WE UNDERSTAND. NEUROSURGERY. progav 2.0 IN TOUCH WITH YOU
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1 WE UNDERSTAND. NEUROSURGERY progav 2.0 IN TOUCH WITH YOU
2 2
3 ADJUSTABLE VALVES HAVE EXISTED FOR DECADES. THE ADJUSTMENT AND TESTING OF THE VALVE SETTING IS STILL A CHALLENGE FOR THOSE INVOLVED (1). Valve adjustments are performed postoperatively in 45 % of the cases. In % of the cases further pressure adjustments will follow during later treatment (1, 2). Every valve adjustment is a challenge, both for the patient and the treating hospital staff. Diagnosis and adjustments are often only possible after a radiological examination, which is both time-consuming and costly. In addition to the journey to the clinic, the patient has to wait for treatment, often also accept radiation exposure (1). This makes it all the more important that valve adjustments are user-friendly and convenient. (1) Bailey NO, Luciano M, Ward MV, Lilienfeld S, Anderson WN, Black P. A Nonradiographic System for Assessing Pressure for the Codman- Hakim Programmable Valve. Neurosurgery Sep;67(3 Suppl Operative):ons96-100; discussion ons (2) Sprung C, Schlosser HG, Lemcke J, Meier U, Messing-Jünger M, Trost HA, Weber F, Schul C, Rohde V, Ludwig HC, Höpfner J, Sepehrnia A, Mirzayan MJ, Krauss JK. The adjustable progav shunt: a prospective safety and reliability multicenter study. Neurosurgery Mar;66(3):
4 VALVE AND SOFT TOUCH TOOLS USER-FRIENDLY ADJUSTMENT & VERIFICATION With the help of the unique Soft Touch instruments, the progav 2.0 offers a high level of patient comfort with its tactile feedback. Pressing the valve surface lightly with your finger releases the Active-Lock mechanism and simultaneously sends a tactile feedback. MRI 3 TESLA CONDITIONAL The Active-Lock mechanism of the progav 2.0 prevents unintended valve adjustments by external magnetic fields up to 3 Tesla (3-5). Strainful follow-up examinations can thus be reduced for the patient. 4
5 (3) Allin DM, Czosnyka ZH, Czosnyka M, Richards HK, Pickard JD. In vitro hydrodynamic properties of the Miethke progav hydrocephalus shunt. Cerebrospinal Fluid Res Jun;3:9. (4) Miyake H. Shunt Devices for the Treatment of Adult Hydrocephalus: Recent Progress and Characteristics. Neurol Med Chir (Tokyo) May 15;56(5): GRAVITATIONAL TECHNOLOGY Miethke gravitational valves offer a high protection against overdrainage complications in hydrocephalus therapy (6-8). (5) Chari A, Czosnyka M, Richards HK, Pickard JD, Czosnyka ZH. Hydrocephalus shunt technology: 20 years of experience from the Cambridge Shunt Evaluation Laboratory. J Neurosurg Mar;120(3): (6) Lemcke J, Meier U, Müller C, Fritsch MJ, Kehler U, Langer N, Kiefer M, Eymann R, Schuhmann MU, Speil A, Weber F, Remenez V, Rohde V, Ludwig HC, Stengel D. Safety and efficacy of gravitational shunt valves in patients with idiopathic normal pressure hydrocephalus: a pragmatic, randomised, open label, multicentre trial (SVASONA). J Neurol Neurosurg Psychiatry Aug;84(8): (7) Freimann FB, Vajkoczy P, Sprung C. Patients benefit from low-pressure settings enabled by gravitational valves in normal pressure hydrocephalus. Clin Neurol Neurosurg Oct;115(10): (8) Suchorska B, Kunz M, Schniepp R, Jahn K, Goetz C, Tonn JC, Peraud A. Optimized surgical treatment for normal pressure hydrocephalus: comparison between gravitational and differential pressure valves. Acta Neurochir (Wien) Apr;157(4):
