The results of this paper were presented orally at the International Society of Paediatric Neurosurgery’s Annual Meeting in Goa, October 2011
Ventriculoatrial (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.
A 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.
Ninety-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.
VA 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.
Arze RS, Rashid H, Morley R, Ward MK, Kerr DN (1983) Shunt nephritis: report of two cases and review of the literature. Clin Nephrol 19:48–53 PubMed
Fernell E, von Wendt L, Serlo W, Heikkinen E, Andersson H (1985) Ventriculoatrial or ventriculoperitoneal shunts in the treatment of hydrocephalus in children? Z Kinderchir 40(Suppl 1):12–14 PubMed
Girotti ME, Singh RR, Rodgers BM (2009) The ventriculo-gallbladder shunt in the treatment of refractory hydrocephalus: a review of the current literature. Am Surg 75:734–737 PubMed
Mazza C, Pasqualin A, Da Pian R (1980) Results of treatment with ventriculoatrial and ventriculoperitoneal shunt in infantile nontumoral hydrocephalus. Childs Brain 7:1–14 PubMed
Nulsen FE, Spitz EB (1951) Treatment of hydrocephalus by direct shunt from ventricle to jugular vain. Surg Forum:399–403
Pollack IF, Albright AL, Adelson PD (1999) A randomized, controlled study of a programmable shunt valve versus a conventional valve for patients with hydrocephalus. Hakim-Medos Investig Group Neurosurg 45:1399–1408, discussion 1408–1311
Tuli S, Tuli J, Drake J, Spears J (2004) Predictors of death in pediatric patients requiring cerebrospinal fluid shunts. J Neurosurg 100:442–446 PubMed
- Ultrasound guided placement of the distal catheter in paediatric ventriculoatrial shunts—an appraisal of efficacy and complications
David J. Clark
Derek J. Roebuck
Dominic N. P. Thompson
- Springer Berlin Heidelberg
Neu im Fachgebiet Chirurgie
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