Some would say I will keep proGAV at 5 at go up and down with proSA. What is your plan with explanation?
We rarely use ProSA in our institution unless the patient shows a complex pattern of under/overdrainage, Shunt Assistant provided with ProGAV shunt is enough in most cases. I think the optimal aperture only could be assessed by analysing ventricle size, neurological status and CSF debits/height in a patient with an EVD or with overnight intracranial pressure monitoring with clinical records.
Very important answer Dr Jose. Can you tell me details (references)
Best regards,
The combination of adjustable valve and adjustable antigravity device offers multiple possibilities.
For example: In the case of an adult with chronic hydrocephalus, the opening pressure is guided by the Katzmann infusion test, if it has been done, placing it below the same or the B wave pattern if chronic monitoring has been performed. In these patients I advise that the ProSa fits between +20 / + 40 depending on the height of the patient.
In children, the opening pressure may be higher, except in low pressure states, in the equivalent of 6-8 mmHg and the adjusted ProSa considering the height of the child to partially compensate for the hydrostatic gradient.
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