6 FUNCTIONALITY OF THE VALVE ADJUSTABLE UNIT GRAVITATIONAL UNIT 6
7 The progav 2.0 is a posture-dependent valve, meaning the opening pressure changes gradually to correspond with the patients body position. progav 2.0 allows for complete customization of the patient s needs a specific opening pressure when the patient is lying down and an opening pressure for when the patient is upright. The adjustment unit is adjustable in 1 cmh 2 O steps between 0 and 20 cmh 2 O. The gravitational unit is offered in different pressure levels. The functionality of progav 2.0 in different body positions is illustrated interactively in the Miethke App. 7
8 FUNCTIONALITY OF VALVE AND BODY POSITION Valve opening pressure (cmh 2 O) ** * 0 Body position INACTIVE 8
9 SUPINE POSITION When the patient is in the supine position, only the adjustable unit is active and preset to 5 cmh 2 O*. The gravitational unit is not active in this body position. UPRIGHT POSITION In the upright position, the gravitational and adjustable unit work together. As the patient sits up, the tantalum ball (presented in green) is activated within the gravitational unit and due to its gravitational forces causes an increase in the valve opening pressure. In the example shown, a gravitational unit with 25 cmh 2 O has been selected. The total opening pressure therefore amounts to 30 cmh 2 O** when standing. ACTIVE 9
10 SOFT TOUCH INSTRUMENTS FOR VALVE ADJUSTMENT Fig. 1 Fig. 2 LOCALIZATION AND SETTING IDENTIFICATION The progav 2.0 Compass is used to localize the adjustable unit and identify current setting of the valve. The Compass should be aligned over the valve with the aid of the integrated template Compass lid is open. After the adjustable unit has been localized with the finger, the progav 2.0 Compass is applied over the valve in the direction of flow (Fig. 1) The closed Compass indicates the opening pressure setting (Fig. 2). 10
11 Fig. 3 ADJUSTING THE VALVE The progav 2.0 Adjustment Tool allows for an opening pressure of the adjustable unit to be set from 0 to 20 cmh 2 O. The progav 2.0 Adjustment Tool should be positioned so that the desired opening pressure is reflected in the direction of the valve inlet connector. The progav 2.0 Adjustment Tool should be centered over the valve. By pressing lightly with the finger on the adjustable unit, the mechanical Active-Lock mechaniscm is deactivated and the opening pressure is set. Releasing the finger pressure automatically locks the valve (Fig. 3). 11
12 PRESSURE RECOMMENDATION Patient Selection of pressure levels Combined opening pressure Adjustable differential pressure unit (SHUNTASSISTANT 2.0) Newborn and children up to 5 years Children from 5 years Adults < 1.60 m > 1.80 m Adults from 65 years < 1.60 m > 1.80 m All pressure levels shown here are in cmh 2 O. This is a non-binding recommendation. The physician decides in each case individually. OPENING PRESSURE RECOMMENDATION The choice of the appropriate pressure level of progav 2.0 depends on several other factors, including age, degree of activity, size and stature of the patient. The values given apply to mobile patients. For patients with little mobility or a high BMI, the gravitational unit should be chosen lower than recommended here. 12
