|LETTERS TO EDITOR
|Year : 2018 | Volume
| Issue : 1 | Page : 127-128
An easy and feasible way of confirming correct placement of ventriculoatrial shunt intraoperatively
Gaurav Singh Tomer1, Keerthi P Nandakumar2, Vikas Chauhan1, Surya Kumar Dube1
1 Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India
2 Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India
|Date of Web Publication||15-Mar-2018|
Surya Kumar Dube
Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Tomer GS, Nandakumar KP, Chauhan V, Dube SK. An easy and feasible way of confirming correct placement of ventriculoatrial shunt intraoperatively. J Anaesthesiol Clin Pharmacol 2018;34:127-8
|How to cite this URL:|
Tomer GS, Nandakumar KP, Chauhan V, Dube SK. An easy and feasible way of confirming correct placement of ventriculoatrial shunt intraoperatively. J Anaesthesiol Clin Pharmacol [serial online] 2018 [cited 2020 Feb 23];34:127-8. Available from: http://www.joacp.org/text.asp?2018/34/1/127/227569
Ventriculoatrial (VA) shunt channels cerebrospinal fluid (CSF) from the ventricle of the brain into the right atrium (RA) of the heart. It is a less commonly performed CSF diversion procedure and is often indicated in conditions where repetitive shunt revisions may be required due to ventriculoperitoneal shunt obstruction, infection, or migration. There are a variety of techniques suggested to confirm position of catheter tip into RA such as transesophageal echocardiography (TEE), chest X-ray, and pressure waveform. The least reliable among these is chest X-ray.
Exposure to ionizing radiation during surgical intervention in a growing child for prolong duration may be hazardous as children are more radiosensitive than adults (i.e., increased cancer risk per unit dose of ionizing radiation). TEE is another method to confirm the catheter position. The shortcomings of TEE are high cost, insertion, and interpretation in a child.
We applied pressure waveform concept (useful for correct positioning of central venous pressure catheter) for correct VA shunt catheter placement., We connected the distal end of VA shunt to a pressure transducer via a fluid filled pressure monitoring line and obtained continuous pressure tracing according to the depth of VA shunt lying inside the chambers of heart. Initially, we obtained a right ventricular type of pressure tracing immediately following insertion of VA shunt catheter, and then it was withdrawn gradually to get a right arterial pressure tracing. With this report, here we highlight the importance of pressure waveform monitoring as a safe alternative to fluoroscopy/TEE to guide the correct placement of VA shunt intraoperatively.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Yavuz C, Demirtas S, Caliskan A, Kamasak K, Karahan O, Guclu O, et al
. Reasons, procedures, and outcomes in ventriculoatrial shunts: A single-center experience. Surg Neurol Int 2013;4:10.
] [Full text]
Camarata PJ, Haines SJ. Ventriculoatrial shunting. In: Rengachary SS, Wilkins RH, editors. Neurosurgical Operative Atlas. Chicago: The American Association of Neurological Surgeons; 1993. p. 231-9.
Machinis TG, Fountas KN, Hudson J, Robinson JS, Troup EC. Accurate placement of the distal end of a ventriculoatrial shunt with the aid of real-time transesophageal echocardiography. Technical note. J Neurosurg 2006;105:153-6.
Cantu RC, Mark VH, Austen WG. Accurate placement of the distal end of a ventriculo-atrial shunt catheter using vascular pressure changes. Technical note. J Neurosurg 1967;27:584-6.
Myles LM, Neil-Dwyer G. Ventriculo-atrial shunt insertion: Pressure monitoring as an aid to accurate placement. Br J Neurosurg 2000;14:462-3.