Miethke DualSwitch Valve in lumboperitoneal shunts

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.