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Miethke DualSwitch Valve in lumboperitoneal shunts

  • Technical Note
  • Published:
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Abstract

Introduction

Despite the existence of wide variety of shunt systems, physiological regulation of intracranial pressure in shunted patients remains a utopian dream. Lumboperitoneal shunts (LPS) have long been used for treating idiopathic intracranial hypertension and other types of “communicating” hydrocephalus. Although they can provide rapid and effective symptom resolution, cerebrospinal fluid (CSF) over-drainage remains a common complication of LPS. We introduce the use of the Miethke DualSwitch Valve (M-DSV) for LPS and describe our preliminary experience with these valves in managing and avoiding CSF over-drainage. This is the first description of the use of M-DSV for LPS.

Materials and methods

Over 6 months, we treated five patients with LPS using M-DSV. Prior to the use of the M-DSV, four patients experienced significant over-drainage symptoms secondary to LPS. Data was collected prospectively, including preoperative details and clinical outcome.

Results

Five patients (age range, 22 to 71 years) were operated upon. Three patients had pseudotumor cerebri, one patient had an LPS for treatment of a posterior fossa pseudomeningocele, and one had an LPS for treatment of cauda equina syndrome secondary to lumbar dural ectasia. Four patients had a history of clinical over-drainage secondary to pre-existing LPS systems. The fifth patient had an LPS revision after the previous LPS migrated. Follow-up ranged from 5 to11 months (mean, 7.8 ± 3 months). All patients had a good outcome with immediate resolution of over-drainage symptoms and are currently asymptomatic.

Conclusions

The use of M-DSV in LPS is an effective alternative for avoiding posture-related over-drainage and managing patients with LPS-related over-drainage symptoms. Further experience is required to address the long-term outcome, balancing sufficient drainage while preventing over-drainage.

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Disclosure

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. None of the authors have received any financial support for the article from any organization.

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Authors and Affiliations

  1. Department of Pediatric Neurosurgery, Dana Children’s Hospital, Tel Aviv University, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv, 64239, Israel

    Suhas Udayakumaran, Jonathan Roth & Shlomi Constantini

  2. Neuro-ophthalmology Unit, Department of Ophthalmology, Tel Aviv University, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv, 64239, Israel

    Anat Kesler

Authors
  1. Suhas Udayakumaran
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  2. Jonathan Roth
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  4. Shlomi Constantini
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Correspondence to Suhas Udayakumaran or Shlomi Constantini.

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Udayakumaran, S., Roth, J., Kesler, A. et al. Miethke DualSwitch Valve in lumboperitoneal shunts. Acta Neurochir 152, 1793–1800 (2010). https://doi.org/10.1007/s00701-010-0724-4

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  • DOI: https://doi.org/10.1007/s00701-010-0724-4

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