13 WITH SA 2.0 Combination of adjustable unit with gravitational unit 17 mm 12 mm * Recommendations should only be used as guideline as other settings may also be necessary depending on the patient and anatomy. Connector: d o = 1.9 mm : d o = 4.5 mm : d o = 4.2 mm FX642T Children up to 5 years old and adults over 65* FX643T Individuals between 5 and 65 years old* (5 cmh 2O presetting) 0-20 cmh 2 O 20 cmh 2 O 0-20 cmh 2 O 25 cmh 2 O OPTIONAL CONFIGURATIONS (5 cmh 2 O presetting) FX410T 0-20 cmh 2 O without FX640T 0-20 cmh 2 O 10 cmh 2 O FX641T 0-20 cmh 2 O 15 cmh 2 O FX644T 0-20 cmh 2 O 30 cmh 2 O FX645T 0-20 cmh 2 O 35 cmh 2 O 13
14 WITH SA 2.0 AND DISTAL CATHETER Combination of adjustable unit and gravitational unit with an integrated distal catheter (1200 mm) 17 mm 12 mm 1200 mm * Recommendations should only be used as guideline as other settings may also be necessary depending on the patient and anatomy. Connector: d o = 1.9 mm : d o = 4.5 mm : d o = 4.2 mm Catheter: d i = 1.2 mm, d o = 2.5 mm FX648T Children up to 5 years old and adults over 65* FX649T Individuals between 5 and 65 years old* (5 cmh 2O presetting) 0-20 cmh 2 O 20 cmh 2 O 0-20 cmh 2 O 25 cmh 2 O OPTIONAL CONFIGURATIONS (5 cmh 2 O presetting) FX417T 0-20 cmh 2 O without FX646T 0-20 cmh 2 O 10 cmh 2 O FX647T 0-20 cmh 2 O 15 cmh 2 O FX650T 0-20 cmh 2 O 30 cmh 2 O FX651T 0-20 cmh 2 O 35 cmh 2 O 14
15 SHUNT SYSTEM WITH SA 2.0 AND PEDIATRIC SPRUNG RESERVOIR Combination of adjustable unit and gravitational unit with an integrated distal catheter (1200 mm) Pediatric SPRUNG RESERVOIR** with an integrated distal catheter (200 mm) Ventricular catheter with introducing stylet (180 mm) 17 mm 12 mm 1200 mm * Recommendations should only be used as guideline as other settings may also be necessary depending on the patient and anatomy. 14 mm 200 mm ** An additional valve in the base of the pediatric SPRUNG RESERVOIR makes it possible to flush the fluid only in the distal direction. This feature allows for controlling the patency of the ventricular catheter and the distal drainage. 180 mm Connector: d o = 1.9 mm : d o = 4.5 mm : d o = 4.2 mm Catheter: d i = 1.2 mm, d o = 2.5 mm FX583T Children up to 5 years old and adults over 65* FX584T Individuals between 5 and 65 years old* (5 cmh 2O presetting) 0-20 cmh 2 O 20 cmh 2 O 0-20 cmh 2 O 25 cmh 2 O OPTIONAL CONFIGURATIONS pediatric SPRUNG RESERVOIR** (5 cmh 2 O presetting) FX580T 0-20 cmh 2 O without FX581T 0-20 cmh 2 O 10 cmh 2 O FX582T 0-20 cmh 2 O 15 cmh 2 O FX585T 0-20 cmh 2 O 30 cmh 2 O FX586T 0-20 cmh 2 O 35 cmh 2 O 15
16 SHUNT SYSTEM WITH SA 2.0 AND PEDIATRIC SPRUNG RESERVOIR Combination of adjustable unit with gravitational unit, pediatric SPRUNG RESERVOIR** with an integrated distal catheter (1200 mm) Ventricular catheter with introducing stylet (180 mm) 14 mm 17 mm 12 mm 1200 mm * Recommendations should only be used as guideline as other settings may also be necessary depending on the patient and anatomy. 180 mm ** An additional valve in the base of the pediatric SPRUNG RESERVOIR makes it possible to flush the fluid only in the distal direction. This feature allows for controlling the patency of the ventricular catheter and the distal drainage. Connector: d o = 1.9 mm : d o = 4.5 mm : d o = 4.2 mm Catheter: d i = 1.2 mm, d o = 2.5 mm FX636T Children up to 5 years old and adults over 65* FX637T Individuals between 5 and 65 years old* (5 cmh 2O presetting) 0-20 cmh 2 O 20 cmh 2 O 0-20 cmh 2 O 25 cmh 2 O OPTIONAL CONFIGURATIONS pediatric SPRUNG RESERVOIR** (5 cmh 2 O presetting) FX633T 0-20 cmh 2 O without FX634T 0-20 cmh 2 O 10 cmh 2 O FX635T 0-20 cmh 2 O 15 cmh 2 O FX638T 0-20 cmh 2 O 30 cmh 2 O FX639T 0-20 cmh 2 O 35 cmh 2 O 16
