Neurosurgical Review

, Volume 34, Issue 2, pp 235–242 | Cite as

Reversible occlusion (on–off) valves in shunted tumor patients

  • Daniel N. HertleEmail author
  • Johannes Tilgner
  • Karin Fruh
  • Timo Keinert
  • Anna M. Hagenston
  • Andreas W. Unterberg
  • Alfred Aschoff
Original Article


The first commercially produced adjustable valve for shunted hydrocephalus patients was introduced by H. Portnoy and R. Schulte in 1973. This valve is still in use and known as reversible occlusion or on–off valve. The reversible occlusion valve is mainly used in conjunction with an existing shunt in patients receiving intraventricular cytostatic therapy. The valve has a simple mechanical lock that is closed by external pressure application with a single finger. The study method is a retrospective clinical series of 15 patients undergoing a total of 16 valve implantations between 2003 and 2010 was carried out, and the valve was tested in vitro. We report a high incidence of accidental occlusions leading to a loss of consciousness in five patients (33.3%). We furthermore demonstrate in vitro that accidental occlusions can occur. The reversible occlusion valve is needed in shunted tumor patients receiving intrathecal administration of cytostatica. The mechanism works as long as no external pressure compresses the valve. However, head positions pose significant risks for unintentional occlusions. We stress the importance of: (1) a position near the midline avoiding the retroauricular or occipital regions, (2) a handling training for nurses and doctors, (3) instruction of patients and relatives, and (4) removal of the device after intrathecal cytostatic treatment.


On–off valve Reversible occlusion valve Hydrocephalus Shunt Intrathecal drug administration 



We thank Rezvan Ahmadi and Christine Dictus for intraoperative posing at an early stage of this project.

Conflict of interest

We have no conflicts of interest, either of financial or other nature. AMH is supported by a postdoctoral fellowship from the Exzellenzcluster CellNetworks, University of Heidelberg, Heidelberg, Germany.


  1. 1.
    Fischer L, Korfel A, Kiewe P, Neumann M, Jahnke K, Thiel E (2009) Systemic high-dose methotrexate plus ifosfamide is highly effective for central nervous system (CNS) involvement of lymphoma. Ann Hematol 88:133–139PubMedCrossRefGoogle Scholar
  2. 2.
    Gerber AM (1977) Malfunction of multipurpose valve shunt. J Neurosurg 47(5):799PubMedGoogle Scholar
  3. 3.
    Glantz MJ, LaFollette S, Jaeckle KA, Shapiro W, Swinnen L, Rozental JR, Phuphanich S, Rogers LR, Gutheil JC, Batchelor T, Lyter D, Chamberlain M, Maria BL, Schiffer C, Bashir R, Thomas D, Cowens W, Howell SB (1999) Randomized trial of a slow-release versus a standard formulation of cytarabine for the intrathecal treatment of lymphomatous meningitis. J Clin Oncol 17(10):3110–3116PubMedGoogle Scholar
  4. 4.
    Groves MD, Glantz MJ, Chamberlain MC, Baumgartner KE, Conrad CA, Hsu S, Wefel JS, Gilbert MR, Ictech S, Hunter KU, Forman AD, Puduvalli VK, Colman H, Hess KR, Yung WK (2008) A multicenter phase II trial of intrathecal topotecan in patients with meningeal malignancies. Neuro Oncol 10(2):208–215PubMedCrossRefGoogle Scholar
  5. 5.
    Harstad L, Hess KR, Groves MD (2008) Prognostic factors and outcomes in patients with leptomeningeal melanomatosis. Neuro-Oncol 10(6):1010–1018PubMedCrossRefGoogle Scholar
  6. 6.
    Hoffmann C, Wolf E, Wyen C, Fätkenheuer G, Van Lunzen J, Stellbrink HJ, Stoehr A, Plettenberg A, Jaeger H, Noppeney R, Hentrich M, Goekbuget N, Hoelzer D, Horst HA (2006) AIDS-associated Burkitt or Burkitt-like lymphoma: short intensive polychemotherapy is feasible and effective. Leuk Lymphoma 47(9):1872–1880PubMedCrossRefGoogle Scholar
  7. 7.
    Portnoy HD, Schulte R, Fox JL (1973) Anti-siphon and reversible occlusion valves for shunting in hydrocephalus and preventing post-shunt subdural hematomas. J Neurosurg 38(6):729–738PubMedCrossRefGoogle Scholar
  8. 8.
    Rudnicka H, Niwinska A, Murawska M (2007) Breast cancer leptomeningeal metastasis—the role of multimodality treatment. J Neurooncol 84:57–62PubMedCrossRefGoogle Scholar
  9. 9.
    Stemmler HJ, Mengele K, Schmitt M, Harbeck N, Laessig D, Herrmann KA (2008) Intrathecal trastuzumab (Herceptin) and methotrexate for meningeal carcinomatosis in HER2-overexpressing metastatic breast cancer: a case report. Anticancer Drugs 19(8):832–836PubMedCrossRefGoogle Scholar
  10. 10.
    Yamasaki S, Sato H, Kitamura J, Hirayama A, Osaka K (1976) Efficiency of the on–off valve in the cerebrospinal fluid shunt. Nippon Geka Hokan 45(1):36–39PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Daniel N. Hertle
    • 1
    Email author
  • Johannes Tilgner
    • 1
  • Karin Fruh
    • 1
  • Timo Keinert
    • 1
  • Anna M. Hagenston
    • 2
  • Andreas W. Unterberg
    • 1
  • Alfred Aschoff
    • 1
  1. 1.Department of NeurosurgeryUniversity of HeidelbergHeidelbergGermany
  2. 2.Department of Neurobiology, Interdisciplinary Center for Neurosciences (IZN), and Exzellenzcluster CellNetworksUniversity of HeidelbergHeidelbergGermany

Personalised recommendations