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Percutaneous placement of ventriculoatrial shunts in the pediatric population
G W Britz1, A M Avellino, R Schaller
1Department of Neurosurgery, University of Washington School of Medicine, Wash., USA.
Insights
Percutaneous ventriculoatrial (VA) shunts offer a safe alternative for pediatric hydrocephalus patients. This minimally invasive technique, using subclavian vein access, proved effective in 7 young patients, avoiding open surgery complications.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Vascular Access
Background:
- Ventriculoatrial (VA) shunts are typically placed in adults.
- Previous shunt placements (ventriculoperitoneal, VP; ventriculopleural) were common in this pediatric cohort.
- Indications for VA shunt conversion included intra-abdominal infection and chronic pleuritic chest pain.
Purpose of the Study:
- To evaluate the feasibility and safety of percutaneous ventriculoatrial (VA) shunt placement in pediatric patients.
- To present a minimally invasive alternative to open surgical venous access for VA shunts in children.
Main Methods:
- Retrospective case series of 7 pediatric patients (ages 6-17).
- Percutaneous venous access via the subclavian vein for VA shunt placement.
- All patients had prior shunt failures or complications necessitating conversion.
Main Results:
- All 7 pediatric patients remained asymptomatic post-procedure.
- No complications were reported during or after the percutaneous VA shunt placements.
- Follow-up ranged from 2 to 12 months, demonstrating sustained efficacy.
Conclusions:
- Percutaneous VA shunt placement is a viable and safe alternative for pediatric patients requiring shunt revision.
- This technique provides a less invasive option for venous access compared to open surgical approaches in the pediatric population.
Abstract:
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.