Miethke DualSwitch Valve in lumboperitoneal shunts

Abstract

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. 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. 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 to 11 months (mean, 7.8 ± 3 months). All patients had a good outcome with immediate resolution of over-drainage symptoms and are currently asymptomatic. 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.