A hybrid technique for ventriculoatrial shunt implantation—technical note

Nowosławska, Emilia; Moszura, Tomasz; Mikołajczyk-Wieczorek, Wanda; Zakrzewski, Krzysztof; Krawczyk, Jacek; Szymański, Wojciech; Polis, Bartosz; Polis, Lech

doi:10.1007/s00381-014-2520-6

Cited by 6 publications

(4 citation statements)

References 6 publications

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“…It is accepted that when choosing VAS, a US-guided peel-away technique with constant cardiac monitoring should be used and distal catheter position should be confirmed with fluoroscopy. [ 7 , 10 , 20 ] Recently, Kim et al . compared complication rates in patients undergoing VAS versus patients operated with a VPS.…”

Section: Discussionmentioning

confidence: 99%

Ventriculo-atrial shunt. Comparison of an ultrasound-guided peel-away technique versus conventional technique in the management of normal pressure hydrocephalus: A retrospective cohort

Segura-Hernández

Hakim

Ramón

et al. 2021

Surgical Neurology International

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Background: Normal pressure hydrocephalus (NPH) is a common neurodegenerative syndrome among the elderly characterized by ventriculomegaly and the classic triad of symmetric gait disturbance, cognitive decline and urinary incontinence. To date, the only effective treatment is a cerebrospinal fluid shunting procedure that can either be ventriculo-atrial, ventriculo-peritoneal, or lumbo-peritoneal shunt. The conventional ventriculo-atrial shunt uses venodissection, whereas the peel-away is a percutaneous ultrasound (US)-guided technique that shows some advantages over conventional technique. We sought to compare perioperative complication rates, mean operating time and clinical outcomes for both techniques in NPH patients at our institution. Methods: A retrospective cohort-type analytical study was conducted, using clinical record data of patients diagnosed with NPH and treated at our center from January 2009 to September 2019. Parameters to be compared include: Perioperative complication rates, intraoperative bleeding, mortality, and mean operating time. Perioperative complication rates are those device-related such as shunt infection, dysfunction, and those associated with the procedure. Complications are further classified in immediate (occurring during the first inpatient stay), early (within the first 30 days of surgery), and late (after day 30 of surgery). Results: A total of 123 patients underwent ventriculo-atrial shunt. Eighty-two patients (67%) underwent conventional venodissection technique and 41 patients (33%) underwent a peel-away technique. Immediate complications were 3 (3.6%) and 0 for conventional and peel-away groups, respectively. Early complications were 0 and 1 (2.4%) for conventional and peel-away groups, respectively. Late complications were 5 (6.1%) and 2 (4.9%) for conventional and peel-away groups, respectively. Mean operating time was lower in the peel-away group (P = 0.0000) and mortality was 0 for both groups. Conclusion: Ventriculo-atrial shunt is an effective procedure for patients with NPH. When comparing the conventional venodissection technique with a percutaneous US-guided peel-away technique, the latter offers advantages such as shorter operating time and lower perioperative complication rates.

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Section: Discussionmentioning

confidence: 99%

Ventriculo-atrial shunt. Comparison of an ultrasound-guided peel-away technique versus conventional technique in the management of normal pressure hydrocephalus: A retrospective cohort

Segura-Hernández

Hakim

Ramón

et al. 2021

Surgical Neurology International

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“… 4) A well-known method for placing the distal catheter tip in the appropriate position is to use an intraoperative radiographic assessment (fluoroscopy) or an electrocardiographic-guided method. 4 13) The method of placing the distal catheter using fluoroscopy is the same for inserting the central venous catheter. Using sonography, the location of the internal jugular vein (IJV) can be identified, and the distal catheter connected to the valve can be placed by tunneling to the IJV puncture site.…”

Section: Discussionmentioning

confidence: 99%

Case Series of Ventriculoatrial Shunt placement in Hybrid Room: Reassessment of Ventriculoatrial Shunt

Kim

Lee

Kim

et al. 2020

Korean J Neurotrauma

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Objective Ventriculoatrial shunt (VAS) remains an alternate option for treatment of hydrocephalus in patients with ventriculoperitoneal shunt (VPS) failure. Unfamiliar anatomy for a neurosurgeon has resulted in the VAS falling out of favor as a treatment option. However, there are unsatisfactory reports on the long-term result of VPS, and VAS has been recently re-evaluated. We are to report the simple way to do the VAS using a peel-away sheath in a hybrid operation room. Methods A jugular vein path was drawn by ultrasound, a small incision was made above the clavicle, and a shunt catheter was tunneled into it. The jugular vein was punctured beside the tunneled catheter with a Seldinger needle under ultrasound guidance. A flexible guide wire was introduced into the vein and 6-Fr peel-away sheath was advanced into the vein along the wire. Under fluoroscopic guidance, the catheter was cut to position approximately mid-level in the atrium. After the guide wire was removed, the distal shunt catheter was passed down. After confirming proper position of the distal catheter under the fluoroscope, the catheter-guiding sheath was pulled out as a peeling-away manner. We performed this surgical procedures in 5 cases. Results All the procedures of the VAS using a peel-away sheath were performed in a hybrid operation room Of 5 patients, 3 patients had the distal catheter failures in the peritoneal cavity and 2 patients had shunt A distal catheter was successfully indwelling in all the cases without any difficulties. After the surgery, neither shunt infection nor thromboembolic event happened. Conclusion VAS using fluoroscopy and a peel-away sheath is a good alternative option for hydrocephalus patients with shunt failure related to peritoneal cavity complications.

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“…That way in cases like the one we described where both veins were occluded, a safe and accessible route to the right atrium is provided. Even though hybrid techniques with endovascular recanalization of the jugular vein have been documented [ 16 ], they require the presence of specialized personnel and equipment that are not always available in many parts of the world.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous placement of the peripheral catheter to the subclavian vein for a VA shunt

et al. 2017

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Hydrocephalus is a common neurosurgical pathology that affects people of all ages and especially the pediatric population. It can be very often a life threatening condition that pediatric neurosurgeons must deal with. Therefore a number of CSF diversion techniques have been established. The gold standard treatment currently is the placement of a ventriculo-peritoneal shunt. Because of hydrocephalus being a lifelong condition, it is almost in daily practice dealing with cases of shunt failures for a number of reasons. Herewith we present a 4 year old child with multiple ventriculo-peritoneal shunt revision surgeries and ventriculo-atrial failure due to distal catheter malfunction that was treated with percutaneous placement of the peripheral catheter in the subclavian vein.

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A hybrid technique for ventriculoatrial shunt implantation—technical note

Cited by 6 publications

References 6 publications

Ventriculo-atrial shunt. Comparison of an ultrasound-guided peel-away technique versus conventional technique in the management of normal pressure hydrocephalus: A retrospective cohort

Ventriculo-atrial shunt. Comparison of an ultrasound-guided peel-away technique versus conventional technique in the management of normal pressure hydrocephalus: A retrospective cohort

Case Series of Ventriculoatrial Shunt placement in Hybrid Room: Reassessment of Ventriculoatrial Shunt

Percutaneous placement of the peripheral catheter to the subclavian vein for a VA shunt

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