Artikel
Insertion of the atrial catheter through the external jugular vein in ventriculoatrial shunt for idiopathic normal pressure hydrocephalus
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Autoren
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K. Takagi
- Department of Neurosurgery, Chiba-Kashiwa Tanaka Hospital, Kashiwa, Japan
| Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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Objective: Cerebrospinal fluid shunt surgery is the only therapeutic modality for idiopathic normal pressure hydrocephalus (iNPH). As for the types of shunt surgery, the ventriculo-peritoneal shunt (VP shunt) is most frequently applied and ventriculo-atrial shunt (VA shunt) has almost been abandoned. However, the VA shunt is still an important method when the peritoneal membrane has adhesions because of previous abdominal surgery. