Gravitational Shunt Valve Offers Flexible Treatment Options

An adjustable gravitational shunt valve allows surgeons to provide a range of treatment options for hydrocephalus patients.

The Miethke proSA gravitational valve provides resistance to cerebral spinal fluid (CSF) flow in the upright position. Implanted in combination with fixed or adjustable valves, the proSA allows surgeons to provide patients with distinctly different pressure settings for the lying and the upright positions, thereby reducing the symptoms that are experienced when the intracranial pressure (ICP) is too low, or conversely, too high. By allowing the upright pressure to be managed independently from the lying pressure, the need to find a setting between optimal lying and standing pressures is eliminated, reducing patient symptoms and allowing them to lead as close to a symptom-free life as possible.


The wide adjustability range (from 0–40 cmH2O) enables surgeons to manage the needs of a wide selection of patient types or patient needs, such as height or weight changes. Resistance can be reduced to zero if a gravitational valve is not needed, or increased if more resistance is required. The maximum setting of 40 cmH2O, when combined with a fixed or adjustable valve, gives surgeons the highest opening pressure available for the upright positions. An integrated Active-Lock magnetic-resonance (MR) brake helps prevent the valve from inadvertent pressure adjustments in 1.5 T and 3 T MRI scanners, and the need for readjustments after an MRI. The Miethke proSA gravitational valve is a product of Christoph Miethke (Potsdam, Germany).

“More important than anything is the need for us to understand our customer’s situation and the situation of the patient,” said Christoph Miethke, president and head of research & development at Christoph Miethke. “proSA is a solution to the difficult situations faced by both the surgeon and the patient.”

Effectively maintaining a patient’s CSF drainage to keep ICP within normal physiological ranges is a challenging aspect of managing a Hydrocephalus patient’s condition since CSF tends to drain faster when a patient is standing. This causes a decrease in ICP, which results in headaches, nausea, and other debilitating symptoms. This necessitates the need for higher valve resistance in upright positions, and the taller the patient, the higher the necessary resistance.

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