Adjustable Shunt Valve Reprogramming at Home

Sikorski, Christian W.; Rosen, David S.; Frim, David M.

doi:10.1227/01.neu.0000249269.11074.ca

Cited by 5 publications

(3 citation statements)

References 9 publications

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“…However, other data 1,2,11,[13][14][15][16]18,22,26,27,33,34 and our experience attest to the ability of PVs to obtain optimum pressures nonoperatively in the outpatient department in the first 6 months of life as an indication for continued use. This current study does not address this short postoperative period.…”

Section: Discussionsupporting

confidence: 55%

Nonprogrammable and programmable cerebrospinal fluid shunt valves: a 5-year study

Hatlen¹,

Shurtleff²,

Loeser

et al. 2012

PED

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Object Programmable valves (PVs) for shunting CSF have increasingly replaced nonprogrammable valves (NPVs). There have been only a few longer-term studies (≥ 5 years) conducted that have compared the effectiveness of NPVs with that of PVs for children with hydrocephalus, and only 1 study has reported NPVs as being favorable over PVs. The objective of this retrospective study was to compare the long-term survival of these 2 types of shunt valves. Methods The authors collected data for all patients who underwent CSF shunt insertion or revision between January 1, 2000, and December 31, 2008. Patients underwent follow-up for a minimum of 2 years postoperatively. Statistical analyses were done using chi-square, Kaplan-Meier survival curve, and multivariate analyses. Results A total of 616 valves were implanted, of which 313 were PVs and 303 were NPVs. Of these, 253 were original shunt implantations and 363 were revisions. The proportion of 5-year survival for NPVs (45.8%) was significantly higher than that for PVs (19.8%) (p = 0.0005, log-rank). The NPVs that survived longer than 6 months also survived through the 5th year better than the PVs (p = 0.0001). Conclusions The authors' data suggest that NPVs survive longer than PVs in children, but there is a need for prospective, case-control studies to confirm these data.

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Section: Discussionsupporting

confidence: 55%

Nonprogrammable and programmable cerebrospinal fluid shunt valves: a 5-year study

Hatlen¹,

Shurtleff²,

Loeser

et al. 2012

PED

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“…These ICP measurements can guide the adjustment of the LP shunt valve and provide information on shunt function. Sikorski et al 26 reported that an adjustable shunt valve can even be reprogrammed at home in appropriately selected patients. However, comprehensive patient education and close patient-physician communication are necessary.…”

Section: Disadvantages Of Lp Shuntsmentioning

confidence: 99%

Concurrent use of a lumboperitoneal shunt with programmable valve and ventricular access device in the treatment of pseudotumor cerebri: review of 40 cases

Nadkarni

Rekate

Wallace

2008

PED

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Object The authors evaluated the efficacy of treating patients with pseudotumor cerebri (PTC) and headaches due to increased intracranial pressure (ICP) by using a lumboperitoneal (LP) shunt with a programmable valve and ventricular access device (VAD). Methods Forty patients in whom PTC was diagnosed were treated using LP shunts with programmable valves and wand-guided placement of a VAD. All patients had papilledema and high opening pressure during spinal tap. The mean follow-up was 18 months (range 3–72 months). When patients complained of headaches that suggested shunt malfunction, the ventricular reservoir was tapped at bedside to assess ICP. The programmable valve was adjusted based on the patient's headache and ICP. Results The VAD was tapped in 21 patients, and the LP valve was redialed in 14. Shunt malfunction was diagnosed accurately. The 10 patients undergoing revision were all found to have shunt obstruction except 1 whose valve was replaced because it could not be reprogrammed. No patient treated with a shunt developed a Chiari malformation. The VAD was exposed in 4 patients with infection or wound breakdown. The LP shunt was revised in 2 patients who developed a pseudomeningocele. In 1 patient, a small bowel obstruction responded to conservative management. Seven patients had headaches despite documented normal ICP. That is, the headaches were unrelated to shunt function, and these patients were referred to a pain management clinic. Conclusions Lumboperitoneal shunts with programmable valves effectively controlled the outflow of lumbar cerebrospinal fluid to ameliorate the symptoms of PTC. The VAD permitted assessment of ICP and thus, indirectly, LP shunt function, and benefits outweighed risks. The programmable valve permitted cerebrospinal fluid flow to be adjusted based on patients' clinical status and ICP to be measured by the VAD.

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confidence: 99%

Letter: Difficulty in Tracing Manufacturer and Brand Names on Ventriculoperitoneal Shunt Catheters and Valves

et al. 2022

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To the Editor:Ventriculoperitoneal shunt (VPS) implantation, including revision surgeries and reprogramming of adjustable shunt valves, is the most common procedure performed by pediatric neurosurgeons, costing an estimated US$100 million each year in the United States alone. [1][2][3][4][5] In the United States, shunt-related procedures rank 10th among the procedures with the highest readmission rates. 6 Mandatory shunt revision surgeries after VPS malfunctions, especially in children, are challenging for neurosurgeons and may cause long-term painful situations for patients and their families. 1,5,7 Before VPS revision surgery, the surgeon's knowledge of the brand name, type, and pressure setting of the VPS that had been implanted in the patient can provide safer and more practical surgical solutions to the problem. However, many times, it is almost impossible to know the trademark, model, year of manufacturing, and pressure setting of the VPS previously inserted in the patient.Such a problem may not arise when the records of the patient's previous surgery can be accessed or if the patient has an implant card. However, there may be problems in the archive of hospital records. The patient's family may have lost the implant card over the years or the patient may be about to have surgery in a different hospital or country than the hospital where the previous surgery was performed. Thus, more often than not, the surgeon should detect the brand and type of implanted VPS by examining the shape of the valve/reservoir on plain skull graphs. Moreover, visual inspection of the VPS during surgery does not usually reveal any identifying information about the implant. In many cases, none of the ventricular, the peritoneal catheters, or the valve/reservoir is marked with the brand name of the company and the model of the shunt, pressure setting record, and year of manufacturing. Sometimes, some numbers/letters can be noticed on the valve/ reservoir, but it is impossible to trace the actual product identity using them.Clinical ethics in the use of VPS should be respected. Through a global secure network, attending neurosurgeons anywhere in the world should be able to access past information about the patient with a VPS implanted; of course, caring for data protection rules. Unfortunately, health information technology is focused on revenue optimization through support for billing documents for devices rather than monitoring the health of patients with implanted devices. [8][9][10][11] Sharing clinical information about these patients among neurosurgeons is not a priority of profit-driven public management systems and associated information technology. Thus, physicians cannot easily obtain information regarding the medical device implanted and must apply to authorized portals, often in vain. 12

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Adjustable Shunt Valve Reprogramming at Home

Cited by 5 publications

References 9 publications

Nonprogrammable and programmable cerebrospinal fluid shunt valves: a 5-year study

Nonprogrammable and programmable cerebrospinal fluid shunt valves: a 5-year study

Concurrent use of a lumboperitoneal shunt with programmable valve and ventricular access device in the treatment of pseudotumor cerebri: review of 40 cases

Letter: Difficulty in Tracing Manufacturer and Brand Names on Ventriculoperitoneal Shunt Catheters and Valves

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