Ultrasound-guided percutaneous ventriculo-atrial shunt placement : Technical nuances with video demonstration

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Muhammad , S , Koski-Palkén , A & Niemelä , M 2019 , ' Ultrasound-guided percutaneous ventriculo-atrial shunt placement : Technical nuances with video demonstration ' , Interdisciplinary neurosurgery: advanced techniques and case management , vol. 17 , pp. 40-41 . https://doi.org/10.1016/j.inat.2019.02.007

Title: Ultrasound-guided percutaneous ventriculo-atrial shunt placement : Technical nuances with video demonstration
Author: Muhammad, Sajjad; Koski-Palkén, Anniina; Niemelä, Mika
Contributor: University of Helsinki, HUS Neurocenter
University of Helsinki, HUS Neurocenter
University of Helsinki, Department of Neurosciences
Date: 2019-09
Language: eng
Number of pages: 2
Belongs to series: Interdisciplinary neurosurgery: advanced techniques and case management
ISSN: 2214-7519
URI: http://hdl.handle.net/10138/303941
Abstract: Hydrocephalic patients with abdominal pathologies often need a ventriculo-atrial (VA) shunt placement. Cutdown on the internal jugular vein has historically been used to insert a VA shunt. This technique is more time consuming and has greater complications. Less invasive methods, such as ultrasound-guided percutaneous VA shunt placement provides greater comfort for surgeon, is more rapid, and has fewer complications. However, this technique has not been demonstrated on video. Here we demonstrate ultrasound-guided and ECG-aided VA shunt catheter placement in a 70-year-old patient with normal pressure hydrocephalus. The internal jugular vein is punctured under ultrasound guidance with an 18-gauge needle. A guidewire is introduced through the needle, the needle is removed, and a small skin incision is placed at the entry point of the guidewire. A skin dilator with a sheath introducer is advanced to the vein using the guidewire and the guidewire is thereafter removed. An atrial shunt catheter (e.g. Codman (R) Medos (R) Atrial catheter) filled with sterile water is inserted through the sheath. The sheath is removed and a syringe filled with sterile aqua is connected to the catheter with a metal tip. The ECG connection of the right upper limb is connected to the tip of syringe to adjust for the optimal depth of the catheter under ECG guidance (point of highest p-wave amplitude). The catheter is clamped and tunneled to reach the site for the valve on the scalp. The ventricle catheter is placed at the Kocher point and connected to the valve (Video 1). Conclusion: Ultrasound-guided VA shunt placement is safe, comfortable, rapid, and has a reduced rate of complications.
Subject: Ventriculo-atrial shunt placement
Surgery
Technical aspects
Video demonstration
3126 Surgery, anesthesiology, intensive care, radiology
3112 Neurosciences
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