The Miethke Dual-Switch Valve in Patients With Normal Pressure Hydrocephalus

Meier, Ullrich; Kiefer, M.; Sprung, Christian

doi:10.1097/00013414-200206000-00004

Cited by 19 publications

(23 citation statements)

References 20 publications

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“…The NPH recovery rate is consistent with the Black grading scale for shunt assessment [24]in terms of the specific clinical symptoms of NPH (table 1). The present authors’ own experience with the NPH recovery rate substantiates the relevance of this scale for clinical practice [16, 20]. During the follow-up examination, a CT imaging study was performed to determine ventricular size, using the Evans index.…”

Section: Methodssupporting

confidence: 71%

“…These positive outcomes are further substantiated by a 50% decrease in the severity of clinical symptoms of NPH, as measured on the Kiefer scale. There is little doubt that the more favorable postoperative clinical improvement (as assessed by our NPH recovery rate) obtained by our three working groups following implantation of the Miethke Dual-Switch valves relative to published results is attributable, on the one hand, to the extensive experience of our teams in the diagnosis and management of patients with NPH [5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 57]and, on the other hand, to the design principle and mechanism of the Miethke Dual-Switch valve, which compensates for the patient’s changes in posture [58]. …”

Section: Discussionmentioning

confidence: 82%

“…(3) The prognosis is positive for early stage NPH patients in whom the intrathecal infusion test shows R out in excess of 15 mm Hg·ml/min or in late stage NPH patients (with cerebral atrophy) with R out >20 mm Hg·ml/min on the intrathecal infusion test. (4) In view of the superior therapeutic outcomes that are obtained with hydrostatic valves, the Miethke Dual-Switch valve should be implanted in patients with NPH [20, 23]. …”

Section: Discussionmentioning

confidence: 99%

“…In the intrathecal infusion test, intracranial pressure (ICP) is measured continuously, while defined changes are made in CSF volume [3, 4]. Our patients were classified as early stage or late stage cases of hydrocephalus in accordance with the results of the intrathecal infusion test [5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22]. While no cerebral atrophy was detected in the patient group with early stage NPH (n = 80), cerebral atrophy was noted in patients with late stage disease (n = 75) – a sign of advanced disease in this group.…”

Section: Methodsmentioning

confidence: 99%

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Predictors of Outcome in Patients with Normal-Pressure Hydrocephalus

2004

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Despite emerging knowledge of over 40 years, the postoperative results after shunt implantations in patients diagnosed for normal-pressure hydrocephalus (NPH) have not improved significantly in the last decade. For this reason, predictors have to be identified in order to preoperatively predict the course of disease. From 1982 to 2000, we examined in a prospective study 200 patients diagnosed for NPH. Of the patients who were surgically treated by a shunt implantation we could re-examine 155 (78%) in a mean time interval of 7 months after operation. The NPH was graduated according to the results of the intrathecal infusion test in an early state NPH (without brain atrophy) and late state NPH (with brain atrophy). In the study we focused our attention on the possible predictors: patient’s age, length of disease, clinical signs – like gait ataxia, dementia and bladder incontinence, etiology idiopathic/secondary as well as implanted valve type and the value of resistance to cerebrospinal fluid outflow. To measure the outcome we used the NPH recovery rate, as statistical test the χ² according to Pearson. In 80 patients with an early stage NPH (without cerebral atrophy) and a short course of disease (<1 year), slightly distinct dementia and an implanted Miethke Dual-Switch valve were significant predictors for a positive postoperative outcome. The outflow resistance measured in the intrathecal infusion test showed only a minimal relevance for the outcome. Those 75 patients with a late state NPH (with cerebral atrophy) had a better outcome when dementia was not present, the outflow resistance was >20 mm Hg·min/ml, the CSF tap test was positive and a Miethke Dual-Switch valve was implanted.

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Section: Methodssupporting

confidence: 71%

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Predictors of Outcome in Patients with Normal-Pressure Hydrocephalus

2004

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“…Bei bestehender Gangataxie, pathologisch erhöh-ten Abflusswiderständen und Besserung der klinischen Symptomatik, insbesondere der Gangataxie, nach der probatorischen Liquorentnahme stellten wir die Indikation zur Shunt-Operation. Bei allen Patienten wurde ein hydrostatisches Ventil (Miethke-Dual-Switch-Ventil) implantiert [14,15].…”

Section: Introductionunclassified

Ist die Rückbildung der Ventrikelgröße nach Shunt-Operation beim Normaldruckhydrozephalus eine Conditio sine qua non?

