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Adjustable gravitational valve for the treatment of hydrocephalus

MIETHKE® – The balanced way of life. Inspired by you.® is the essence of over 28 years of experience with valve technology for the treatment of hydrocephalus and is based on feedback from numerous doctors and patients worldwide.® focuses on the patient's active time, which is mostly spent sitting or upright and takes up about 2/3 of a day. This is where the greatest risk of positional overdrainage exists.

With its adjustable gravitational unit and a wide adjustment range of 0-40 cmH2O, the valve can be adapted to the individual requirements in life with hydrocephalus: mobility, growth and changes in the course of the disease. [1], [2], [3], [4]® – the next generation

Reliable. Balanced. Simple. Individual.

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

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

Learn more about®

  • ONE valve for the special requirements of a life with hydrocephalus: mobility, growth, changes in the course of disease [1], [2], [3], [4]
  • 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 [11], [12]
  • Smallest adjustable gravitational valve worldwide
  • Efficient protection against overdrainage through individually and continuously adjustable opening pressure from 0-40 cmH2O [5], [6],  [7], [8]
  • MRI-compatible up to 3 Tesla – no X-ray verification after MRI necessary, no additional radiation exposure for the patient [9], [10]
  • Safe from unintentional adjustment by everyday magnets such as smartphones, toys, induction cookers and safety barriers at the airports [9], [10]
  • 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. [5], [6], [7], [8]

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®.

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. [13]


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 – Patient Diary App

iTunes Preview and Free Download
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MIETHKE App – Understanding Valves easily

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THOMALE GUIDE App – An Accessory for the THOMALE GUIDE

iTunes Preview and Free Download

AESCULAP Neurosurgery Main Catalog

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

[1] 2010, Mar, Sprung C., Schlosser H. G., Lemcke J., Meier U., Messing-Junger M., Trost H. A., Weber F., Schul C., Rohde V., Ludwig H. C., Hopfner J., Sepehrnia A., Mirzayan M. J. and Krauss J. K.: "The adjustable proGAV shunt: a prospective safety and reliability multicenter study", Neurosurgery 66(3): 465-474
[2] 2015, Oct, Kehler U., Kiefer M., Eymann R., Wagner W., Tschan C. A., Langer N., Rohde V., Ludwig H. C., Gliemroth J., Meier U., Lemcke J., Thomale U. W., Fritsch M., Krauss J. K., Mirzayan M. J., Schuhmann M. and Huthmann A.: "PROSAIKA: a prospective multicenter registry with the first programmable gravitational device for hydrocephalus shunting", Clin Neurol Neurosurg 137: 132-136
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[6] 2014, Tschan C. A., Antes S., Huthmann A., Vulcu S., Oertel J. and Wagner W.: "Overcoming CSF overdrainage with the adjustable gravitational valve proSA", Acta Neurochir (Wien) 156(4): 767-776,
[7] 2017, May, Alavi S.,Schulz M., Schaumann A., Schwarz K. and Thomale U. W.: "Valve exchange towards an adjustable differential pressure valve with gravitational unit, clinical outcome of a single-center study", Childs Nerv Syst 33(5): 759-765
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[10] 2017, Pierson M. J., Wehrmann D., Albers J. A., El Tecle N. E., Costa D. and Elbabaa S. K.: "Programmable shunt valve interactions with osseointegrated hearing devices", J Neurosurg Pediatr 19(4): 384-3
[11] 2019, Aschoff A: "In-Depth View: Functional Characteristics of CSF Shunt Devices (Pros and Cons)", Textbook of Pediatric Neurosurgery, Editor: C. Di Rocco90 56(5): 274-28210
[12] 2020, Gutowski P., Golz L., Rot S., Lemcke J. and Thomale U. W.:"Gravitational shunt valves in hydrocephalus to challenge the sequelae of over-drainage", Expert Rev Med Devices 17(11): 1155-1168
[13] 2013, Nov, Gebert A. F., Schulz M., Haberl H. and Thomale U. W.: "Adjustments in gravitational valves for the treatment of childhood hydrocephalus-a retrospective survey", Childs Nerv Syst 29(11): 2019-2025