Ventriculojugular shunt against the direction of blood flow. IV. Technical modifications and policy for treatment.

During evolution of the surgical procedure to implant ventriculojugular (VJ) shunts against the direction of blood flow for the treatment of hydrocephalus, various modifications were made in the shunting catheter and in the implantation technique with the aim of improving the results. Shunt implantation was difficult in infants and young children with compressible craniums and the modifications failed to improve the results. Accordingly, they were not considered suitable for this method of cerebrospinal fluid (CSF) shunting. Our present policy is to implant VJ shunts in hydrocephalic patients with rigid craniums and ventriculoperitoneal (VP) shunts in infants and young children to tide them over a period until they become suitable for VJ shunting. During the past 5 years, 110 hydrocephalic patients with rigid craniums were treated by implanting VJ shunts without need for further modifications. The shunt was revised in one patient during the early postoperative period due to CSF leakage under the scalp. There were no complications related to CSF overdrainage in any of the cases.