Considerations in the Use of Gravitational Valves in the Management of Hydrocephalus. Some Lessons Learned with the Dual-Switch Valve
Poca Pastor, María Antonia (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Gándara, Dario F. (Hospital Universitari Vall d'Hebron)
Rosas, Katiuska (Hospital Universitari Vall d'Hebron)
Alcina, Aloma (Hospital Universitari Vall d'Hebron)
López-Bermeo, Diego (Hospital Universitari Vall d'Hebron)
Sahuquillo Barris, Juan (Universitat Autònoma de Barcelona. Departament de Cirurgia)

Fecha:	2021
Resumen:	In the past decade, there has been a clear trend towards better outcomes in patients with hydrocephalus, especially those with normal pressure hydrocephalus (NPH). This is partly due to the availability of more sophisticated hardware and a better understanding of implants. However, there is little evidence to show the superiority of a specific type of valve over another. The most commonly reported consequence of hydrodynamic mismatch is shunt over-drainage. Simple differential pressure valves, with a fixed opening pressure or even adjustable valves, lead to non-physiologic intraventricular pressure (IVP) as soon as the patient moves into an upright posture. These valves fail to maintain IVP within physiological limits due to the changes in hydrostatic pressure in the drainage system. To solve this problem more complex third-generation hydrostatic valves have been designed. These gravitational devices aim to reduce flow through a shunt system when the patient is upright but there are important technical differences between them. Here we review the main characteristics of the Miethke ® Dual-Switch valve, which includes two valve chambers arranged in parallel: a low-opening pressure valve, designed for working in the supine position, and a second high-opening pressure valve, which starts working when the patient assumes the upright position. This paper specifies the main advantages and drawbacks of this device and provide a series of recommendations for its use. The discussion of this specific gravitational valve allows us to emphasize the importance of using gravitational control in implanted shunts and some the caveats neurosurgeons should take into consideration when using gravitational devices in patients with hydrocephalus. The correct function of any gravitational device depends on adequate device implantation along the vertical body axis. Misalignment from the vertical axis equal to or more than 45° might eliminate the beneficial effect of these devices.
Ayudas:	Instituto de Salud Carlos III PI18/00468
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Complications ; Dual-Switch valve ; Gravitational valves ; Hydrocephalus ; Hydrostatic valves ; Shunt dysfunction
Publicado en:	Journal of clinical medicine, Vol. 10 (january 2021) , ISSN 2077-0383

DOI: 10.3390/jcm10020246
PMID: 33445418

14 p, 1.9 MB

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