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Adjustable gravitational valve for the treatment of hydrocephalus

MIETHKE® – The balanced way of life. Inspired by you.

When developing a hydrocephalus valve which offers an optimal individual treatment, it is crucial to focus on the flexible adjustability of the opening pressure during the active time of the day, i.e., the upright body position. After fixed pressure gravitational valves and adjustable gravitational valves, the® provides neurosurgeons and patients with the next generation of hydrocephalus valves operating in a position-dependent manner.® is the essence of 26 years of experience with valve technology for hydrocephalus and the feedback of numerous doctors and patients worldwide.® – the next generation

Reliable. Balanced. Simple. Individual.

The® takes the proSA® to the next level, by combining the adjustable gravitational unit with a fixed differential pressure unit. Together, these two units automatically adjust the opening pressure depending on the patient’s body position. For particularly challenging forms of hydrocephalus, requiring a much greater flexibility in treatment, the plus® is available, in which the adjustable gravitational unit is combined with an adjustable differential pressure unit.

Learn more about®

  • ONE valve for the special requirements of a life with hydrocephalus: mobility, growth, changes in the course of disease
  • 2 in 1 technology: adjustable gravitational unit combined with fixed differential pressure unit in one valve
  • Unique uncompromising pressure adaption to optimize individual patient needs
  • Smallest adjustable gravitational valve worldwide
  • Efficient protection against overdrainage through individually and continuously adjustable opening pressure from 0-40 cmH2O
  • MRI-compatible up to 3 Tesla – no X-ray verification after MRI necessary, no additional radiation exposure for the patient
  • Safe from unintentional adjustment by everyday magnets such as smartphones, toys, induction cookers and safety barriers at the airports
  • Innovative plus® Instruments for® and proGAV® 2.0
  • Intuitive, secure and comfortable adjustment
  • Precision engineering
  • Robust and durable: made of titanium

The® is a hydrocephalus valve operating in a position-dependent manner. It consists of an adjustable gravitational unit and a fixed differential pressure unit.

The combination of these two units ensures automatic adjustment of the opening pressure depending on the patient's body position and thus counteracts the risk of possible overdrainage complications, especially in the upright and active body position.

Particularly challenging and difficult forms of hydrocephalus require a much greater flexibility in treatment. This is what the plus® stands for: a combination of an adjustable gravitational unit and an adjustable differential pressure unit (proGAV® 2.0).

Both® variants are made of robust and biocompatible titanium and are the result of precise precision engineering.

The differential pressure unit in the® is available in the units 0, 5, 10 and 15 cmH2O. The selected opening pressure of the differential pressure unit is equally effective in all body positions. When lying down, the differential pressure unit acts alone and usually has a low selected opening pressure, so that the valve drains brain water in time when the brain pressure increases during sleep and rest phases. A microspiral spring that presses a sapphire ball into a ball seat is responsible for the correct pressure. If the brain pressure rises above the selected opening pressure, the spring gives way, the differential pressure valve opens and allows brain fluid to pass through until the brain pressure has dropped again accordingly.

The gravitational unit in the® is adjustable from 0-40 cmH2O and is only effective in the upright body position. Now the sum of both units - gravitational and differential pressure unit – determines the total opening pressure of the®. The more upright the patient is, the higher the opening pressure of the®. The considerably higher opening pressure in the active phases of the day is particularly important because hydrostatic and hydrodynamic phenomena in the shunt system take effect in the upright body position and there is otherwise a risk of overdrainage.

The opening pressure of the gravitational unit is determined by a combination of rotor, rod spring, tantalum weight and sapphire ball. The tantalum weight holds a sapphire ball in the ball seat via a lever, which closes or opens the valve. Depending on the body position of the patient, the influence of a tantalum weight on a sapphire ball changes and thus the valve opening pressure. The preload of the rod spring connected to the lever can be adjusted via a rotor using the plus® Instruments and can influence the desired opening pressure.

In the freely available MIETHKE App, the functionality of the adjustment and the position-dependent opening pressures are shown very clearly (for Android, for iOS).

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More information about the different pressure levels and their X-ray detection can be found in the download area below.

User-friendly adjustment and verification plus® instruments allow users to measure, verify, and adjust the pressure level on®’s adjustable gravitational unit (0-40 cmH2O) as well as the pressure level on the adjustable differential pressure unit (proGAV® 2.0) of plus®. The instruments offer simple steps for the physician and make the adjustment process comfortable for patients.


Locate valve by palpating the area with your finger through the open plus® compass.


Close plus® compass and use the floater to lock location and read current valve opening pressure setting.


With the help of the inserted adjustment ring the valve opening pressure can easily be set to the desired level.
After setting the valve opening pressure, it is advisable to double-check the pressure level settings.

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Related documents

Description Document Link
Sheet Standard pressure levels for® and plus®
pdf (111.0 KB)
Infographic Challenges for hydrocephalus shunt development
pdf (45.4 KB)
Infographic Miethke Gravitational valves – designed to give you confidence
pdf (36.8 KB)
Patient manual® – shunt system for the treatment of hydrocephalus
Brochure® – the balanced way of life. Inspired by you.

Digital Applications

MIETHKE HC&ME App – Your Hydrocephalus Diary

iTunes Preview and Free Download
Google Play Preview and Free Download

MIETHKE App – Understanding Valves easily

iTunes Preview and Free Download
Google Play Preview and Free Download

THOMALE GUIDE App – An Accessory for the THOMALE GUIDE

iTunes Preview and Free Download

AESCULAP Neurosurgery Main Catalog

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Google Play Preview and Free Download

For further information please contact your Aesculap representative or mail to
Aesculap AG
Am Aesculap-Platz
78532 Tuttlingen