Distal Ventriculoatrial Shunt Revision in Adult Myelomeningocele Patient Performed via Endovascular Transvenous Approach

• Published in: World neurosurgery 2019-01, Vol.121, p.24-27
• Main Authors: Rao, Abigail J., Teton, Zoe, Rodriguez, Victor, Tieu, Brandon H., Raslan, Ahmed M.
• Format: Article
• Language: English
• Subjects: Cerebrospinal fluid diversion; Endovascular; Hydrocephalus; Myelomeningocele; Revision; Ventriculoatrial shunt
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.09.129

Myelomeningocele patients with shunt-dependent hydrocephalus often require multiple shunt revisions, eventually exhausting first-line distal diversion sites. Ventriculoatrial (VA) shunts are used less commonly than ventriculoperitoneal shunts, but knowledge of their use and complications is important to the neurosurgeon's armamentarium. VA shunts differ from ventriculoperitoneal and ventriculopleural shunts in that the ideal distal catheter target is an anatomically small area in comparison with the peritoneal and pleural cavities. Here we present a case of an adult myelomeningocele patient who experienced migration of a distal VA shunt catheter. A minimally invasive revision technique that does not require recannulation of the vessels or open manipulation of the shunt is presented. This is the fourth reported instance of successful distal revision of a migrated VA shunt catheter via transfemoral endovascular snaring. Knowledge of the opportunities afforded by this technique and collaboration with thoracic surgery colleagues is of benefit to all neurosurgeons. •Myelomeningocele patients typically have shunt-dependent hydrocephalus.•Ventriculoatrial (VA) shunts are an important option for cerebrospinal fluid diversion.•Reported is a unique case of distal VA shunt revision via endovascular snare.•This technique allows for minimally invasive VA shunt revision.