17 SHUNT SYSTEM WITH SA 2.0 AND SPRUNG RESERVOIR Combination of adjustable unit with gravitational unit with an integrated distal catheter (1200 mm) SPRUNG RESERVOIR** with an integrated distal catheter (200 mm) Ventricular catheter with introducing stylet (180 mm) 17 mm 12 mm 1200 mm * Recommendations should only be used as guideline as other settings may also be necessary depending on the patient and anatomy. 20 mm 200 mm ** An additional valve in the base of the SPRUNG RESERVOIR makes it possible to flush the fluid only in the distal direction. This feature allows for controlling the patency of the ventricular catheter and the distal drainage. 180 mm Connector: d o = 1.9 mm : d o = 4.5 mm : d o = 4.2 mm Catheter: d i = 1.2 mm, d o = 2.5 mmm FX576T Children up to 5 years old and adults over 65* FX577T Individuals between 5 and 65 years old* (5 cmh 2O presetting) 0-20 cmh 2 O 20 cmh 2 O 0-20 cmh 2 O 25 cmh 2 O OPTIONAL CONFIGURATIONS SPRUNG RESERVOIR** (5 cmh 2 O presetting) FX424T 0-20 cmh 2 O without FX574T 0-20 cmh 2 O 10 cmh 2 O FX575T 0-20 cmh 2 O 15 cmh 2 O FX578T 0-20 cmh 2 O 30 cmh 2 O FX579T 0-20 cmh 2 O 35 cmh 2 O 17
18 SHUNT SYSTEM WITH SA 2.0 AND SPRUNG RESERVOIR Combination of adjustable unit with gravitational unit, SPRUNG RESERVOIR** with an integrated distal catheter (1200 mm) Ventricular catheter with introducing stylet (180 mm) 20 mm 17 mm 12 mm 1200 mm * Recommendations should only be used as guideline as other settings may also be necessary depending on the patient and anatomy. 180 mm ** An additional valve in the base of the SPRUNG RESERVOIR makes it possible to flush the fluid only in the distal direction. This feature allows for controlling the patency of the ventricular catheter and the distal drainage. Connector: d o = 1.9 mm : d o = 4.5 mm : d o = 4.2 mm Catheter: d i = 1.2 mm, d o = 2.5 mm FX629T Children up to 5 years old and adults over 65* FX630T Individuals between 5 and 65 years old* (5 cmh 2O presetting) 0-20 cmh 2 O 20 cmh 2 O 0-20 cmh 2 O 25 cmh 2 O OPTIONAL CONFIGURATIONS SPRUNG RESERVOIR** (5 cmh 2 O presetting) FX626T 0-20 cmh 2 O without FX627T 0-20 cmh 2 O 10 cmh 2 O FX628T 0-20 cmh 2 O 15 cmh 2 O FX631T 0-20 cmh 2 O 30 cmh 2 O FX632T 0-20 cmh 2 O 35 cmh 2 O 18
19 SHUNT SYSTEM WITH SA 2.0 AND PEDIATRIC CONTROL RESERVOIR Combination of adjustable unit with gravitational unit, pediatric CONTROL RESERVOIR** with an integrated distal catheter (1200 mm) Ventricular catheter with pediatric deflector and introducing stylet (250 mm) 14 mm 17 mm 12 mm 1200 mm * Recommendations should only be used as guideline as other settings may also be necessary depending on the patient and anatomy. ** An additional valve in the inlet of the pediatric CONTROL RESERVOIR makes it possible to flush the fluid only in the distal direction. This feature allows for controlling the patency of the ventricular catheter and the distal drainage. Connector: d o = 1.9 mm : d o = 4.5 mm : d o = 4.2 mm Catheter: d i = 1.2 mm, d o = 2.5 mm 250 mm FX609T Children up to 5 years old and adults over 65* FX610T Individuals between 5 and 65 years old* (5 cmh 2O presetting) 0-20 cmh 2 O 20 cmh 2 O 0-20 cmh 2 O 25 cmh 2 O OPTIONAL CONFIGURATIONS pediatric CONTROL RESERVOIR** (5 cmh 2 O presetting) FX606T 0-20 cmh 2 O without FX607T 0-20 cmh 2 O 10 cmh 2 O FX608T 0-20 cmh 2 O 15 cmh 2 O FX611T 0-20 cmh 2 O 30 cmh 2 O FX612T 0-20 cmh 2 O 35 cmh 2 O 19
