pressure Hydrocephalus. Thesis. Cambridge, MA: Massachusetts Institute of Technology, 1985

    • Search Google Scholar
    • Export Citation
  • 17.

    Hakim S, , Duran de la Roche F, & Burton JD: A critical analysis of valve shunts used in the treatment of hydrocephalus. Dev Med Child Neurol 15:230255, 1973 Hakim S, Duran de la Roche F, Burton JD: A critical analysis of valve shunts used in the treatment of hydrocephalus. Dev Med Child Neurol 15:230–255, 1973

    • Search Google Scholar
    • Export Citation
  • 18.

    Kamano S, , Nakano Y, & Imanishi T, et al: Management with a programmable pressure valve of subdural hematomas caused by a ventriculoperitoneal shunt: case report. Surg Neurol 35:381383, 1991 Kamano S, Nakano Y, Imanishi T, et al: Management with a programmable pressure valve of subdural hematomas caused by a ventriculoperitoneal shunt: case report. Surg Neurol 35:381–383, 1991

    • Search Google Scholar
    • Export Citation
  • 19.

    Kamiryo T, , Fujii Y, & Kusaka M, et al: Intracranial pressure monitoring using a programmable pressure valve and a telemetric intracranial pressure sensor in a case of slit ventricle syndrome after multiple shunt revisions. Childs Nerv Syst 7:233234, 1991 Kamiryo T, Fujii Y, Kusaka M, et al: Intracranial pressure monitoring using a programmable pressure valve and a telemetric intracranial pressure sensor in a case of slit ventricle syndrome after multiple shunt revisions. Childs Nerv Syst 7:233–234, 1991

    • Search Google Scholar
    • Export Citation
  • 20.

    Kuurne T, , Servo A, & Porras M: Subdural effusions re-appearing after shunts in patients with non-tumoural stenosis of the aqueduct. Acta Neurochir 67:127134, 1983 Kuurne T, Servo A, Porras M: Subdural effusions re-appearing after shunts in patients with non-tumoural stenosis of the aqueduct. Acta Neurochir 67:127–134, 1983

    • Search Google Scholar
    • Export Citation
  • 21.

    Langley JM, , LeBlanc JC, & Drake J, et al: Efficacy of antimicrobial prophylaxis in placement of cerebrospinal fluid shunts: meta-analysis. Clin Infect Dis 17:98103, 1993 Langley JM, LeBlanc JC, Drake J, et al: Efficacy of antimicrobial prophylaxis in placement of cerebrospinal fluid shunts: meta-analysis. Clin Infect Dis 17:98–103, 1993

    • Search Google Scholar
    • Export Citation
  • 22.

    Larsson A, , Jensen C, & Bilting M, et al: Does the shunt opening pressure influence the effect of shunt surgery in normal pressure hydrocephalus? Acta Neurochir 117:1522, 1992 Larsson A, Jensen C, Bilting M, et al: Does the shunt opening pressure influence the effect of shunt surgery in normal pressure hydrocephalus? Acta Neurochir 117:15–22, 1992

    • Search Google Scholar
    • Export Citation
  • 23.

    Lumenta CB, , Roosen N, & Dietrich U: Clinical experience with a pressure-adjustable valve SOPHY in the management of hydrocephalus. Childs Nerv Syst 6:270274, 1990 Lumenta CB, Roosen N, Dietrich U: Clinical experience with a pressure-adjustable valve SOPHY in the management of hydrocephalus. Childs Nerv Syst 6:270–274, 1990

    • Search Google Scholar
    • Export Citation
  • 24.

    Matsumae M, , Sato O, & Itoh K, et al: Quantification of cerebrospinal fluid shunt flow rates. Assessment of the programmable pressure valve. Childs Nerv Syst 5:356360, 1989 Matsumae M, Sato O, Itoh K, et al: Quantification of cerebrospinal fluid shunt flow rates. Assessment of the programmable pressure valve. Childs Nerv Syst 5:356–360, 1989

    • Search Google Scholar
    • Export Citation
  • 25.

    McQuarrie IG, , Saint-Louis L, & Scherer PB: Treatment of normal pressure hydrocephalus with low versus medium pressure cerebrospinal fluid shunts. Neurosurgery 15:484488, 1984 McQuarrie IG, Saint-Louis L, Scherer PB: Treatment of normal pressure hydrocephalus with low versus medium pressure cerebrospinal fluid shunts. Neurosurgery 15:484–488, 1984

    • Search Google Scholar
    • Export Citation
  • 26.

    Miyake 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 40:931935, 1997 Miyake 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
  • 27.

    Mursch K, , Behnke J, & Christen HJ, et al: Use of transcranial real-time ultrasonography for programming a shunt valve system. Childs Nerv Syst 12:392395, 1996 Mursch K, Behnke J, Christen HJ, et al: Use of transcranial real-time ultrasonography for programming a shunt valve system. Childs Nerv Syst 12:392–395, 1996

    • Search Google Scholar
    • Export Citation
  • 28.

    Nulsen FE, & Spitz EB: Treatment of hydrocephalus by direct shunt from ventricle to jugular vein. Surg Forum 2:399403, 1952 Nulsen FE, Spitz EB: Treatment of hydrocephalus by direct shunt from ventricle to jugular vein. Surg Forum 2:399–403, 1952

    • Search Google Scholar
    • Export Citation
  • 29.

