Ventriculoatrial Shunt Placement Research Articles

Improvement of obstructive sleep apneas caused by hydrocephalus associated with Chiari malformation Type II following surgery

Chiari malformation (CM) is the downward herniation of the caudal part of the cerebellum and/or medulla oblongata into the spinal canal. It can alter several neurological functions, including respiratory control and upper airway motility, and can be the cause of sleep-disordered breathing (SDB). The authors describe a 6-year-old boy affected by CM Type II associated with myelomeningocele who showed symptoms indicative of severe airway obstruction during sleep. Polysomnography revealed severe obstructive sleep apnea syndrome (OSAS). Magnetic resonance imaging demonstrated herniation of the cerebellar tonsils and diffuse ventricular dilation with a large pseudocystic formation in the third ventricle. Surgical marsupialization of the cystic wall was performed, associated with ventriculocystostomy and endoscopic replacement of the ventricular catheter. Polysomnography repeated 2 months after surgery revealed a striking improvement in the sleep-related respiratory pattern. The pathogenesis of OSAS was probably referable to a combination of CM and elevated intracranial pressure. However, the striking improvement of symptoms after ventriculoatrial shunt placement suggested that hydrocephalus plays a major role in this condition. Assessment and effective treatment of SDB is crucial in the care of patients with CM.

Thrombosis associated with ventriculoatrial shunts

In this single-center study, the authors examined the clinical characteristics, risk factors, treatment strategies, and outcomes in patients with thrombosis associated with ventriculoatrial (VA) shunts. Inpatient and outpatient charts of patients who underwent treatment and follow-up in the Hematology-Oncology Division at the authors' institution and in whom thrombosis developed secondary to a VA shunt placement were reviewed. A complete thrombophilia work-up was performed in each patient, and these records were also reviewed. Treatment including medical and surgical management was noted and outcome data were recorded. Resolution of thrombosis was seen after anticoagulation therapy in all patients; this may be an alternative to surgical therapy. Patients with VA shunts represent a unique group at risk for thrombosis. The duration of anticoagulation therapy must be individualized. However, larger studies are needed to evaluate the efficacy of screening for asymptomatic thrombosis and to investigate the role of prophylactic anticoagulation.

Ultrasound-guided percutaneous placement of ventriculoatrial shunts

In accordance with the literature on ventriculoatrial (VA) shunts, a percutaneous approach to the internal jugular vein is preferable to surgical preparation of the vein before catheter placement. Inspired by the above and the problems still remaining in the percutaneous method and successful results from anaesthesiology with the use of ultrasound-guided placement of central venous catheters, we have implemented an ultrasound-guided percutaneous technique for placement of VA shunts including pre- and intraoperative ultrasound guidance. Data on 26 VA shunt operations were collected and analysed with special reference to the applicability of the method to pediatric patients, surgical complications and differences between revisions and first-time VA shunts. All patients with VA shunt indications were operated successfully with this technique including children down to the age of 5 years. The ultrasound-guided percutaneous technique results in a safe, quick and easy procedure with preoperative knowledge of the diameter of the vein, no accidental carotid artery puncture or pneumothorax, a minimal blood loss, a short operative time, few infectious complications and a good cosmetic result. Results for all parameters were identical in first-time VA shunt operations and revisions.

Electrocardiographic guided placement of central venous catheters

We describe a technique for central venous catheterization based on electrocardiographic principles, first utilized for the placement of ventriculoatrial shunts. This method uses the catheter, filled with a conducting medium, as an exploring electrode; the catheter, tip position is judged by easily observable and reproducible P wave changes on an electrocardiographic monitor

Percutaneous Placement of Ventriculoatrial Shunts in the Pediatric Population

The percutaneous placement of ventriculoatrial (VA) shunts has been previously described, usually in adults. We report a series of 7 pediatric cases ranging from 6 to 17 years. Five patients were female and 2 were male. All patients had prior ventriculoperitoneal (VP) shunts for hydrocephalus, of which 1 had been subsequently converted to a ventriculopleural shunt. Indications for conversion to a VA shunt were intra-abdominal infection in 6 cases and chronic pleuritic chest pain in 1 patient. The venous entry was the subclavian vein in all cases. All patients have remained asymptomatic since the operation. There were no complications associated with the procedures, with follow-up ranging from 2 to 12 months. This technique is a viable alternative to the open cervical approach for venous entry to the right atrium in the pediatric population.

Atrial Placement of Ventriculoatrial Shunts

Atrial Placement of Ventriculoatrial Shunts

Atrial Placement of Ventriculoatrial Shunts

Atrial Placement of Ventriculoatrial Shunts

Percutaneous jugular placement of ventriculo-atrial shunts using a split sheath. Technical note.

The percutaneous placement of ventriculo-atrial (V-A) shunts for treatment of hydrocephalus has been previously reported by several authors as a simplified procedure. However, this technique did not avoid the use of a distal connector between the outlet catheter and the atrial one, which may lead to a disconnection. A technique of percutaneous V-A shunt insertion using a split sheath is described and illustrated with a series of 22 patients. The use of a split sheath eliminates any distal connector thus avoiding the risk of shunt disconnection and reducing the operating time. The average operating time was 31 min. This rapid procedure allowed us to operate on two of our patients under local anaesthesia. The correct placement of the atrial catheter tip was performed under fluoroscopic control and always confirmed by postoperative radiographs. Two incidents of carotid artery puncture were controlled by simple local compression without further consequences. The mean follow-up time is one year. All the patients' clinical conditions improved. We are encouraged to use this V-A technique more frequently as a method of choice in the treatment of adult hydrocephalus or when the peritoneal cavity is inaccessible in children. The use of a split sheath is successful in reducing the operating time and avoiding the use of a distal connector.

Percutaneous placement of ventriculoatrial shunts

Percutaneous placement of ventriculoatrial shunts

Percutaneous placement of ventriculoatrial shunts: four-year case experience.

During the past 4 years, we have used percutaneous placement of the atrial catheter in 39 patients who have undergone ventriculoatrial shunting. The age range of our patients has been from 9 to 74 years of age, with routine indications existing. Both subclavian and internal jugular venous access have been utilized, with the latter being our preferred route of access for reasons of safety. Average operative time has been approximately 35 to 40 minutes. Both traditional and split-sheath introducer catheters have been used. Patient follow-up has been up to 4 years. Intraoperative complications have been limited to puncture of the carotid artery on two occasions; neither affected the ultimate performance of the procedure. Postoperative complications have been limited to those peculiar to shunt procedures in general and have required revision in four instances. One patient suffered an infection secondary to shunting. The benefits of this procedure seem to include safety, decreased operative site exposure, and decreased operative time, all factors that may contribute to a lower than normal infection rate and may warrant consideration of this procedure in adolescents and adults for whom ventriculoatrial shunting is indicated.

Intraoperative echocardiographic control during ventriculoatrial shunt placement

A method for positioning the cardiac end of a ventriculoatrial shunt with the aid of echocardiography is described. This simple procedure has resulted in safe and accurate shunt placement in infants.

Accurate placement of ventriculo-atrial shunt for hydrocephalus under electrocardiographic control.

Accurate placement of ventriculo-atrial shunt for hydrocephalus under electrocardiographic control.