gms | German Medical Science

Objective: We report three unusual cases of programmable valve breakage (Codman Hakim-Medos valve) in shunt-systems of children with posthemorrhagic hydrocephalus. Only four similarly studies have been published in the current literature.

Methods: Between 2010 and 2016 three children with posthemorrhagic hydrocephalus were admitted to our pediatric department. All patients had a history of slight blows to the head in a minor trauma. One patient presented with auto-aggressive behavior and initial vomiting, one with vomiting and neurologic deterioration, another one with focal seizures for 2 months. After initial examination, CT scan and X-ray were conducted.

Results: In all cases pumping the reservoir resulted in very slow refilling. The cranial computertomography (CT) in one patient showed slit ventricles confirming the suspicion of an overdrainage, the other cases a slight enhancement of the hydrocephalus. In lateral X-rays of the skull in comparison to the first X-ray control of the shunt-valve, the pressure control chamber could be seen dislocated in the inferior part of the reservoir in all cases. Surgery revealed that the shunt valve was broken. The pressure control chamber had dropped to the bottom of the reservoir. After implantation of a new shunt valve the symptoms resolved completely in all three children.

Conclusion: The well accepted Codman-Hakim programmable valve is part of a tube-system, which is designed to offer the possibility of a reliable and precise treatment of hydrocephalus. Various mechanical and non-mechanical complications of shunt-systems have been reported. The most common complications in the childhood are mechanical complications like obstruction, fracture and dislocation of the tubings. Valve breakage is a very rare condition but must be kept in mind when head trauma is reported.