| Use of intraoperative venography to guide the distal portion of a ventriculoatrial shunt past an obstruction in the central veins: technical case report. | |
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MedLine Citation:
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PMID: 20489529 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Eric N Momin; Pablo F Recinos; Alexander L Coon; Daniele Rigamonti |
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Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Neurosurgery Volume: 66 ISSN: 1524-4040 ISO Abbreviation: Neurosurgery Publication Date: 2010 Jun |
Date Detail:
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Created Date: 2010-05-21 Completed Date: 2010-12-16 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7802914 Medline TA: Neurosurgery Country: United States |
Other Details:
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Languages: eng Pagination: 370-1; discussion 371 Citation Subset: IM |
Affiliation:
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Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Brachiocephalic Veins / radiography*, surgery* Catheterization, Central Venous / instrumentation, methods* Cerebrospinal Fluid Shunts / instrumentation, methods* Humans Intracranial Hypertension / surgery Jugular Veins / radiography, surgery Male 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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