Document Detail

Use of intraoperative venography to guide the distal portion of a ventriculoatrial shunt past an obstruction in the central veins: technical case report.
MedLine Citation:
PMID:  20489529     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Ventriculoatrial (VA) shunting is commonly used to treat hydrocephalus when ventriculoperitoneal shunting has failed. Placement of a VA shunt in patients with narrowing or occlusion of the central veins presents considerable difficulty because few imaging modalities exist to safely and reliably insert a guidewire or atrial catheter past the occlusion. We report the use of intraoperative venography to guide the placement of the distal portion of a VA shunt in a patient with a valve blocking the left brachiocephalic vein.
CLINICAL PRESENTATION: A 42-year-old man with pseudotumor cerebri and a left ventriculoperitoneal shunt presented with severe headaches. He was diagnosed with partial distal shunt obstruction. Because of a history of failed attempts at ventriculoperitoneal shunting, conversion to a VA shunt via the left internal jugular vein was planned.
TECHNIQUE: Surgery was performed by using the standard technique until resistance was encountered when inserting a guidewire into the internal jugular vein. Intraoperative venography of the central veins was performed, which showed a large valve blocking progression of the guidewire in the left brachiocephalic vein. Using fluoroscopic guidance, a 0.035-inch guidewire was successfully directed through the vein past the obstruction and exchanged for a peel-away introducer. The distal shunt catheter was then inserted, and the correct position in the atrium was confirmed fluoroscopically.
CONCLUSION: When obstruction of the central veins is found during a VA shunting procedure, intraoperative venography is a useful method to aid in the placement of the atrial catheter through the central veins.
Eric N Momin; Pablo F Recinos; Alexander L Coon; Daniele Rigamonti
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  66     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-21     Completed Date:  2010-12-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  370-1; discussion 371     Citation Subset:  IM    
Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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MeSH Terms
Brachiocephalic Veins / radiography*,  surgery*
Catheterization, Central Venous / instrumentation,  methods*
Cerebrospinal Fluid Shunts / instrumentation,  methods*
Intracranial Hypertension / surgery
Jugular Veins / radiography,  surgery
Monitoring, Intraoperative / methods
Neurosurgical Procedures / methods*
Phlebography / methods*
Pseudotumor Cerebri / surgery
Treatment Outcome
Venous Valves / radiography,  surgery
Ventriculostomy / instrumentation,  methods

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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