Possible Shunt Components; Tube Systems; Implantation - MIETHKE proGAV 2.0 Mode D'emploi

| INSTRUCTIONS FOR USE
GB

POSSIBLE SHUNT COMPONENTS

The proGAV 2.0 can be ordered as a shunt sys-
tem in a range of configurations. The configura-
tions can be combined with the accessories pre-
sented in brief below. In each case, versions for
paediatric hydrocephalus and for normal pressu-
re hydrocephalus (NPH) in adults are available.
Reservoirs
The use of a reservoir in combination with shunt
systems provides options for the withdrawal of
cerebrospinal fluid, administration of drugs and
pressure control.
Due to the non-return
SPRUNG RESERVOIR and the CONTROL
RESERVOIR, cerebrospinal fluid can be pum-
ped towards the valve, thus making it possible
to check the distal part of the drainage system
as well as (proximal) ventricular catheter. Duri-
ng the pump action, access to the ventricular
catheter is closed. The use of reservoirs does
not increase the opening pressure of the shunt
system. A puncture should be performed as
perpendicular as possible to the reservoir
surface with a maximum cannula diameter of
0.9 mm. 30 punctures are possible without any
restrictions.
Warning notice: Frequent pumping can re-
sult in excessive drainage and thus lead
to pressure conditions outside the normal
physiological range. The patient should be
properly informed about this risk.
Burrhole deflector
Because of the tight fit on the ventricular cathe-
ter, the burrhole deflector makes it possible to
choose the length of catheter penetrating into
the skull prior to implantation. The ventricular ca-
theter is deflected at a right angle in the burrhole
(see chapter "Implantation").

TUBE SYSTEMS

The proGAV 2.0 can be ordered as an individual
valve unit or as a shunt system with integrated
catheters (interior diameter 1.2 mm, exterior
diameter 2.5 mm). The supplied catheters do
not fundamentally change the pressure-flow
characteristics. If catheters by other manufac-
turers are used, a tight fit must be ensured. In
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any case, catheters have to be carefully fixed
with a ligature to the valve's titanium connec-
tors.

IMPLANTATION

Positioning the ventricular catheter
Several surgical techniques are available for po-
sitioning the ventricular catheter. The required
skin incision should be made in form of a lobule
pedicled towards the draining catheter. If a burr-
hole deflector is used, the skin incision should
not be located right above the reservoir. To avoid
CSF leakage, care should be taken that the dura
valve of the opening is kept as small as possible after app-
lying the burrhole.
The proGAV 2.0 is available in a range of different
configurations: If a burrhole reservoir is used, the
ventricular catheter is implanted first. Once the
introducing stylet has been removed, the paten-
cy of the ventricular catheter can be tested by
checking if cerebrospinal fluid is dripping out.
The catheter is shortened and connected the
burrhole reservoir connected, with the connec-
tion secured with a ligature. A shunt system with
prechamber comes with a burrhole deflector.
The deflector is used for adjusting the length of
catheter to be implanted and for its positioning
inside the ventricle. The ventricular catheter is
deflected and the prechamber is put into place.
The position of the ventricular catheter should be
checked after implantation by imaging (such as
CT or MRI).
Positioning the valve
The proGAV 2.0 operates depending on its po-
sition. You must therefore ensure that the gra-
vitational unit is implanted parallel to the body
axis. Therefore, if a Shunt System in which the
valve has been pre-fitted with a burrhole reser-
voir, only the occipital access should be used.
A location behind the ear is suitable as an im-
plantation position, whereby the implantation
height has no influence on the valve function.
The adjustable differential pressure unit should
be contacting the bone or the periosteum since
pressure must be exerted on the valve during
any later adjustment. A large arch-shaped or a
smaller straight skin incision should be made,
which is then provided with two pockets (proxi-
mal from the incision for the adjustable differen-
tial pressure unit and distal from the incision for
proGAV 2.0