What is the ideal initial valve pressure setting in neonates with ventriculoperitoneal shunts?

The Strata programmable valve for shunt-dependent hydrocephalus: the pediatric experience at a single institution

BACKGROUND AND OBJECTIVE

The Medtronic PS Medical Strata valve has pressure flow characteristics that are noninvasively adjusted with a magnetic tool. The objective of this study was to examine its efficacy during our initial experience with it in shunt-dependent children.

MATERIALS AND METHODS

A retrospective review of 53 children with a median age of 2.0 years who had 61 Strata valves implanted.

CONCLUSION

The Strata valve is efficacious in the treatment of shunt-dependant hydrocephalus in children. The 1-year shunt survival rate of 67.2% is comparable to that previously reported from a multicenter trial. Of the 30 therapeutically aimed adjustments during the study period, 16 (53.3%) resulted in improvement in abnormal signs or symptoms. Our data indicate that adjustments can be used to treat signs or symptoms of cerebrospinal fluid overdrainage or underdrainage, which may obviate the need for additional surgery.

Helmetlike skull deformity with a large arachnoid cyst

BACKGROUND

It is not difficult to find localized skull ballooning or macrocrania in patients with intracranial arachnoid cysts. However, there have been no previous reports regarding large localized skull protuberant deformities resembling a war helmet. The authors report with a review of literature a case of an adult with helmetlike skull deformity resulting from a large supratentorial arachnoid cyst.

CASE DESCRIPTION

A 35-year-old man presented with a large head deformity since his early childhood that had been the result of gradual progression from infantile macrocrania. He also had mental retardation, sixth cranial nerve palsy with recent aggravation of headache, reduced activity, poor voiding control, and walking disturbance. Magnetic resonance imaging of the head showed hydrocephalus with a large supratentorial arachnoid cyst located in the bilateral parietooccipital area compressing the hemisphere anteriorly, and the tentorium and cerebellum inferiorly. Magnetic resonance venogram demonstrated low-lying short transverse and lateral sinuses, and the superior sagittal sinus and falx were displaced to the right side. Radioisotopic cisternogram showed nonfilling of the isotope in the bilateral parietooccipital area. Cerebrospinal fluid pressure measured by lumbar puncture was 17 cm H(2)O. We tentatively diagnosed the condition as normopressure hydrocephalus with a large supratentorial arachnoid cyst. His headache, reduced activity, poor voiding control, and walking disturbance improved after a cystoperitoneal shunt.

CONCLUSIONS

This might suggest that large arachnoid cysts found in childhood should be treated for prevention of skull deformity and late aggravation of increased intracranial pressure.