title: Effect of transcranial magnetic stimulation on four types of pressure-programmable valves.
abstract: BACKGROUND
  Exposure to powerful magnetic fields may alter the settings of programmable ventriculoperitoneal shunt valves or even cause permanent damage to these devices. Transcranial magnetic stimulation (TMS) and magnetic resonance imaging both generate a high-intensity, focal magnetic field. To the best of our knowledge, there is no literature data on the compatibility of TMS with neurosurgical implants. The aim of the present in vitro study was to investigate the effects of TMS on four types of pressure-programmable valves (the Strata 2 from Medtronic, the Polaris from Sophysa, the ProGAV from Miethke, and a cylindrical valve from Codman-Hakim).
  
  
  METHODS
  We used a Magpro X100 stimulator (Medtronic) for monophasic or biphasic TMS via a circular or a figure-of-eight coil. Each valve setting was tested before and after exposure to TMS. Experiment 1: The effect of the coil-valve distance (10, 5, 2.5, and 1 cm) was assessed. Experiment 2: We mimicked in situ stimulation with a human mannequin by placing the valve in a retroauricular position, the TMS circular coil on the apex, and figure-of-eight coil centered over the primary motor area site. Temperature changes were monitored throughout the experiments. Experience 3: TMS-induced valve movements were assessed by using an in-house accelerometric setup.
  
  
  RESULTS
  Our results primarily demonstrated that the Strata 2 and Codman-Hakim valves' settings were perturbed by TMS. There was no heating effect for any of the valves. However, TMS induced movements of the Strata 2, Polaris, and ProGAV valves. Experiment 1: The unsetting frequencies observed for the Strata 2 and the Codman-Hakim valve showed an influence of the distance, the coil model, and the magnetic field characteristics, whereas the Polaris and ProGAV's settings remained unchanged. Experiment 2: Unsetting occurred for Strata 2 valve with the circular coil only, whereas the Polaris, ProGAV, and Codman-Hakim valves' settings remained stable. Experiment 3: The Strata 2, Polaris, and ProGAV valves showed high-amplitude oscillations during TMS under all stimulation conditions, whereas the Codman-Hakim valve did not move.
  
  
  CONCLUSIONS
  Our in vitro experiments showed that TMS can interfere with programmable shunt valves by inducing unsetting or movement. This finding suggests that great care must be taken if applying TMS in hydrocephalic, shunted patients.
authors: Service de Neurochirurgie, Centre Hospitalier Universitaire d'Amiens, Amiens cedex 1, France.
authors: Michel
authors: M
authors: Lefranc
authors: Julie Yeung Lam
authors: JY
authors: Ko
authors: Johann
authors: J
authors: Peltier
authors: Anthony
authors: A
authors: Fichten
authors: Christine
authors: C
authors: Desenclos
authors: Jean-Michel
authors: JM
authors: Macron
authors: Patrick
authors: P
authors: Toussaint
authors: Daniel
authors: D
authors: Le Gars
authors: Michel
authors: M
authors: Petitjean
mesh_terms: D015170:Cerebrospinal Fluid Pressure / Q000502:physiology; D004867:Equipment Design; D019544:Equipment Failure Analysis; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D066298:In Vitro Techniques; D008953:Models, Anatomic; D012984:Software; D013813:Therapy, Computer-Assisted / Q000295:instrumentation*; D050781:Transcranial Magnetic Stimulation / Q000009:adverse effects* / Q000295:instrumentation; D017287:Ventriculoperitoneal Shunt / Q000295:instrumentation*