Successful ventricle to direct heart shunt placement as a salvage cerebrospinal fluid diversion technique - Case report

Eric M. Thompson, Stephen G. Giles, Howard Song, Zachary N. Litvack, Kiarash J. Golshani, Andrew N. Nemecek

    Research output: Contribution to journalArticle

    2 Citations (Scopus)

    Abstract

    The authors report a complex case in a 35-year-old woman who underwent shunt placement at birth for myelomeningocele. She had previously undergone more than 30 shunt revisions, with placement of the distal catheter in the peritoneum multiple times, and also in the pleura, the gall bladder, and the upper venous system. All shunts had failed and the possible placement sites were now anatomically hostile. A median sternotomy was performed as the next option. The catheter was placed directly into the appendage of the right atrium and secured with a pursestring suture. One month postoperatively, the patient presented with a large pericardial effusion after the distal catheter migrated out of the atrium and into the pericardial space. A repeat sternotomy was performed to drain the pericardial CSF collection. The catheter was reinserted into the atrial appendage, and a tunnel was created in the atrial wall to fix the device more securely. At 1 year postoperatively, the patient had no further symptoms of shunt obstruction or cardiac tamponade, and imaging studies suggested that the shunt system was functional. The authors report the first successful ventricle to direct heart shunt in an adult.

    Original languageEnglish (US)
    Pages (from-to)521-524
    Number of pages4
    JournalJournal of Neurosurgery: Pediatrics
    Volume3
    Issue number6
    DOIs
    StatePublished - Jun 2009

    Fingerprint

    Cerebrospinal Fluid
    Catheters
    Sternotomy
    Atrial Appendage
    Meningomyelocele
    Cardiac Tamponade
    Pericardial Effusion
    Pleura
    Peritoneum
    Pericardium
    Heart Atria
    Sutures
    Urinary Bladder
    Parturition
    Equipment and Supplies

    Keywords

    • Cerebrospinal fluid diversion
    • Direct heart shunt
    • Hydrocephalus salvage treatment

    ASJC Scopus subject areas

    • Clinical Neurology
    • Surgery
    • Pediatrics, Perinatology, and Child Health

    Cite this

    Successful ventricle to direct heart shunt placement as a salvage cerebrospinal fluid diversion technique - Case report. / Thompson, Eric M.; Giles, Stephen G.; Song, Howard; Litvack, Zachary N.; Golshani, Kiarash J.; Nemecek, Andrew N.

    In: Journal of Neurosurgery: Pediatrics, Vol. 3, No. 6, 06.2009, p. 521-524.

    Research output: Contribution to journalArticle

    Thompson, Eric M. ; Giles, Stephen G. ; Song, Howard ; Litvack, Zachary N. ; Golshani, Kiarash J. ; Nemecek, Andrew N. / Successful ventricle to direct heart shunt placement as a salvage cerebrospinal fluid diversion technique - Case report. In: Journal of Neurosurgery: Pediatrics. 2009 ; Vol. 3, No. 6. pp. 521-524.
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