Summary
Two different technical principles of gravitational valves (G-valves) have been presented: counterbalancer and switcher G-valves. The objective of our prospective study was to look for clinically relevant differences between both.
A total of 54 patients with normal-pressure hydrocephalus (NPH) were treated; 30 patients received an Aesculap-Miethke GA-Valve (GAV; counterbalancer), and in 24 patients an Aesculap-Miethke Dualswitch-Valve (DSV; switcher) was implanted. The opening pressure of the posture-independent valve was 5 cm H2O in both devices. The outcome was clearly better with the usage of the GAV than with the DSV. The frequency and severity of complications was pronounced in the DSV group.
We recommend the Aesculap-Miethke-GAV valve with a low opening pressure in a posture-independent valve for patients with NPH.
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References
Arriada N, Sotelo J (2002) Review: treatment of hydrocephalus in adults. Surg Neurol 58: 377–384
Aschoff A, Kremer P, Benesch C, Fruh K, Klank A, Kunze S (1995) Overdrainage and shunt technology. A critical comparison of programmable, hydrostatic and variable-resistance valve and flow-reducing devices. Childs Nerv Syst 11: 193–202
Bech RA, Waldemar G, Gjerris F, Klinken L, Juhler M (1999) Shunting effects in patients with idiopathic normal pressure hydrocephalus; correlation with cerebral and leptomeningeal biopsy findings. Acta Neurochir (Wien) 141: 633–639
Boon AJ, Tans JT, Delwel EJ, Egeler-Peerdeman SM, Hanlo PW, Wurzer HA, Avezaat CJ, de Jong DA, Gooskens RH, Hermans J (1998) Dutch Normal-Pressure Hydrocephalus Study: randomized comparison of low-and medium-pressure shunts. J Neurosurg 88: 490–495
Dauch WA, Zimmermann R (1990) Normal pressure hydrocephalus. An evaluation 25 years following the initial description [in German]. Fortschr Neurol Psychiatr 58: 178–190
Drake JM, Kestle JR, Milner R, Cinalli G, Boop F, Piatt J Jr, Haines S, Schiff SJ, Cochrane DD, Steinbok P, MacNeil N (1998) Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery 43: 294–303; discussion 303–305
Hanlo PW, Cinalli G, Vandertop WP, Faber JA, Bogeskov L, Borgensen SE, Boschert J, Chumas P, Eder H, Pople IK, Serlo W, Vitzthum E (2003) Treatment of hydrocephalus determined by the European Orbis Sigma Valve II survey: a multicenter prospective 5-year shunt survival study in children and adults in whom a flow-regulating shunt was used. J Neurosurg 99: 52–57
Hebb AO, Cusimano MD(2001) Idiopathic normal pressure hydrocephalus: a systematic review of diagnosis and outcome. Neurosurgery 49: 1166–1184; discussion 1184–1186
Kiefer M, Eymann R, Steudel WI (2000) The dynamic infusion test in rats. Childs Nerv Syst 16: 451–456
Kiefer M, Eymann R, Meier U (2002) Five years experience with gravitational shunts in chronic hydrocephalus of adults. Acta Neurochir (Wien) 144: 755–767; discussion 767
Kiefer M, Eymann R, Komenda Y, Steudel WI (2003) A grading system for chronic hydrocephalus [in German]. Zentralbl Neurochir 64: 109–115
Kiefer M, Eymann R, Steudel WI, Strowitzki M (2005) Gravitational shunt management of long-standing overt ventriculomegaly in adult (LOVA) hydrocephalus. J Clin Neurosci 12: 21–26
Meier U, Zeilinger FS, Kintzel D (1999) Diagnostic in normal pressure hydrocephalus: A mathematical model for determination of the ICP-dependent resistance and compliance. Acta Neurochir (Wien) 141: 941–947; discussion 947–948
Meier U, Kiefer M, Sprung C (2004) Evaluation of the Miethke dual-switch valve in patients with normal pressure hydrocephalus. Surg Neurol 61: 119–127; discussion 127–128
Meier U, Kiefer M, Lemcke J (2005) On the optimal opening pressure of hydrostatic valves in cases of idiopathic normal pressure hydrocephalus. Neurosurg Q 15: (in press)
Portnoy HD, Amirjamshidi A, Hoffman HJ, Levy LP, Haase J, Scott RM, Zhao YD, Peter J, Krivoy A, Sotelo J (1998) Shunts: which one, and why? Surg Neurol 49: 8–13
Richards HK, Seeley HM, Pickard JD (2000) Shunt revisions: Data from the UK shunt registry. Eur J Pediatr Surg [Suppl] 10: 59
Vanneste JA (2000) Diagnosis and management of normal-pressure hydrocephalus. J Neurol 247: 5–14
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Kiefer, M., Meier, U., Eymann, R. (2006). Gravitational valves: relevant differences with different technical solutions to counteract hydrostatic pressure. In: Hoff, J.T., Keep, R.F., Xi, G., Hua, Y. (eds) Brain Edema XIII. Acta Neurochirurgica Supplementum, vol 96. Springer, Vienna. https://doi.org/10.1007/3-211-30714-1_71
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DOI: https://doi.org/10.1007/3-211-30714-1_71
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