The Value of Programmable Shunt Valves for the Management of Subdural Collections in Patients with Hydrocephalus

Abstract

Background. The aim of the present study was to assess the value of electromagnetic programmable shunt valves for the treatment of subdural collections. Methods. Adult patients with hydrocephalus of various causes that were treated with programmable shunt valves during the last ten years were retrospectively studied. In 127 patients, 139 electromagnetic programmable shunt valves were implanted. Results. A nontraumatic subdural fluid collection was detected in 12 patients. The treatment of these patients consisted of reprogramming of the valve's opening pressure. In 5 patients small subdural hematomas were detected; 4 of these patients were treated by raising the opening pressure alone and one patient required surgical drainage and change of the pressure setting. Traumatic chronic subdural hematomas were detected in 6 patients. These patients were treated by surgical drainage and readjustment of the valve's opening pressure. Conclusion. The ability to treat a shunt-related complication, such as a subdural fluid collection, by reprogramming the valve's opening pressure to a higher setting is an advantage over nonprogrammable valves, and it enables the opening pressure to be slowly lowered once the fluid collection is reabsorbed. Based on our results, we believe that programmable shunt valves should be preferred.

Subdural hematomas in 1846 patients with shunted idiopathic normal pressure hydrocephalus: treatment and long-term survival

“…Small case series indicate that surgical hematoma evacuations and shunt revisions could be avoided by using adjustable shunt valves. 2,8,11,13 This hypothesis was supported in this large patient cohort, and the long-term survival associated with SDH and different treatment options was evaluated. We found that the use of adjustable shunts is well established and increasing in Sweden and that most SDHs are treated by opening pressure adjustments when adjustable shunts are present.…”

“…Proportion of treatment regimens of SDH between 2004 and 2015 for fixed as well as adjustable shunts. The total number of patients treated for SDH each year were6,5,9,11,18,17, 24, 22,18, 23,17, and 14, respectively. Figure is available in color online only.…”

Subdural Hematoma Complicating Ventriculoperitoneal Shunts: An Algerian Centers Experience

“…Skull enlargement, if present, exaggerates this effect because of the great discrepancy in volume between the size of the brain and the cranial cavity. 1 According to Pachatouridis et al 3 the valve's opening pressure is the most important factor in determining CSF drainage. This is attested by the study of Boon et al that the subdural effusions occurred in 71% of patients with a low-pressure shunt and in 34% of patients with a medium pressure shunt.…”

“…6 According to Boon et al, 4 the incidence depends on the type of the valve and reported subdural effusions to occur in 71% of patients with a low pressure shunt and in 34% of patients with a medium pressure shunt. After using a programmable valve, Pachatouridis et al 3 reported a nontraumatic subdural fluid collection (hygroma) in 12 (9.4%) patients. Code et al reported an incidence of 1.4% in a series with a fixed drainage shunt.…”