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Neurosurgery

Hydrocephalus & ICP management

Gravitational valves improve patient outcomes[6-7]

Hydrocephalus shunts, intraventricular neuroendoscopy and long-term implants for non-invasive telemetric pressure measurement

In the treatment of hydrocephalus, so-called shunt systems are very often implanted in order to drain the excess cerebrospinal fluid (CSF) to other parts of the body. This is done in an attempt to bring the intracranial pressure, which is elevated due to the accumulation of fluid in the brain, back into the normal range in order to prevent damage to the brain.

An alternative procedure to shunt surgery is an endoscopic third ventriculostomy (ETV). Instead of inserting a shunt, the surgeon makes a hole in the floor of third ventricle to allow the trapped cerebrospinal fluid (CSF) to escape to the brain's surface, where it can be absorbed. Aesculap offers various intraventricular neuroendoscopic systems: MINOP®, PaediScope® and MINOP® InVent.

MIETHKE gravitational shunts offer special protection to avoid position-dependent complications such as over- and underdrainage, with positive clinical outcomes for the patient and a significant reduction of overdrainage events.^[1-4]

All MIETHKE valves are manufactured with high precision from titanium and are protected against unintentional reprogramming by magnetic fields of up to 3 Tesla.^[5]

Advances in shunt technology, in particular adjustable and gravitational valves, have improved patient outcomes.^[6-7] Finding the best possible patient-individual pressure setting and assessing shunt function can however be challenging and time-consuming. M.scio® is a telemetric pressure sensor approved for permanent implantation. Valve adjustments following telemetric read-out of the pressure via the M.scio® improve outcomes in most patients and knowledge of the pressure can help to avoid unnecessary hospitalisations, investigations, and radiation exposure.^[6-8]

Hydrocephalus & ICP Management

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[1] Tschan CA, Antes S, Huthmann A, et al. Overcoming CSF overdrainage with the adjustable gravitational valve proSA. Acta Neurochir (Wien). 2014;156(4):767-76; discussion 776.

[2] Suchorska B, Kunz M, Schniepp R, et al. Optimized surgical treatment for normal pressure hydrocephalus: comparison between gravitational and differential pressure valves. Acta Neurochir (Wien). 2015;157(4):703-9.

[3] Lemcke J, Meier U, Muller C, et al. Safety and efficacy of gravitational shunt valves in patients with idiopathic normal pressure hydrocephalus: a pragmatic, randomised, open label, multicentre trial (SVASONA). J Neurol Neurosurg Psychiatry. 2013;84(8):850-7

[4] Sprung C, Schlosser HG, Lemcke J, et al. The adjustable proGAV shunt: a prospective safety and reliability multicenter study. Neurosurgery. 2010;66(3):465-74.

[5] Chari A, Czosnyka M, Richards HK, Pickard JD, Czosnyka ZH. Hydrocephalus shunt technology: 20 years of experience from the Cambridge Shunt Evaluation Laboratory. J Neurosurg. 2014;120(3):697-707.

[6] Antes S, Stadie A, Muller S, et al. Intracranial Pressure-Guided Shunt Valve Adjustments with the Miethke Sensor Reservoir. World Neurosurg. 2018;109:e642-e50.

[7] Freimann FB, Schulz M, Haberl H, et al. Feasibility of telemetric ICP-guided valve adjustments for complex shunt therapy. Childs Nerv Syst. 2014;30(4):689-97.

[8] Thompson S, Thorne L, Toma A, et al. Telemetric monitoring of ICP within a shunt system. A single centre experience including the first in vivo comparison versus conventional intraparenchymal monitoring. Fluids and Barriers of the CNS. 2017;14(Suppl 1):A63.

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Hydrocephalus & ICP management