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PATIENT HANDBOOK

GB

THE COMPANY

Christoph Miethke GmbH & Co. KG is a Branden-
burg-based company that develops, manufactures 
and markets innovative neurosurgical implants for 
the treatment of hydrocephalus. In this, we work 
in 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 picked up the knowledge gained 
in 50 years of valve treatment and developed a 
new generation of highprecision valves made of 
the metal titanium. For the first time, there are valve  
systems available that consistently take into ac-
count the physical conditions of brain fluid drai-
nage and can thus maintain a physiological brain 
pressure, independent of the body position of the 
patient.

Fig. 1: Anatomic sketch of the cranium (inner cover page)
1) skull pan
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 fluid known as cerebrospinal fluid (CSF). Ce-
rebrospinal fluid is produced in several chambers, 
so-called ventricles, that are found within the brain. 
The channels, by which the ventricles are intercon-
nected, constitute a complex drainage system. 
The fluid in the brain circulates through these 
ventricles and eventually flows into the venous 

blood. The function of this fluid is to protect the 
brain from mechanical damage. The CSF also 
regulates the internal brain pressure (intracranial 
pressure, ICP), keeps the brain tissue moist and 
transports the products of metabolism.

CLINICAL PICTURE OF THE CONDITION

In healthy humans, 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 adults approx. 500 ml. If the 
amount of fluid produced exceeds the amount re-
sorbed, the ventricles expand, leading to the con-
dition known as hydrocephalus (fig. 2). The term 
hydrocephalus refers to the continuous increase 
of the volume of “water” (hydro) in the “head” (ce-
phalus). 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 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.

a)  

  

 b) 

Fig. 2: Ventricle size
a) normal, b) hydrocephalus

Содержание GAV

Страница 1: ...s this device to sale by or on order of a physician USA CHRISTOPH MIETHKE GMBH CO KG 0297 Patientenhandbuch Patient Handbook Manuel du patient Manual para el paciente Manuale per il paziente D F E I G...

Страница 2: ......

Страница 3: ...Abb 1 Fig 1 Abb 9 Fig 9 1 2 3 4 5 6 1 2 3 4 a b...

Страница 4: ......

Страница 5: ...sser Liquor umgeben Im Inneren des Kopfes befinden sich mehrere Hirnkammern so genannte Ventrikel in denen das Hirnwasser produziert wird Die Ventrikel sind durch Kan le untereinander ver bunden und s...

Страница 6: ...ezeichnet Ultraschall Nur bei kleinen Kindern kann bei diesem Verfahren durch die offene Fontanelle das Kopfinnere unter sucht werden Durch Druckmessungen kann eine Erh hung des Hirndrucks festgestell...

Страница 7: ...t der Hirn innendruck unabh ngig von der K rperlage er h ht die Hirnkammern sind erweitert Abb 5 Abb 5a Hirnkammerdruck beim kranken Menschen in liegender Position 1 Hirnkammerbeh lter 2 Erweiterte Hi...

Страница 8: ...system eingesetzt bewirkt dies eine Erh hung des Wasserspiegels im Hirnkammerbeh lter um den ffnungsdruck des Ventils Jetzt wirken die Hirn kammerbeh lter und die Bauchh hlenbeh lter erst dann zusamm...

Страница 9: ...ch der Oberk rper des Patienten ist desto gr er ist der ffnungsdruck des GAV Das ist notwendig da sich der H henunterschied zwischen Hirnkam mern und Bauchh hle vergr ert siehe physika lische Grundlag...

Страница 10: ...mark Fl ssigkeit oder Hirnwasser Liquorbestandteile Hirnwasserbestandteile Lumbalpunktion Punktion des R ckenmarkskanals am unteren Teil der Wirbels ule Lumbo peritoneale Ableitung Ableitung des Hirnw...

Страница 11: ...11 PATIENTENHANDBUCH D NACHUNTERSUCHUNGEN Eine Nachuntersuchung ist in jedem Fall erforderlich Datum Behandlung Notizen und Anmerkungen...

Страница 12: ...erebrospinal fluid CSF Ce rebrospinal fluid is produced in several chambers so called ventricles that are found within the brain The channels by which the ventricles are intercon nected constitute a c...

Страница 13: ...I scanning Ultrasound This procedure in which the interior of the head is examines through the open fontanel can only be applied to small children Another way of diagnosing hydrocephalus is through pr...

Страница 14: ...ocephalus drainage The ventricle pressure and the pressure in the ab dominal cavity are represented by water levels In a healthy human the ventricular pressure water level in the ventricle container i...

Страница 15: ...l both water levels are at the same height This means however that the ventricle container is emptied completely Since the ventricles do not have rigid walls this emptying leads to a contraction of th...

Страница 16: ...tional overdrainage of cerebrospinal fluid fig 8 x opening pressure in horizontal position 1 ventricle container 2 ventricles 3 drainage tube 4 abdominal cavity 5 abdominal container 6 GAV Fig 8 Ventr...

Страница 17: ...external pressure on the functioning of the valve to a negligible minimum Hence a high level of functional reliability and a long service life are guaranteed Fig 10 GAV scale 1 1 27 4 mm 4 6 mm Warni...

