Four-Year Experience with the Routine use of the Programmable Hakim Valve in the Management of Children with Hydrocephalus

Summary  Objective. Cerebrospinal fluid (CSF) over- and underdrainage symptoms are frequent sequelae of shunt placement in patients with hydrocephalus, sometimes requiring repeated operations. To achieve more adequate CSF drainage, the non-invasively programmable Hakim valve has been developed. Because the clinical experiences with this valve so far are confined to adults, we describe our experiences with the routine use of the programmable Hakim valve in childhood hydrocephalus.  Method. Sixty children (mean age of 3.4 years) with hydrocephalus of various aetiologies have been shunted with the programmable Hakim valve. In the majority of cases, initial opening pressures of between 100 and 120 mm H₂O were selected. The mean follow-up period was 2.1 years.  Results. Thirty-three readjustment of the pressure setting of the valve were performed in 20 children because of CSF overdrainage (low intracranial pressure syndrome n=13, slit ventricle syndrome n=2, hygroma n=1), CSF underdrainage (n=3) and CSF leakage through the operation wound (n=1). The symptoms of inadequate CSF drainage were cured in 18 of the 20 children. The necessity for valve readjustments was independend of the aetiology of the hydrocephalus. Thirty-one complications requiring repeated operation occurred during the follow-up period, accounting for an annual complication rate of 24.6%. Three complications were valve-related.  Conclusion. In the majority of cases, the programmable Hakim valve allows the successful management of symptoms related to CSF over- and underdrainage by non-invasive change of the initial pressure setting of the valve. Therefore, the programmable Hakim valve should be considered as an alternative to non-programmable valves of advanced design.