Ultrasound guided placement of the distal catheter in paediatric ventriculoatrial shunts-an appraisal of efficacy and complications.

David J Clark,Dominic N P Thompson,Derek J Roebuck,Aabir Chakraborty

doi:10.1007/s00381-016-3120-4

David J Clark, Dominic N P Thompson + Show 2 more

Open Access

https://doi.org/10.1007/s00381-016-3120-4

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Abstract

PurposeVentriculoatrial (VA) shunts are commonly used as a second-line treatment of hydrocephalus when the peritoneum is an unsuitable site for the distal catheter. Many centres now utilise ultrasound and interventional radiology techniques to aid placement of the distal catheter. The purpose of this study was to conduct a contemporary audit of VA shunting in children using interventional radiology techniques for placement of the distal catheter.MethodsA retrospective analysis of all patients who had VA shunts inserted between June 2000 and June 2010 was conducted using a prospectively updated surgical database and case notes review.ResultsNinety-four VA shunts were inserted in 38 patients. Thirty-seven patients had been treated initially with ventriculoperitoneal (VP) shunts. Twenty-two patients required at least 1 shunt revision (58 %). The 6-month, 1- and 2-year shunt survival rates were 53, 43 and 27 %, respectively. Blockage was the commonest reason for shunt failure (68 %). The site of failure was proximal (ventricular catheter +/− valve) in 32 % and distal (atrial catheter) in 21 % of cases. The overall infection rate was 6 % per procedure and 11 % per patient. There were 7 deaths, of which 3 were shunt related.ConclusionsVA shunting provides a viable second-line option for shunt placement in complex hydrocephalus. The causes of shunt failure (blockage, infection and equipment failure) are similar to VP shunting though shunt survival rates are inferior to VP shunts. Ultrasound guided VA shunt placement provides a relatively safe, second-line alternative to the placement of a ventriculoperitoneal shunt when this route is unsuitable.

Highlights

The causes of shunt failure are similar to VP shunting though shunt survival rates are inferior to VP shunts
Despite the current enthusiasm for endoscopic third ventriculostomy, ventricular shunting procedures continue to be the mainstay of hydrocephalus management in children and ventriculoperitoneal shunting remains the preferred first-line option
We present our experience of Ventriculoatrial shunting (VA) shunting with percutaneous insertion of the distal catheter under ultrasound guidance as a second-line treatment for childhood hydrocephalus over a 10-year period

Summary

Introduction

Despite the current enthusiasm for endoscopic third ventriculostomy, ventricular shunting procedures continue to be the mainstay of hydrocephalus management in children and ventriculoperitoneal shunting remains the preferred first-line option. Approximately 50 % of ventriculoperitoneal (VP) shunts inserted fail within 2 years [9, 19, 21], with this figure rising to 85 % after 15 years [22]. The majority of VP shunts fail due to obstruction, followed by mechanical failures (migration and disconnection) and infection [22]. Distal shunt failure may occur as a result of adhesions, intraperitoneal infection, ascites and cerebrospinal fluid (CSF) pseudocysts [11, 20]; in these situations, an alternative site for the distal catheter may have to be considered. VP shunting has become the preferred treatment since surgical placement is more straightforward and as VA shunts can cause serious complications including pulmonary embolism, pulmonary hypertension [17] and shunt nephritis [1]

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