Percutaneous construction of ventriculo-atrial (VA) shunt - Case report.

The commonest method of elective CSF diversion remains ventriculo-peritoneal shunt (VP shunt). But in some circumstances, VP shunts fail repeatedly or becomes unattractive to the neurosurgeon and this calls for exploration of alternatives. For the index case, Ventriculo-atrial (VA) shunt was favoured and the objective in this report is to share experience gathered there from. Learning points serve to highlight the use of VA shunts as a resort in the drainage of cerebrospinal fluid in the case of repeated failures of peritoneal diversion of CSF and to explain our explain our experience with this index case.

Methods: A 54 years old obese woman with previous history of total abdominal hysterectomy was reported. She underwent repeated (three times) revisions of failed peritoneal end of her VP shunt on a background of obstructive hydrocephalus secondary to a posterior fossa tumour (previously excised). Following repeated failure of peritoneal catheter function, she underwent VA shunt and did well. The decision to place a VA shunt was made after careful deliberations. We discuss the peculiarities in placing a VA shunt. Following placement of a VA shunt, improvement was noted in her clinical condition at one week post op and has been sustained at multiple follow up clinic visits.

Conclusions: VA shunts become an option for cerebrospinal fluid drainage when it becomes unequivocally clear in a multidisciplinary setting that the peritoneal catheter is unlikely to work in view of the unfavourable circumstances of the peritoneal cavity.