[Percutaneous ventriculoatrial shunt: experience with 179 cases].

Background And Purpose: The aim of the study was to assess the impact of percutaneous placement of a distal catheter on treatment results in patients with hydrocephalus undergoing ventriculoatrial shunt (VA) implantation.

Material And Methods: This retrospective study included 184 patients aged 14-80 years (mean: 48 yrs) with hydrocephalus who were treated with VA shunt between 1990-2003. In 179 patients the cardiac catheter was introduced by catheterization of the internal jugular vein, rarely the subclavian or external jugular vein, using the Seldinger technique and standard equipment for central vein catheterization. The mean follow-up time was 64 months.

Results: The most frequent complication related to the method used was an incidental puncture of the carotid artery (5% of cases). Pneumothorax was observed in two cases. None of these complications caused permanent sequelae. Early (<6 months) postoperative complications included shunt infection in the neck region (2 cases), impatience of the cardiac catheter (3), disconnection between the outlet and the cardiac catheter with its subsequent migration (1) and kinking of the distal catheter (1). Late (>6 months) complications included infection along the distal catheter (2 cases), occlusion of the cardiac catheter (4) and its disconnection (1). The mean duration of the procedure was 40 minutes.

Conclusions: Percutaneous placement of the cardiac catheter is a safe procedure which shortens the duration of the operation and minimizes tissue traumatization. This method may contribute to a decreased risk of infection. VA shunt with presented modification may be used in those patients for whom implantation of ventriculoperitoneal shunt is contraindicated.