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| PATIENT MANUAL
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THE COMPANY
Christoph Miethke GmbH & Co. KG is a company
based in Berlin-Brandenburg region that develops,
manufactures and markets innovative neurosurgi-
cal implants for the treatment of hydrocephalus. In
the course of our work we established successful
partnerships with numerous hospitals worldwide.
The purpose of this booklet is to provide you and
your family with some understanding of the treat-
ment of hydrocephalus. The successful treatment
of this condition has only been possible since the
1950s. In a dramatic race against time to save the
life of his son, Casey, who suffered from hydroce-
phalus, a technician named John D. Holter deve-
loped, in only a few weeks, a novel silicone valve.
Despite the fact that, since its first implantation in
March 1956, this valve has proven to be clinically
effective and a giant step in the treatment of this
condition, there are many patients today who ex-
perience considerable problems with hydrocepha-
lus valve systems.
Christoph Miethke utilised the knowledge gained in
50 years of valve treatment and developed a new
generation of highprecision valves made of the me-
tal titanium. For the first time, there are valve sys-
tems available that consistently take into account
the physical conditions of brain fluid drainage and
can thus maintain a physiological brain pressure,
independent of the body position of the patient.
Fig. 1: Anatomic sketch of the cranium
(see inner cover page)
1) skull
2) brain
3) cerebrospinal fluid
4) lateral ventricle
5) third ventricle
6) fourth ventricle
BASIC ANATOMY
The human brain (fig. 1) is surrounded by a spe-
cial substance known as cerebrospinal fluid (CSF).
Cerebrospinal fluid is produced in several cham-
bers, so-called ventricles, that are found within
the brain. The channels, by which the ventricles
are interconnected, constitute a complex draina-
ge system. The fluid in the brain circulates through
these ventricles and eventually flows into the ve-
nous blood. The function of this fluid is to protect
the brain from mechanical damage. The CSF also
regulates the internal brain pressure (intracranial
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pressure, ICP), keeps the brain tissue moist and
transports the products of metabolism.
CLINICAL PICTURE OF THE CONDITION
In healthy people, a balance exists between the
production and resorption of cerebrospinal fluid.
In infants, approx. 100 ml of this fluid is produced
every day; in small children, the daily production is
approx. 250 ml, in grown-ups approx. 500 ml. If
the amount of fluid produced exceeds the amount
resorbed, the ventricles expand, leading to the
condition known as hydrocephalus (fig. 2). The
term hydrocephalus refers to the continuous incre-
ase of the volume of "water" (hydro) in the "head"
(cephalus). This condition is often observed at birth
(congenital hydrocephalus), but it can also deve-
lop later in life, e.g., as the result of inflammation,
hemorrhage or severe head injury, or after brain
surgery. Such cases are referred to as acquired
hydrocephalus.
a)
b)
Fig. 2: Ventricle size
a) normal, b) hydrocephalus
A further distinction is made between obstructive
hydrocephalus and communicating hydrocepha-
lus. In obstructive hydrocephalus, the links bet-
ween the ventricles of the brain are interrupted
so that the ventricles cannot "communicate" with
each other. Cases in which the ventricles are in-
terlinked through open channels, but resorption of
cerebrospinal fluid is impaired, are diagnosed as
communicating hydrocephalus.
CLINICAL SYMPTOMS OF THE CONDITION
In infants, the cranial bones have not yet grown
together solidly. The increasing volume of cerebro-
spinal fluid causes the head to increase in circum-
ference while, at the same time, brain tissue disin-
tegrates. From the age of about 2, the hardened
skull prevents any growth of the head's circum-
ference. In this case, the increase in fluid volume
leads to a massive pressure increase, resulting in
the expansion of the brain ventricles and the com-
pression of the brain itself. The consequence for
infants and adults can be irreversible brain dama-
ge. Symptoms (depending on the severity of the
disorder) include nausea, headache, vomiting, im-
paired coordination, drowsiness and, in the end,
unconsciousness.
DIAGNOSIS OF THE CONDITION
Doctors have a variety of methods at their dispo-
sal to diagnose hydrocephalus. The ventricle size
is measured through imaging procedures (e.g.
computerized tomography, ultrasound or NMR-
tomography).
Computerized tomography (CT)
This quick and painless diagnostic procedure pro-
duces X-ray images of different layers of the head.
Nuclear Magnetic Resonance (NMR) tomography
This painless electromagnetic imaging process
produces images of very fine layers of the head.
It is also known as NMR, MRT, or MRI scanning.
Ultrasound
This procedure, in which the interior of the head is
examined through the open fontanel, can only be
applied to small children.
Another way of diagnosing hydrocephalus is
through pressure measurements showing an incre-
ased brain pressure. The circulation of cerebrospi-
nal fluid is investigated through examinations with
contrast agents.
METHODS OF TREATMENT
For all the efforts to find therapeutic alternatives to
valve implantation (e. g. through pharmaceutical
treatment or, most recently, by minimally invasive
surgery), there is currently no alternative, in most
cases, to the implantation of a drainage system,
referred to as a shunt.
PATIENT MANUAL |
1 right atrium
2 heart catheter (atrial catheter)
3 valve
4 reservoir
5 ventricular catheter
6 ventricles
7 abdominal catheter (peritoneal catheter)
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5
6
3
2
1
a)
b)
Fig. 3: Drainage systems for hydrocephalus patients
a) ventriculo-atrial, b) ventriculo-peritoneal
THERAPY COMPLICATIONS
In certain instances, complications can result from
the treatment of hydrocephalus with a shunt sys-
tem. As with any surgical procedure, an infection
can develop. Unfortunately, problems can also ari-
se that are either directly or indirectly linked with
the implanted valve system. These complications
include blockage of the drainage system, an una-
voidable adaptation of the system to the growth of
the child, and an unintended increase in drainage
of cerebrospinal fluid. In order to help you under-
stand why your physician decided to use proSA,
the basic physical principles underlying a typical
drainage system are explained in the section en-
titled „Physics background".
AFTER THE OPERATION
As a rule, the everyday activities of patients with
shunt implants are not restricted. However, pa-
tients should abstain from major physical exer-
tion (e. g. hard physical work, strenuous sports).
Hydrocephalus patients who experience hea-
dache, dizziness, unnatural gait or similar sym-
ptoms should consult a physician without delay.
Apart from that, we recommend medical check-
ups at regular intervals.
GB
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