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What is the cost of Ventriculoatrial Shunt Placement?

  • Posted on- Apr 16, 2018
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The placing of Ventriculoatrial Shunt makes the cerebrospinal fluid (CSF) to flow from the cerebral ventricular system to the atrium of the heart. Ventriculoatrial shunt placement is indicated for hydrocephalus (it is a condition that occurs when fluid builds up in the skull and causes the brain to swell), which is among the most common conditions encountered in neurosurgical practice.

There are multiple potential anatomic configurations for cerebrospinal fluid (CSF) shunts. Generally, a catheter is positioned within the cerebral ventricle (termed the proximal site) and linked to a unidirectional valve that limits the flow based on pressure or flow rate.

The outflow port of the valve is connected to another length of the catheter, which is passed to a space within which cerebrospinal fluid (CSF) can be absorbed.

The preferred distal site is the peritoneal space (ventriculoperitoneal shunt), in that this space is generally safely accessible and possesses more than adequate absorptive capacity for the cerebrospinal fluid (CSF) volume produced by a given person.

In some of the cases, the peritoneal space is not complete, which necessitates the use of an alternative distal site. The most common of these alternative sites are the cardiac atrium (Ventriculoatrial shunt) and the pleural space (ventriculopleural shunt).

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The basic consideration in any patient who may undergo Ventriculoatrial shunt placement is whether the patient has symptomatic hydrocephalus that necessitates cerebrospinal fluid (CSF) diversion. If so, the surgeon must rule out the peritoneal space as an acceptable location before selecting the cardiac atrium as the site for the distal catheter.

Common reasons for this placement include previous intra-abdominal infection and scarring due to prior procedures or intra-abdominal pathology. Once the peritoneum is ruled out, the surgeon must verify that the atrium is an acceptable target.

Thrombosis of the feeding jugular or subclavian veins may preclude successful access to the cardiac atrium. Long-term thrombosis or previous instrumentation of these vessels can lead to scarring and permanent occlusion.

Doppler ultrasonography can be used to effectively measure the patency of these large veins if this is of concern. The presence of other intravascular devices (e.g., peripherally inserted central catheter PICC line or indwelling central venous catheter) may complicate placement of the shunt catheter or removal of either catheter.

Other considerations include whether the pleural space might represent an adequate alternative. In children younger than 4 years and in patients with poor pulmonary reserve, the pleura may not provide the necessary cerebrospinal fluid (CSF) absorptive capacity.

Indications

Ventriculoatrial shunt placement is indicated for patients with shunt-dependent hydrocephalus in whom the peritoneum is not an acceptable site for distal catheter placement.

Some surgeons may prefer to position the distal portion of the shunt into the pleural space rather than the cardiac atrium.

An analysis was conducted, and it was found that for normal-pressure hydrocephalus, Ventriculoatrial shunting appeared to be at least as safe as the more commonly used ventriculoperitoneal shunting.

Contraindications

Contraindications for Ventriculoatrial shunt placement include the following:

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  • Bacteremia
  • CSF infection
  • Endocarditis
  • History of immune complex glomerulonephritis (e.g., shunt nephritis)
  • Prothrombotic state
  • Pulmonary hypertension
  • Congestive heart failure

Relative contraindications may include a history of pulmonary embolism and systemic anticoagulation.

What are the tests which have to be performed before placement of Ventriculoatrial Shunt?

Some of the different tests which have to be performed before the placement of Ventriculoatrial Shunt are:

  1. Ultrasound
  2. CT Scans
  3. MRI Scans


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