gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

Overdrainage – a solved problem in hydrocephalus shunting? Experience with the Miethke shunt assistant

Überdrainage – ein gelöstes Problem? Erfahrungen mit dem Miethke-Shuntassistenten

Meeting Abstract

Search Medline for

  • corresponding author U. Kehler - Abteilung für Neurochirurgie, Allgemeines Krankenhaus Hamburg-Altona
  • N. Langer - Abteilung für Neurochirurgie, Allgemeines Krankenhaus Hamburg-Altona

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocFR.04.05

The electronic version of this article is the complete one and can be found online at:

Published: May 8, 2006

© 2006 Kehler et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Ventriculoperitoneal shunting for hydrocephalus using differential pressure valves is complicated by overdrainage in 10 to 20%. Gravitational driven shunt-assistants (Miethke shunt-assistant) compensate the hydrostatic pressure difference in the up-right position and might reduce problems of overdrainage. The clinical effect of shunt-assistants in cases of overdrainage is analyzed in a retrospective study.

Methods: Patients: Since Oct. 2001 we have implanted 22 shunt-assistants (SA) (14 females, 8 males, ages 10 to 78 years). SAs were used with an adjustment of 15, 20, and 25cm H2O for the vertical position. The medium follow-up was 9.1 months (range: 1 to 30,5 months).

Results: The mean implantation time was 21 minutes (range: 15 to 100). Clinical symptoms improved in 15 cases, in 3 case the symptoms did not change. In 4 cases revision of the valve and SA was necessary due to dysfunction (1 overdrainage and 3 underdrainages). The site of underdrainage remained unclear in all cases. In 2 cases of initial improvement, the shunts had to be revised due to infection.

Conclusions: Shunt-assistants are very effective in the treatment of overdrainage. The selection of pressure compensation of the SA (depending on body height and intraperitoneal pressure) is difficult, but even if it is chosen too low, symptoms of overdrainage will be more attenuated than in VP-shunting without SAs. The development of an adjustable SA should overcome these problems especially when parameters may change as in growing children, pregnant women, and pathologies accompanied by intraperitoneal pressure changes such as weight gain or loss.