20 SHUNT SYSTEM WITH SA 2.0 AND PEDIATRIC CONTROL RESERVOIR with pediatric CONTROL RESERVOIR** with integrated distal catheter (1200 mm) Ventricular catheter with pediatric deflector and introducing stylet (250 mm) 14 mm 17 mm * Recommendations should only be used as guideline as other settings may also be necessary depending on the patient and anatomy. ** An additional valve in the inlet of the pediatric CONTROL RESERVOIR makes it possible to flush the fluid only in the distal direction. This feature allows for controlling the patency of the ventricular catheter and the distal drainage. Connector: d o = 1.9 mm : d o = 4.5 mm : d o = 4.2 mm Catheter: d i = 1.2 mm, d o = 2.5 mm 600 mm 250 mm 12 mm 900 mm FX558T Children up to 5 years old and adults over 65* FX559T Individuals between 5 and 65 years old* (5 cmh 2O presetting) 0-20 cmh 2 O 20 cmh 2 O 0-20 cmh 2 O 25 cmh 2 O OPTIONAL CONFIGURATIONS pediatric CONTROL RESERVOIR** (5 cmh 2 O presetting) FX556T 0-20 cmh 2 O 10 cmh 2 O FX557T 0-20 cmh 2 O 15 cmh 2 O FX560T 0-20 cmh 2 O 30 cmh 2 O FX561T 0-20 cmh 2 O 35 cmh 2 O 20
21 SHUNT SYSTEM WITH SA 2.0 AND CONTROL RESERVOIR Combination of adjustable unit and gravitational unit with CONTROL RESERVOIR** with an integrated distal catheter (1200 mm) Ventricular catheter with deflector and introducing stylet (250 mm) 20 mm 17 mm 12 mm 1200 mm * Recommendations should only be used as guideline as other settings may also be necessary depending on the patient and anatomy. ** An additional valve in the inlet of the CONTROL RESERVOIR makes it possible to flush the fluid only in the distal direction. This feature allows for controlling the patency of the ventricular catheter and the distal drainage. Connector: d o = 1.9 mm : d o = 4.5 mm : d o = 4.2 mm Catheter: d i = 1.2 mm, d o = 2.5 mm 250 mm FX602T Children up to 5 years old and adults over 65* FX603T Individuals between 5 and 65 years old* (5 cmh 2O presetting) 0-20 cmh 2 O 20 cmh 2 O 0-20 cmh 2 O 25 cmh 2 O OPTIONAL CONFIGURATIONS CONTROL RESERVOIR** (5 cmh 2 O presetting) FX431T 0-20 cmh 2 O without FX600T 0-20 cmh 2 O 10 cmh 2 O FX601T 0-20 cmh 2 O 15 cmh 2 O FX604T 0-20 cmh 2 O 30 cmh 2 O FX605T 0-20 cmh 2 O 35 cmh 2 O 21
22 SHUNT SYSTEM MIT SA 2.0 AND CONTROL RESERVOIR with integrated CONTROL RESERVOIR** with integrated proximal (600 mm) and distal catheter (900 mm) Ventricular catheter with deflector and introducing stylet (250 mm) 20 mm 17 mm * Recommendations should only be used as guideline as other settings may also be necessary depending on the patient and anatomy. ** An additional valve in the inlet of the CONTROL RESERVOIR makes it possible to flush the fluid only in the distal direction. This feature allows for controlling the patency of the ventricular catheter and the distal drainage. Connector: d o = 1.9 mm : d o = 4.5 mm : d o = 4.2 mm Catheter: d i = 1.2 mm, d o = 2.5 mmm 600 mm 250 mm 12 mm 900 mm FX551T Children up to 5 years old and adults over 65* FX552T Individuals between 5 and 65 years old* (5 cmh 2O presetting) 0-20 cmh 2 O 20 cmh 2 O 0-20 cmh 2 O 25 cmh 2 O OPTIONAL CONFIGURATIONS CONTROL RESERVOIR** (5 cmh 2 O presetting) FX549T 0-20 cmh 2 O 10 cmh 2 O FX550T 0-20 cmh 2 O 15 cmh 2 O FX553T 0-20 cmh 2 O 30 cmh 2 O FX554T 0-20 cmh 2 O 35 cmh 2 O 22
