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Background: Ventriculoperitoneal (VP)shunt has been widely utilized in the treatment of hydrocephalus as a safe option but there is recent literature evidence that ventricularatrial(VA) shunt is not as notorious for its complications as proclaimed, to analyse and report our success with this procedure we conducted our study.Methods: A total of 64 patients undergoing VA shunting were included in this case series study conducted at RMC and Allied hospital Rawalpindi. The data was collected over a period of 4 years from, 1st June 2010 to 1st June 2015.Result: Our study included 64 patients who underwent a VA shunt for hydrocephalus. Their age ranged from 25 to 75 years.Most of the patients were females(60%).The following complications were observed with 2(3.12%) patients having blockage of the shunt at the neck, 3(4.68%)suffered from glomerulonephritis,2(3.1%) had post-operative neck hematoma,4(6.25%) had wound infection, short lower end of the tube was found in 3(4.68%),migrated lower end(into the subclavian) was seen in 1(1.56%). Mortality was 1(1.56%).These results were comparable to other studies.Conclusion: Neurosurgeons have been doinga VA shunt as a second procedure, aftera VP shunt when the need due to a complication was encountered. We however share our experience regardingventriculo-atrial shunting, as first choice procedure, because of its low incidence of shunt blockage unlike VP shunt, which has high rate of shunt blockage and therefore warrants repeated surgeries.Keywords: VAShunt,VPshunt,Hydrocephalus,Glomerlulonephritis,Neck hematomaJ Ayub Med Coll Abbottabad 2015;27(4):817–20INTRODUCTIONHydrocephalus is excessive accumulation of CSF (cerebrospinal fluid) in the ventricular chain.It can be due to many causes such as space occupying lesion, infections, inflammatory conditions, traumatic causes or congenital disorders that may impede the drainage of CSF. To divert excessive CSF and decrease the intracranial pressure various modalities that can be utilized are external ventricular drainage, ventriculoperitoneal (VP) shunt,ventricularatrial(VA)shunt, Lumbar-peritoneal(LP) shunts; among the above, VP shunt is commonly utilized to treat hydrocephalus but VP shunt blockage; remains a significant cause of morbidity and therefore an obstacle in the successful outcome of hydrocephalus. Although less common then a VP shunt, VA shunt is still used to manage hydrocephalus.1Ventricularatrial shunts were first used in 1952 as standard treatment for hydrocephalus.2Various sites namely cardiac atrium, pleural cavity, ureter, fallopian tubes, bladder and gastric lumen have been used as alternative for distal CSF flow, particularly in situations when serosal surface of abdomen is not conducive for absorption.3Treatment of hydrocephalus, after multiple VP shunt failures, due to blockage; remains a challenge. We on the other hand, used a VA shunt as primary procedure to see its efficacy as literature shows that its rate of blockage is less than VP shunt.4Ventricularatrialshunts are generally avoided due to their high rate of mortality, morbidity and because of technical/operative difficulties.Howeversome recent reports show that VA shunt is now becoming a popular alternative2, irrespective of whether a VP shunt was utilized initially for the treatment of hydrocephalus or not.Newer techniques have been devised and advanced monitoring methods have been instituted to improve the efficacy of this treatment as chang et al.,described in his minimally invasive percutaneous technique,utilizing trans-oesophageal echocardiogram and the endovascular placement was done by Gonzales et al.,we however used the conventional open techniquein which a transverse incision is made in the neck below the mandible and blunt dissection done to expose the internal jugular vein.5The goal of our study was to share our experience regarding VA shunt, which thoughrequires surgical skills, yet is an important alternative in cases where VP shunting may not be possible or appropriate. MATERIAL AND METHODS This was a descriptive case series in which VA shunt, was applied in 64 patients who suffered from hydrocephalus; this was done by the department of neurosurgery at District Head quarter hospital and
Dr Nadeem Akhtar, dil Aziz Khan, , Muhammad Yousaf. (2015) EXPERIENCE AND OUTCOME OF VENTRICULAR-ATRIAL SHUNT: A MULTI CENTRE STUDY, JOURNAL OF AYUB MEDICAL COLLEGE ABBOTTABAD, Volume 27, Issue 4.
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