There are a number of choices for placement of the distal catheter during ventricular shunting for hydrocephalic patients. In very rare instances, patients with multiple revisions can no longer have their shunt placed in the routine locations. We describe the placement of the distal catheter into the atrium through direct cardiac access, a technique described decades ago but rarely needed in clinical practice. This can be a useful location in the limited number of patients who have exhausted other more routine locations.

Keywords:
Hydrocephalus, Vascular shunt, Direct cardia shunt
1.
Nulsen FE, Spitz EB: Treatment of hydrocephalus by direct shunt from ventricle to jugular vein. Surg Forum 1951.
2.
Boockvar JA, Loudon W, Sutton LN: Development of the Spitz-Holter valve in Philadelphia. J Neurosurg 2001;95:145–147.
3.
Bondurant CP, Jimenez DF: Epidemiology of cerebrospinal fluid shunting. Pediatr Neurosurg 1995;23:254–258.
4.
Drake JM, Kestle JR, Milner R, Cinalli G, Boop F, Piatt J Jr, Haines S, Schiff SJ, Cochrane DD, Steinbok P, MacNeil N: Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery 1998;43:294–303.
5.
Di Rocco C, Marchese E, Velardi F: A survey of the first complication of newly implanted CSF shunt devices for the treatment of nontumoral hydrocephalus. Cooperative survey of the 1991–1992 Education Committee of the ISPN. Childs Nerv Syst 1994;10:321–327.
6.
Piatt JH Jr, Carlson CV: A search for determinants of cerebrospinal fluid shunt survival: retrospective analysis of a 14-year institutional experience. Pediatr Neurosurg 1993;19:233–241.
7.
Venes JL, Shaw RK: Ventriculopleural shunting in the management of hydrocephalus. Child’s Brain 1979;5:45–50.
8.
Stringel G, Turner M, Crase T: Ventriculo-gallbladder shunts in children. Childs Nerv Syst 1993;9:331–333.
9.
Kempe LG, Blaylock R: Ventriculolymphatic shunt. J Neurosurg 1977;47:86–95.
10.
Weiss MH, Jane JA, Apuzzo ML, Heiden JS, Kurze T: Ventriculogastrostomy, an alternative means for CSF diversion. A preliminary study. Bull Los Angeles Neurol Soc 1975;40:140–144.
11.
Matson DD: Current treatment of infantile hydrocephalus. N Engl J Med 1956;255:933–936.
12.
Ames RH: Ventriculo-peritoneal shunts in the management of hydrocephalus. J Neurosurg 1967;27:525–529.
13.
Raimondi AJ, Matsumoto S: A simplified technique for performing the ventriculo-peritoneal shunt. Technical note. J Neurosurg 1967;26:357–360.
14.
West KW, Turner MK, Vane DW, Boaz J, Kalsbeck J, Grosfeld JL: Ventricular gallbladder shunts: an alternative procedure in hydrocephalus. J Pediatr Surg 1987;22:609–612.
15.
Philips MF, Schwartz SB, Soutter AD, Sutton LN: Ventriculofemoroatrial shunt: a viable alternative for the treatment of hydrocephalus. Technical note. J Neurosurg 1997;86:1063–1066.
16.
Tomita T: Placement of a ventriculoatrial shunt using external jugular catheterization. Technical note. Neurosurgery 1984;14:74–75.
17.
Milhorat TH, McClenathan JE: Direct cardiac shunt for hydrocephalus of infancy and childhood. Technical note. J Neurosurg 1975;42:605–608.
18.
Morello A, Corona C: Results of ventriculo-auriculostomy in 45 cases of congenital hydrocephalus. Min Pediatr 1969;21:1595–1597.
19.
Overton MC, 3rd, Kirksey TD, Snodgrass SR, Nelson WJ, Derrick JR: Direct atrial and vena caval shunting procedures for hydrocephalus. Surg Gynecol Obstet 1967;124:819–825.
20.
Pestel M: New technic of shunt of cerebrospinal fluid in the right auricle: ventriculo-auriculostomy. Presse Méd 1957;65:22.
21.
Pudenz RH, Russell FE, Hurd AH, Shelden CH: Ventriculo-auriculostomy; a technique for shunting cerebrospinal fluid into the right auricle; preliminary report. J Neurosurg 1957;14:171–179.
22.
Weinman D, Paul AT: Ventriculoauriculostomy for infantile hydrocephalus using a direct cardiac approach. Technical note. J Neurosurg 1967;27:471–474.
23.
Martin JE, Keating RF, Cogen PH, Midgley FM: Long-term follow-up of direct heart shunts in the management of hydrocephalus. Pediatr Neurosurg 2003;38:94–97.
24.
Szczerbicki MR, Michalak M: Echocardiographic placement of cardiac tube in ventriculoatrial shunt. Technical note. J Neurosurg 1996;85:723–724.
© 2012 S. Karger AG, Basel
2012
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.