'Two weeks later, on her 73rd birthday, Patricia had surgery to insert a CODMAN® HAKIM® Programmable Valve. HAKIM is a registered trademark of Hakim USA, LLC and is used under license by Codman & Shurtleff, Inc. She spent a week in the hospital recovering from surgery and then went to a skilled nursing center for physical therapy for another week or so.'
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The treatment of choice for NPH patients who show a positive response to diagnostic testing is the placement of a CSF shunt. A shunt is an implantable device designed to drain CSF fluid away from the brain thereby allowing the enlarged ventricles to return to a normal state. As CSF fluid builds and the pressure in the ventricle increases, a one-way shunt in the shunt opens, and the excess CSF fluid drains into the abdomen where it is easily absorbed. This technique is very effective in improving the troubling symptoms of NPH.

With a traditional fixed pressure shunt, choice of the correct pressure setting is very important as under-drainage will not improve symptoms, whereas over-drainage can cause symptoms in itself, or predispose to problems such as subdural hematoma. Incorrect choice of a fixed pressure shunt requires removal of the original shunt, and repositioning of a different one.

Surgical revisions such as this can be avoided if your neurosurgeon is certified in the use of programmable shunt technology. With a programmable shunt, the pressure setting can be adjusted with a special magnetic programmer in your doctor's office, eliminating the need for additional surgery if the initial setting proves not to help.

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