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

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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.

Article Information

Address reprint requests to: Bertil Romner, M.D., Ph.D., Department of Neurosurgery, Division of Neurological Sciences, Lund University Hospital, 221 85 Lund, Sweden.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Bar graph showing the distribution of patient ages at the time of valve and shunt implantation.

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    Upper: Bar graph demonstrating the average opening pressure in different age groups at the time of valve and shunt implantation. Error bars represent standard deviations. Lower: Bar graph demonstrating the average opening pressure at the time of valve and shunt implantation, grouped by diagnosis. Error bars represent standard deviations. IVH = intraventricular hemorrhage; MMC = myelomeningocele; PTC = pseudotumor cerebri; SAH = subarachnoid hemorrhage.

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    Bar graph demonstrating the average changes in opening pressure (increase or decrease) at follow-up review compared with the time of valve and shunt implantation. Error bars represent standard errors of the mean.

  • View in gallery

    Bar graph depicting the time after implantation at which opening pressure adjustments were performed. Most opening pressure adjustments were made during the 1st year after implantation. In selected cases opening pressure adjustments were made up to 6.5 years after insertion.

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    Bar graph demonstrating the magnitude and direction of changes in opening pressure caused by MR imaging in 35 cases.

  • View in gallery

    Graph depicting the shunt survival curve for patients in whom a first-time shunt implantation procedure had been performed. Patients who died were included if their follow-up period was sufficient.

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