23 SHUNT SYSTEM WITH SA 2.0 AND PEDIATRIC BURRHOLE RESERVOIR Combination of adjustable unit and gravitational unit with distal catheter (1200 mm) Pediatric burrhole reservoir with integrated distal catheter (200 mm) Ventricular catheter and introducing stylet (180 mm) 17 mm 12 mm 14 mm 200 mm * Recommendations should only be used as guideline as other settings may also be necessary depending on the patient and anatomy. 180 mm Connector: d o = 1.9 mm : d o = 4.5 mm : d o = 4.2 mm Catheter: d i = 1.2 mm, d o = 2.5 mm FX570T Children up to 5 years old and adults over 65* FX571T Individuals between 5 and 65 years old* (5 cmh 2O presetting) 0-20 cmh 2 O 20 cmh 2 O 0-20 cmh 2 O 25 cmh 2 O OPTIONAL CONFIGURATIONS (5 cmh 2 O presetting) FX445T 0-20 cmh 2 O without FX568T 0-20 cmh 2 O 10 cmh 2 O FX569T 0-20 cmh 2 O 15 cmh 2 O FX572T 0-20 cmh 2 O 30 cmh 2 O FX573T 0-20 cmh 2 O 35 cmh 2 O 23
24 SHUNT SYSTEM WITH SA 2.0 AND PEDIATRIC BURRHOLE RESERVOIR Combination of adjustable unit with gravitational unit, pediatric burrhole reservoir with an integrated distal catheter (1200 mm) Ventricular catheter and introducing stylet (180 mm) 14 mm 17 mm 12 mm 1200 mm 180 mm * Recommendations should only be used as guideline as other settings may also be necessary depending on the patient and anatomy. Connector: d o = 1.9 mm : d o = 4.5 mm : d o = 4.2 mm Catheter: d i = 1.2 mm, d o = 2.5 mmm FX622T Children up to 5 years old and adults over 65* FX623T Individuals between 5 and 65 years old* (5 cmh 2O presetting) 0-20 cmh 2 O 20 cmh 2 O 0-20 cmh 2 O 25 cmh 2 O OPTIONAL CONFIGURATIONS (5 cmh 2 O presetting) FX468T 0-20 cmh 2 O without FX620T 0-20 cmh 2 O 10 cmh 2 O FX621T 0-20 cmh 2 O 15 cmh 2 O FX624T 0-20 cmh 2 O 30 cmh 2 O FX625T 0-20 cmh 2 O 35 cmh 2 O 24
25 SHUNT SYSTEM WITH SA 2.0 AND PEDIATRIC PRECHAMBER Combination of adjustable unit with gravitational unit, pediatric prechamber with an integrated distal catheter (1200 mm) Ventricular catheter with pediatric deflector and introducing stylet (250 mm) 14 mm 17 mm 12 mm 1200 mm 250 mm * Recommendations should only be used as guideline as other settings may also be necessary depending on the patient and anatomy. Connector: d o = 1.9 mm : d o = 4.5 mm : d o = 4.2 mm Catheter: d i = 1.2 mm, d o = 2.5 mm FX596T Children up to 5 years old and adults over 65* FX597T Individuals between 5 and 65 years old* (5 cmh 2O presetting) 0-20 cmh 2 O 20 cmh 2 O 0-20 cmh 2 O 25 cmh 2 O OPTIONAL CONFIGURATIONS (5 cmh 2 O presetting) FX438T 0-20 cmh 2 O without FX594T 0-20 cmh 2 O 10 cmh 2 O FX595T 0-20 cmh 2 O 15 cmh 2 O FX598T 0-20 cmh 2 O 30 cmh 2 O FX599T 0-20 cmh 2 O 35 cmh 2 O 25
26 SHUNT SYSTEM WITH SA 2.0 AND PRECHAMBER with prechamber with integrated proximal (600 mm) and distal catheter (900 mm) Ventricular catheter with deflector and introducing stylet (250 mm) 20 mm 17 mm 600 mm 12 mm 900 mm * Recommendations should only be used as guideline as other settings may also be necessary depending on the patient and anatomy. 250 mm Connector: d o = 1.9 mm : d o = 4.5 mm : d o = 4.2 mm Catheter: d i = 1.2 mm, d o = 2.5 mmm FX539T Children up to 5 years old and adults over 65* FX540T Individuals between 5 and 65 years old* (5 cmh 2O presetting) 0-20 cmh 2 O 20 cmh 2 O 0-20 cmh 2 O 25 cmh 2 O OPTIONAL CONFIGURATIONS (5 cmh 2 O presetting) FX537T 0-20 cmh 2 O 10 cmh 2 O FX538T 0-20 cmh 2 O 15 cmh 2 O FX541T 0-20 cmh 2 O 30 cmh 2 O FX542T 0-20 cmh 2 O 35 cmh 2 O 26
