Ventriculoatrial Shunt Under Locoregional Anesthesia: A Technical Note

Area of Science:

• Neurosurgery
• Anesthesiology
• Geriatric Medicine

Background:

• Ventriculoatrial shunt is a standard procedure for hydrocephalus, typically requiring general anesthesia.
• Elderly patients with idiopathic normal pressure hydrocephalus often have comorbidities, making general anesthesia and opioid use potentially risky.
• Minimally invasive approaches are desirable for this patient population.

Purpose of the Study:

• To evaluate the feasibility and safety of performing ventriculoatrial shunt procedures under locoregional anesthesia.
• To assess the impact of this technique on operating times, complications, and opioid administration in elderly patients.

Main Methods:

• Ten consecutive elderly patients underwent ventriculoatrial shunt placement using sedation combined with cervical plexus and scalp blocks.
• Data collected included demographics, American Society of Anesthesiologists (ASA) scores, vital signs, sedation levels (Ramsay scale), and procedure duration.
• Outcomes were assessed using the Idiopathic Normal Pressure Hydrocephalus Grading Scale, with complications monitored at 3-month follow-up.

Main Results:

• The mean patient age was 74 years, with a median ASA score of 3.
• Opioid administration was limited to 4 patients, and 6 patients achieved a Ramsay sedation scale score of 5.
• The average procedure duration was 59.5 minutes, with no conversions to general anesthesia.

Conclusions:

• Ventriculoatrial shunt under locoregional anesthesia is a feasible technique for elderly patients.
• This method avoids general anesthesia, limits opioid requirements, and does not increase operating times or complications.
• It offers a valuable option for enhancing treatment quality in complex geriatric neurosurgical cases.