The Use of the Programmable Valve Shunt System in the Management of Patients with Hydrocephalus

OBJECTIVE: The goal of this study was to clarify the value of the programmable valve shunt system to readjust the pressure noninvasively for the adequate cerebrospinal fluid(CSF) drainage. METHODS: The authors analyzed a single-center retrospective study of 54 patients suffering from hydrocephalus of various causes, as aneurysm(21 patients), trauma(13 patients), normal-pressure hydrocephalus(NPH, 7 patients) and so on. In 51 cases a programmable valve was implanted at the first shunt implantation. In three cases the shunt was replaced to a programmable valve system. RESULTS: In 33 patients(61%) of cases valve pressure adjustment was required at least once(total number of readjustment 54, mean 1.7, maximum 5) for the reason of underdrainage(36) or overdrainge(18). The range of reprogrammed valve pressure was 10 to 90mmH2O(mean 11.1+/-15.9mmH2O), the radiological finding improved 48.6% of frontal horn index at the beginning of reprogramming to 41.3%, and the clinical symptom related with hydrocephalus improved in 29 patients(87.8%) of pressure adjustment. Shunt reprogramming was necessary in patients with congenital hydrocephalus(100%), aneurysm(55%), NPH(71%), trauma(50%); the programmable valve proved particularly beneficial for overdrainge as subdural hygroma. CONCLUSION: The programmable valve was useful for the correction of overdrainge or underdrainage by the easy control of valve pressure without any invasive procedure.

Usefulness of Intrathecal Gadolinium Enhanced Magnetic Resonance Cisternography in Cerebrospinal Fluid Fistula: Case Report

Accurate localization of cerebrospinal fluid(CSF) fistulae makes the planning of surgery easier, increases the chances of successful dural repair and eliminates negative exploration. The authors report our early experience with intrathecal use of gadolinium DTPA(Gd-DTPA) magnetic resonance(MR) cisternography for evaluation of CSF leakage and localization. By means of lumbar puncture, a single dose of 1ml of gadolinium DTPA mixed with 4ml NaCl 5% was injected. The images were interpreted by comparing those before and after injection. Three patients showed leakage of contrast material through the cribriform plate into the ethmoid or sphenoid air cells. No leakage was observed in one patient. The study results show the relatively safety and feasibility of low-dose Gd-DTPA MR cisternography in confirming the presence and determining the focus of active CSF leaks.