Abigail J Rao1, Zoe Teton2, Victor Rodriguez3, Brandon H Tieu4, Ahmed M Raslan5. 1. Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA; Department of Neurosurgery, University of California, Los Angeles, California, USA. 2. Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA. 3. Division of Cardiothoracic Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA; Division of Cardiothoracic Surgery, Department of Surgery, University of California-Davis, Sacramento, California, USA. 4. Division of Cardiothoracic Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA. 5. Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA. Electronic address: raslana@ohsu.edu.
Abstract
BACKGROUND: Myelomeningocele patients with shunt-dependent hydrocephalus often require multiple shunt revisions, eventually exhausting first-line distal diversion sites. Ventriculoatrial (VA) shunts are used less commonly than ventriculoperitoneal shunts, but knowledge of their use and complications is important to the neurosurgeon's armamentarium. VA shunts differ from ventriculoperitoneal and ventriculopleural shunts in that the ideal distal catheter target is an anatomically small area in comparison with the peritoneal and pleural cavities. CASE DESCRIPTION: Here we present a case of an adult myelomeningocele patient who experienced migration of a distal VA shunt catheter. A minimally invasive revision technique that does not require recannulation of the vessels or open manipulation of the shunt is presented. CONCLUSIONS: This is the fourth reported instance of successful distal revision of a migrated VA shunt catheter via transfemoral endovascular snaring. Knowledge of the opportunities afforded by this technique and collaboration with thoracic surgery colleagues is of benefit to all neurosurgeons.
BACKGROUND: Myelomeningocele patients with shunt-dependent hydrocephalus often require multiple shunt revisions, eventually exhausting first-line distal diversion sites. Ventriculoatrial (VA) shunts are used less commonly than ventriculoperitoneal shunts, but knowledge of their use and complications is important to the neurosurgeon's armamentarium. VA shunts differ from ventriculoperitoneal and ventriculopleural shunts in that the ideal distal catheter target is an anatomically small area in comparison with the peritoneal and pleural cavities. CASE DESCRIPTION: Here we present a case of an adult myelomeningocele patient who experienced migration of a distal VA shunt catheter. A minimally invasive revision technique that does not require recannulation of the vessels or open manipulation of the shunt is presented. CONCLUSIONS: This is the fourth reported instance of successful distal revision of a migrated VA shunt catheter via transfemoral endovascular snaring. Knowledge of the opportunities afforded by this technique and collaboration with thoracic surgery colleagues is of benefit to all neurosurgeons.