Programmable shunt radiography.

This article discusses a programmable ventricular shunt valve system used to treat hydrocephalus. With this system, valve pressure can be ascertained easily with plain-film radiographs, thus avoiding complications associated with inappropriate pressures. The authors describe the shunt's design and techniques for imaging it, present illustrative cases and outline a strategy for coordinating the care of patients with these shunts.

Intratumoral administration of 5-[123I]iodo-2'-deoxyuridine in a patient with a brain tumor.

UNLABELLED: We have initiated a study in which patients suspected of having primary gliomas are given a single intracerebral injection of the thymidine analog 5-[123I]iodo-2'-deoxyuridine ([123I]IUdR). The purpose of the study is to determine the biodistribution of the radiopharmaceutical and to calculate dose estimates to the tumor and normal tissues. METHODS: A patient with a cystic glioma was injected with [123I]IUdR. Whole-body scans and brain scans were obtained at various times after injection, and blood, urine and stools were collected and assayed for radioactivity to assess its biodistribution and clearance. RESULTS: Scintigraphic imaging demonstrated that the distribution of radiolabeled IUdR was mainly confined to the tumor (injection site), stomach and bladder. Disappearance from the tumor site and blood clearance were delayed probably due to collection in the cystic lesion. Eighty percent of the injected dose was recovered in the urine. CONCLUSION: The pharmacokinetics of [123I]IUdR locoregionally administered to a human glioma in situ resembled those observed in a rat glioma model where administration of the radiopharmaceutical radiolabeled with the Auger electron emitter 125I was therapeutically effective.

The use of the Codman-Medos Programmable Hakim valve in the management of patients with hydrocephalus: illustrative cases.

Cerebrospinal fluid shunting is an important method of treating hydrocephalus. It sometimes has been difficult to achieve the optimum CSF pressure and ventricular size after shunt placement. Hydraulic and mechanical mismatching may occur, creating either overdrainage, as manifested by slit ventricle syndrome and/or subdural hygromas; or underdrainage, as manifested by a failure of the ventricles to change in size, with persistence of symptoms. A variable pressure valve (Codman-Medos Programmable Hakim valve system) has been developed to allow non-invasive increase or decrease in cerebrospinal fluid pressure in differentials of 10 mm of water within a range of 30-200 mm of water. This allows the neurosurgeon to adjust the pressure to the patient's particular clinical needs at any given moment. As part of a pilot study of the valve's safety, 13 patients in this center were treated with this programmable shunting system from October 1991 to January 1993. Twelve patients were over age 18 and one was younger than this. Six patients had previously been shunted with other valve systems, and the remaining seven had never been shunted before. The etiology of hydrocephalus included idiopathic normal pressure hydrocephalus (6 patients), aqueductal stenosis (3 patients), Chiari malformation (2 patients), meningitis (1 patient), and unknown etiology (1 patient). This paper describes the use of this valve in five illustrative cases; slit ventricle syndrome in an adult, chronic ventriculomegaly with aqueductal stenosis (2 cases), and idiopathic normal pressure hydrocephalus (2 cases). This programmable valve has been particularly useful in gradually decreasing ventricle size in idiopathic normal pressure hydrocephalus.(ABSTRACT TRUNCATED AT 250 WORDS)