Vegetation of Ventriculoatrial Shunt Managed via Multidisciplinary Surgical Approach

World Neurosurg. 2020 Dec:144:15-18. doi: 10.1016/j.wneu.2020.08.040. Epub 2020 Aug 11.

Abstract

Introduction: The popularity of the ventriculoatrial shunt as a means for cerebrospinal fluid diversion was temporally limited, overcome by the success of the peritoneum as a site for distal drainage. Nevertheless, it remains an important tool for patients for whom ventriculoperitoneal shunting is not an option.

Clinical presentation: We present the case of a 9-year-old girl with a ventriculoatrial shunt, who had undergone multiple revisions. Ultimately, she suffered a wound dehiscence, resulting in infectious seeding of the bloodstream and formation of a thrombus, presumed granuloma, at the tip of the distal catheter in the right atrium. She underwent successful removal of the lesion via an open approach by our cardiothoracic colleagues.

Discussion: Previous authors have noted a high number of mortalities as a result of these lesions. A collaborative approach resulted in a successful outcome for our patient. Although limited in utility today, the ventriculoatrial shunt remains a common procedure for neurosurgeons today.

Conclusion: Recognizing the potential for atrial thrombus formation and using a team approach can help avoid a poor outcome.

Keywords: Cardiac surgery; Cerebrospinal fluid disorders; Infection; Ventriculoatrial shunts.

Publication types

  • Case Reports

MeSH terms

  • Cerebrospinal Fluid Shunts / adverse effects*
  • Child
  • Female
  • Heart Atria / diagnostic imaging*
  • Heart Atria / microbiology
  • Heart Atria / surgery*
  • Humans
  • Prosthesis Failure / adverse effects*
  • Prosthesis-Related Infections / diagnostic imaging*
  • Prosthesis-Related Infections / surgery*
  • Thrombosis / diagnostic imaging
  • Thrombosis / etiology
  • Thrombosis / surgery