11272031

pubmed:Citation

6

The objective of the investigation was to determine the pattern of use of the Hakim (Medos) programmable valve implanted in patients with complex hydrocephalus and their clinical outcome. A prospective audit of patients with complex hydrocephalus undergoing Hakim programmable valve implantation between 1989 and 1994 in the United Kingdom and Ireland, was followed-up for a minimum of 5 years. Surgical practice and complications were audited together with clinical outcome. One-hundred-and-thirty-nine patients (80 male, 59 female; mean age 43.4 years; median 47 years; range 1 month-84 years) with complex hydrocephalus due to a wide range of aetiologies were implanted with the Hakim programmable valve. Eighty-eight (63%) had large or massive ventricles prior to implantation; seven (5%) were slit. Fifty-five (40%) had previously been shunted with a fixed pressure system. One-hundred-and-thirty-one (94%) of the Hakim programmable shunts were ventriculoperitoneal; four (3%) ventriculoatrial; two (1.4%) cystoperitoneal; and two (1.5%) lumboperitoneal. The initial opening pressure selected ranged from 50 to 200 mmH2O (median 120). Valves were reprogrammed on average 1.7 times with 143 reprogrammings in the first year after implantation; 67 in the second; 19 in the third; three in the fourth; two in the fifth. Forty-nine (36%) valves were never reprogrammed after implantation. During the 5 years audit period, there were 70 (50%) shunt revisions, 40 of which were performed within 1 year of implantation. Thirty-six (27%) shunts were removed. There were 24 (18%) shunt infections. Subdural collections were identified in 37(27%) patients after Hakim programmable valve implantation; 10 (27%) required surgical drainage. Five (3.7%) patients developed symptomatic slit ventricles after Hakim programmable valve implantation. Headache was improved following reprogramming in 27(71%) of the 38 patients with refractory headache. After Hakim programmable valve implantation, patients underwent an average of 4.6 CT scans (range 1-25); 0.3 MRI (range 1-5) and 1.8 skull radiographs (range 1-20). The mean hospital stay per patient over 5 years was 26 days (range 1-110 days). Five years after implantation, the Glasgow Outcome scale was favourable in 64% of patients. The Hakim programmable valve is useful in the management of patients with complex hydrocephalus and may reduce the need for shunt revision for headache. Non-haemorrhagic, post-shunting, subdural collections identified on routine postoperative CT may be treated by reprogramming.

http://linkedlifedata.com/resource/pubmed/journal/8800054

MEDLINE

0268-8697

Print

NLM

535-42

pubmed-meshheading:11272031-Adolescent, pubmed-meshheading:11272031-Adult, pubmed-meshheading:11272031-Age Distribution, pubmed-meshheading:11272031-Aged, pubmed-meshheading:11272031-Aged, 80 and over, pubmed-meshheading:11272031-Attitude of Health Personnel, pubmed-meshheading:11272031-Cerebrospinal Fluid Shunts, pubmed-meshheading:11272031-Child, pubmed-meshheading:11272031-Child, Preschool, pubmed-meshheading:11272031-Female, pubmed-meshheading:11272031-Humans, pubmed-meshheading:11272031-Hydrocephalus, pubmed-meshheading:11272031-Infant, pubmed-meshheading:11272031-Length of Stay, pubmed-meshheading:11272031-Male, pubmed-meshheading:11272031-Medical Audit, pubmed-meshheading:11272031-Middle Aged, pubmed-meshheading:11272031-Patient Selection, pubmed-meshheading:11272031-Prospective Studies, pubmed-meshheading:11272031-Reoperation, pubmed-meshheading:11272031-Tomography, X-Ray Computed, pubmed-meshheading:11272031-Treatment Outcome

A clinical audit of the Hakim programmable valve in patients with complex hydrocephalus.

Journal Article