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28 TOOLS progav 2.0 Adjustment Tool progav 2.0 Compass progav 2.0 Tool Set progav Check-mate, re-sterilisable progav 2.0 Adjustment Tool progav 2.0 Compass progav 2.0 Tool Set progav Check-mate FX400T FX401T FX404T FV409T on request Tools progav 2.0 Adjustment Tool progav 2.0 Compass progav 2.0 Tool Set (contains FX400T and FX401T) progav Check-mate, re-sterilisable progav 2.0 X-ray template and pressure recommendation card 28
29 prosa TOOLS Adjustment Tool prosa Verification Tool prosa prosa Adjustment Tool prosa Verification Tool FV790T FV791T Tools prosa Adjustment Tool prosa Verification Tool 29
30 prosa TOOLS Tool Set prosa Masterdisc prosa Compass prosa Adjustment Disc prosa Check-mate, re-sterilisable prosa prosa Tool Set prosa Masterdisc prosa Compass prosa Adjustment Disc prosa Check-mate FV792T FV793T FV794T FV795T FV796T on request Instruments prosa Tool Set (contains FV790T - FV791T, FV793T - FV795T) prosa Masterdisc prosa Compass prosa Adjustment Disc prosa Check-mate, re-sterilisable prosa X-ray template and pressure recommendation card 30
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32 NEUROSURGERY WE UNDERSTAND THE GRAVITY OF THE SITUATION. GRAVITATIONAL VALVES BY MIETHKE AESCULAP a B. Braun brand Aesculap AG Am Aesculap-Platz Tuttlingen Germany
33 OUR SHUNT SYSTEMS YOUR CHOICE prosa progav 2.0 GAV 2.0 SHUNT- ASSISTANT 2.0 DUALSWITCH mininav Accessories Valve Description Adjustable gravitational unit with differential pressure valve Adjustable differential pressure valve with gravitational unit Gravitational valve for the treatment of hydrocephalus for integration into shunt systems in order to avoid excess drainage Gravitational valve with large flow volumes for CSF Differential pressure valve, specifically for premature babies and newborns or bedridden or non-mobile patients Indication LP NPH Pediatric HC Adult HC Patient Lying Active * Feature 3-Tesla MR Conditional Adjustable * in combination with SHUNTASSISTANT 2.0 or prosa
34 SENSOR RESERVOIR SENSOR PRECHAMBER TELEMETRIC SHUNT CONTROL READING INNER VALUES AESCULAP a B. Braun brand Aesculap AG Am Aesculap-Platz Tuttlingen Germany
35
36 Manufacturer acc. to MDD 93/42/EEC Christoph Miethke GmbH & Co. KG Ulanenweg Potsdam Germany Phone Fax AESCULAP a B. Braun brand Distributed by Aesculap AG Am Aesculap-Platz Tuttlingen Germany Phone Fax The product trademarks GAV, mininav, progav, prosa and SHUNTASSISTANT are registered trademarks of Christoph Miethke GmbH & Co. KG in the majority of the world. For more detailed information please contact us: info@miethke.com. The main product trademark Aesculap is a registered trademark of Aesculap AG. Subject to technical changes. All rights reserved. This brochure may only be used for the exclusive purpose of obtaining information about our products. Reproduction in any form partial or otherwise is not permitted. C /x.x/x
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