Meier

Paris

Gräwe

et al. 2002

Klinische Neuroradiologie

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ZusammenfassungHintergrund: Nach Shunt-Implantation von konventionellen Differentialdruckventilen bei Patienten mit Hydrocephalus internus oder mit Normaldruckhydrozephalus ist in der Mehrzahl der Fälle eine postoperative Abnahme der Ventrikelweite zu sehen. Patienten und Methoden: Von September 1997 bis Mai 2001 wurden im Unfallkrankenhaus Berlin 60 Patienten mit einem Normaldruckhydrozephalus durch Implantation eines hydrostatischen Ventils (Miethke-Dual-Switch-Ventil) operativ behandelt. Bei allen Patienten erfolgten in einer prospektiven Studie die klinische und eine CT-Untersuchung präoperativ und 1 Jahr nach der Operation. Dabei wurde die Ventrikelgröße mittels Bestimmung des EvansIndex verifiziert. Ergebnisse: 77% der Patienten weisen nur eine geringe oder gar keine Änderung der Ventrikelgröße nach der Operation auf, wobei in dieser Gruppe 65% einen exzellenten bis guten, 13% einen befriedigenden und 22% einen schlechten Krankheitsverlauf haben. Bei 17% der Patienten wurde eine mäßige Rückbildung der Ventrikelweite 1 Jahr nach der Shunt-Operation sichtbar. In dieser Patientengruppe fanden wir in 40% ein exzellentes bis gutes, in 20% ein zufrieden stellendes und in 40% ein schlechtes Outcome. Bei der Patientengruppe mit deutlicher Reduktion der Ventrikelgröße (6%) sind zu je 50% exzellente bis gute bzw. schlechte Krankheitsverläufe zu eruieren. Schlussfolgerung: Nach Implantation eines hydrostatischen Ventils ist ein guter postoperativer Krankheitsverlauf bei Patienten mit einem Normaldruckhydrozephalus in der Mehrzahl der Fälle nicht mit einer Reduktion der Ventrikelweite 1 Jahr nach der Operation vergesellschaftet. Bei Patienten mit einem Normaldruckhydrozephalus ist nach unseren Erfahrungen die Implantation eines Miethke-Dual-Switch-Ventils zu empfehlen. AbstractBackground: After implantation of conventional differential pressure valves in patients with hydrocephalus internus or with normal pressure hydrocephalus, it is known that the ventricle size decreases postoperatively. Patients and Methods: From September 1997 to May 2001 we had treated 60 patients with normal pressure hydrocephalus with implantation of a hydrostatic valve (Miethke-Dual-Switch-Valve) at the Unfallkrankenhaus Berlin. During a time interval of 1 year after operation the patients were again examined clinically and computertomographically and the Evans index was determined as a measure for the ventricle size. Results: 77% of the patients showed no postoperative change of the ventricle size, although in the same group of patients 65% have excellent and good, 13% a satisfactory and 22% no improvement of the clinical symptoms. In 17% EinleitungUnter Neurochirurgen, Neuroradiologen und Neurologen ist die Frage umstritten, ob eine eindeutige und positive Korrelation zwischen dem Grad der postoperativen Rückbildung der Ventrikelerweiterung und dem klinischen Behandlungsergebnis nach einer Shunt-Operation bei Patienten mit Hydrocephalus internus besteht. Hierbei ist zu berücksichtigen, dass alle diesbezüglichen Studien nach Implantation von ...

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Predictors of outcome in patients with normal-pressure hydrocephalus

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The Miethke Dual-Switch Valve in Patients With Normal Pressure Hydrocephalus

Cited by 19 publications

References 20 publications

Predictors of Outcome in Patients with Normal-Pressure Hydrocephalus

Predictors of Outcome in Patients with Normal-Pressure Hydrocephalus

Ist die Rückbildung der Ventrikelgröße nach Shunt-Operation beim Normaldruckhydrozephalus eine Conditio sine qua non?

Predictors of outcome in patients with normal-pressure hydrocephalus

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