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- Zemack, Göran, et al.
(författare)
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Adjustable valves in normal-pressure hydrocephalus: a retrospective study of 218 patients.
- 2008
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Ingår i: Neurosurgery. - : Ovid Technologies (Wolters Kluwer Health). - 0148-396X. ; 62 Suppl 2, s. 2-1400
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: We sought to assess the value of adjusting shunt valve opening pressure, complications, and outcomes with the use of an adjustable shunt valve in the treatment of patients with normal-pressure hydrocephalus (NPH). METHODS: In a single-center retrospective study, 231 adjustable valves (range, 30-200 mm H2O) were the first shunt implantations in 147 patients with idiopathic NPH (INPH) and 71 patients with secondary NPH (SNPH). The effect of adjustment on gait disturbance, cognitive impairment, urinary incontinence and other symptoms were evaluated, and an improvement index was created. RESULTS: In the INPH group, 138 adjustments were performed in 49.0% of the patients (average, 0.94 adjustments/patient). For the SNPH group, 49 adjustments were performed in 32.4% of the patients (average, 0.69 adjustments/patient). The reasons for adjustment were overdrainage in 48 patients (25.7%), underdrainage in 98 patients (52.4%), subdural hematoma in 37 patients (19.8%), and other reasons in 2 patients (2.1%). Clinical status improved after 56 (49.1%) of all 114 adjustments, whereas 23 (42.6%) of 54 minor (< or = 20 mm H2O) and 33 (66.0%) of 50 larger adjustments improved the patient's clinical status. The correlation of the improvement index with the size of the individual adjustments was not significant. Complications occurred in 43 (19.7%) of 218 patients, valve malfunction occurred in 3 patients (1.3%), infection occurred in 14 patients (6.4%), and nontraumatic subdural effusion occurred in 15 patients (6.9%; 8 were treated by adjustment alone). The 5-year shunt survival rate was 80.2%. Outcomes were excellent or good in 71 (78.9%) of 90 patients with INPH and in 30 (69.8%) of 43 patients with SNPH. CONCLUSION: Noninvasive, particularly consecutive, minor or single larger adjustments to the valve opening pressure can further improve outcome in patients with NPH who undergo shunting.
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- Zemack, Göran
(författare)
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Clinical evaluation of an adjustable cerebrospinal fluid shunt valve
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Shunting systems are implanted for draining cerebrospinal fluid to treat hydrocephalus, intracranial cysts, and idiopathic intracranial hypertension. Most shunt systems include a valve which regulates drainage. A differential pressure valve opens when intracranial pressure exceeds the valve’s opening pressure. The difficulty with these valves is selecting and predicting the most suitable valve opening pressure for the individual patient after insertion. Using a valve with a non-adjustable opening pressure requires surgery to change the opening pressure. Potentially, an adjustable valve, such as the Codman Hakim programmable valve, allows non-invasive valve pressure-adjustment for managing over- and underdrainage by being able to fine-tune the valve's opening pressure to the patient’s changing intracranial hydrodynamics. Objective: To evaluate the use of an adjustable valve in a consecutive, non-selected group of patients. To evaluate its reliance, spectrum of complications, use and effects of opening pressure adjustments and economical impact. Results and conclusions: An adjustable valve has the advantage of enabling trans-cutaneous alterations of the valve's opening pressure as the patients’ clinical course changes during the postoperative period. Pressure-adjustment optimized treatment, and clinical outcome improved following the majority of adjustments. Subdural fluid collections could be managed with pressure-adjustment. The rate of shunt complications was similar to other studies. Valve malfunction was uncommon. Accidental pressure-resetting, other than that caused by magnetic resonance imaging, was rare. Avoided shunt revisions reduce cost. Because we cannot predict which patient will need pressure-adjustment, our preference is to use an adjustable valve for all conditions.
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