    Ortler M, , Kostron H, & Felber S: Transcutaneous pressure-adjustable valves and magnetic resonance imaging: an ex vivo examination of the Codman-Medos programmable valve and the Sophy adjustable pressure valve. Neurosurgery 40:10501058, 1997 Ortler M, Kostron H, Felber S: Transcutaneous pressure-adjustable valves and magnetic resonance imaging: an ex vivo examination of the Codman-Medos programmable valve and the Sophy adjustable pressure valve. Neurosurgery 40:1050–1058, 1997

    • Search Google Scholar
    • Export Citation
  • 30.

    Piatt JH Jr, & Carlson CV: A search for determinants of cerebrospinal fluid shunt survival: retrospective analysis of a 14-year institutional experience. Pediatr Neurosurg 19:233242, 1993 Piatt JH Jr, Carlson CV: A search for determinants of cerebrospinal fluid shunt survival: retrospective analysis of a 14-year institutional experience. Pediatr Neurosurg 19:233–242, 1993

    • Search Google Scholar
    • Export Citation
  • 31.

    Reinprecht A, , Czech T, & Dietrich W: Clinical experience with a new pressure-adjustable shunt valve. Acta Neurochir 134:119124, 1995 Reinprecht 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
  • 32.

    Reinprecht A, , Dietrich W, & Bertalanffy A, et al: The Medos Hakim programmable valve in the treatment of pediatric hydrocephalus. Childs Nerv Syst 13:588594, 1997 Reinprecht 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
  • 33.

    Rohde V, , Mayfrank L, & Ramakers VT, et al: Four-year experience with the routine use of the programmable Hakim valve in the management of children with hydrocephalus. Acta Neurochir 140:11271134, 1998 Rohde V, Mayfrank L, Ramakers VT, et al: Four-year experience with the routine use of the programmable Hakim valve in the management of children with hydrocephalus. Acta Neurochir 140:1127–1134, 1998

    • Search Google Scholar
    • Export Citation
  • 34.

    Sainte-Rose C, , Piatt JH, & Renier D, et al: Mechanical complications in shunts. Pediatr Neurosurg 17:29, 1991 Sainte-Rose C, Piatt JH, Renier D, et al: Mechanical complications in shunts. Pediatr Neurosurg 17:2–9, 1991

    • Search Google Scholar
    • Export Citation
  • 35.

    Schmitt J, & Spring A: [Therapy of normal pressure hydrocephalus with the transcutaneously magnetically adjustable shunt.] Neurochirurgia 33 (Suppl 1):2326, 1990 (Ger) Schmitt J, Spring A: [Therapy of normal pressure hydrocephalus with the transcutaneously magnetically adjustable shunt.] Neurochirurgia 33 (Suppl 1):23–26, 1990 (Ger)

    • Search Google Scholar
    • Export Citation
  • 36.

    Sindou M, , Guyotat-Pelissou I, & Chidiac A, et al: Transcutaneous pressure adjustable valve for the treatment of hydrocephalus and arachnoid cysts in adults. Experience with 75 cases. Acta Neurochir 121:135139, 1993 Sindou M, Guyotat-Pelissou I, Chidiac A, et al: Transcutaneous pressure adjustable valve for the treatment of hydrocephalus and arachnoid cysts in adults. Experience with 75 cases. Acta Neurochir 121:135–139, 1993

    • Search Google Scholar
    • Export Citation
  • 37.

    Sutcliffe JC, & Battersby RD: Do we need variable pressure shunts? Br J Neurosurg 6:6770, 1992 Sutcliffe JC, Battersby RD: Do we need variable pressure shunts? Br J Neurosurg 6:67–70, 1992

    • Search Google Scholar
    • Export Citation
  • 38.

    Trost HA: Is there a reasonable differential indication for different hydrocephalus shunt systems? Childs Nerv Syst 11:189192, 1995 Trost HA: Is there a reasonable differential indication for different hydrocephalus shunt systems? Childs Nerv Syst 11:189–192, 1995

    • Search Google Scholar
    • Export Citation
  • 39.

    Trost HA, , Heissler HE, & Claussen G, et al: Testing the hydrocephalus shunt valve: long-term bench test results of various new and explanted valves. The need for model for testing valves under physiological conditions. Eur J Pediatr Surg 1 (Suppl 1):3840, 1991 Trost HA, Heissler HE, Claussen G, et al: Testing the hydrocephalus shunt valve: long-term bench test results of various new and explanted valves. The need for model for testing valves under physiological conditions. Eur J Pediatr Surg 1 (Suppl 1):38–40, 1991

    • Search Google Scholar
    • Export Citation
  • 40.

    Walsh JW, & James HE: Subtemporal craniectomy and elevation of shunt valve opening pressure in the management of small ventricle-induced cerebrospinal fluid shunt dysfunction. Neurosurgery 10:698703, 1982 Walsh JW, James HE: Subtemporal craniectomy and elevation of shunt valve opening pressure in the management of small ventricle-induced cerebrospinal fluid shunt dysfunction. Neurosurgery 10:698–703, 1982

    • Search Google Scholar
    • Export Citation
  • 41.

    Yamashita N, , Kaiya K, & Yamada K: Experience with a programmable valve shunt system. J Neurosurg 91:2631, 1999 Yamashita N, Kaiya K, Yamada K: Experience with a programmable valve shunt system. J Neurosurg 91:26–31, 1999

    • Search Google Scholar
    • Export Citation

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