Comparison of programmable shunt valves vs standard valves for communicating hydrocephalus of adults: a retrospective analysis of 407 patients

BACKGROUND: The aim of the present study was to clarify whether programmable shunt valves are advantageous in the treatment of adults with communicating hydrocephalus with respect to valve-related shunt complications and surgical shunt revisions, in comparison with standard valves. METHODS: Adult patients with communicating hydrocephalus treated with Codman Hakim programmable (CHP) valves or Hakim (H) standard valves during 12 years were retrospectively studied. Patients were analyzed for demographic data, implantation diagnosis, valve type, opening pressure at implantation, opening pressure adjustments, and incidence of shunt complications, especially valve-related complications. The end point of the study was a surgical shunt revision. RESULTS: In 407 patients, 247 CHP valves and 160 H valves were implanted. Median opening pressure of CHP at implantation was 110 mm H(2)O, while 3 low-pressure, 153 medium-pressure, and 4 high-pressure H valves were implanted. Opening pressure adjustments were performed in 39% of CHP patients--1.44 adjustments per adjusted valve. Overall complication rate as well as the rate of surgical revisions for infections and catheter- and valve-related problems did not show any significant difference between CHP and H valves. The incidence of nontraumatic subdural hematomas and hygromas was significantly higher in the CHP group; however, the rate of surgical decompressions did not differ. CONCLUSIONS: The advantage of reprogramming of CHP did not translate into a reduction in surgical shunt revisions. Therefore, in conjunction with the present data, we believe it is still justified to implant H standard valves in adult patients with communicating hydrocephalus.