Страница 18: ...on of the lumbar vertebrae in the abdominal cavity Meninges Membrane found in the brain and spine Meningitis Inflammation of the meninx Minimally invasive Minimally infiltrating Overdrainage Undesirab...

Страница 19: ...19 PATIENT HANDBOOK GB FOLLOW UP EXAMINATIONS A follow up examination must be carried out in all cases Date Treatment Notes and comments...

Страница 20: ...S DE BASE Le cerveau humain fig 1 baigne dans un liquide biologique particulier appel le liquide c phalo rachidien LCR L int rieur du cr ne comprend plusieurs cavit s c r brales appel es ventricules d...

Страница 21: ...ue sur les tout petits enfants pour examiner l int rieur de la t te par la fontanelle ouverte Enfin des mesures de pression permettent de constater une hausse de la pression intracr ni enne Les produi...

Страница 22: ...de 0 fig 4 En cas d hydroc phalie la pression intraventricu laire est accrue ind pendamment de la position du corps le niveau hydrostatique du r cipient ventri culaire est bien sup rieur 0 Les ventric...

Страница 23: ...tube jusqu ce que les deux niveaux hydrostatiques soient quilibr s Mais dans ce cas le r cipient ventricu laire est enti rement vid Les ventricules n tant pas rigides cet coulement entra ne la contrac...

Страница 24: ...ne orient e sur les valeurs en pr sence chez l homme sain Une valve ressort commande la pression intracr nienne lorsque le patient est couch D s que le patient se rel ve une lourde bille en tantale es...

Страница 25: ...nt en arachno de et pie m re Liquide c phalorachidien LCR Liquide contenu dans le cerveau et la moelle pini re M ningite Inflammation des m ninges Moelle pini re Partie du syst me nerveux central enfe...

Страница 26: ...26 MANUEL DU PATIENT F EXAMENS DE CONTR LE Un examen de contr le est n cessaire dans tous les cas Date Traitement Notes et remarques...

Страница 27: ...aje El l quido circula a trav s de estos ventr culos y desemboca final mente en el sistema venoso La tarea del l quido cefalorraqu deo consiste en proteger al cerebro de da os mec nicos Adem s regula...

Страница 28: ...minar un aumento de la presi n cerebral Los an lisis con medios de contraste sirven para analizar la circula ci n del l quido cefalorraqu deo TRATAMIENTO A pesar del esfuerzo realizado para encontrar...

Страница 29: ...en el recipiente ventri cular es bastante mayor de 0 Los ventr culos est n aumentados fig 5 Ahora es imprescindible reducir la presi n intra craneal independientemente de la posici n corpo ral y resta...

Страница 30: ...os Una consecuencia de esto puede ser el mencionado cierre del sistema de drenaje El l quido cefalorraqu deo es succionado y el ce rebro se deforma Pero si el cerebro se contrae puede producirse como...

Страница 31: ...rporaci n del paciente activa una pesada bola de t ntalo que provoca un aumento de la presi n de apertura de la v lvula ayudada por la fuerza de gravedad Cuanto m s vertical se encuentra la parte supe...

Страница 32: ...rganismo Leptomeninge Meninge blanda formada por la aracnoides y la piamadre L quido cefalorraqu deo L quido contenido en los ventr culos cerebrales y el conducto medular M dula espinal Porci n intrar...

Страница 33: ...33 MANUAL PARA EL PACIENTE E EX MENES POSTERIORES En todos los casos se requiere un examen posterior Fecha Tratamiento Notas y observaciones...

Страница 34: ...tema di deflusso estre mamente complesso Il liquor circola attraverso le camere cerebrali ed infine escreto nel circolo venoso La funzione del liquor quella di proteg gere il cervello da ogni danno me...

Страница 35: ...si possono utilizzare indagini con mezzi di contrasto METODI DI TRATTAMENTO Nonostante tutti gli sforzi fatti per trovare terapie alternative all impianto di una valvola come ad es trattamenti farmac...

Страница 36: ...o delle camere cerebrali 2 Camere cerebrali dilatate Fig 5a Pressione nelle camere cerebrali dei pazienti affetti da idrocefalo in posizione stesa 0 1 2 0 1 Fig 5b Pressione nelle camere cerebrali dei...

Страница 37: ...si nella posizione corporea stesa La pressione di apertura della valvola che conce pita per la posizione stesa tuttavia notevolmente inferiore al predetto dislivello tra camere cerebrali e cavit addom...

Страница 38: ...busto del paziente verticale tanto maggiore la pressione d apertura della GAV Ci necessario in quanto aumenta la differenza d altezza tra le camere ce rebrali e la cavit addominale vedere la sezione F...

Страница 39: ...ivide in aracnoide e pia madre Liquor fluido cerebro spinale Fluido presente nell encefalo e nel midollo spinale Meningi Membrane che rivestono l en cefalo ed il midollo spinale Meningite Infiammazion...

Страница 40: ...40 MANUALE PER IL PAZIENTE I SUCCESSIVI CONTROLLI Successivi controlli sono assolutamente necessari in tutti i casi Data Trattamento Appunti ed annotazioni...

Страница 41: ......

Страница 42: ...Technical alterations reserved Sous r serve de modifications techniques Sujeto a modificationes t cnicas Con riserva di modifiche tecniche Manufacturer acc MDD 93 42 EEC CHRISTOPH MIETHKE GMBH CO KG...

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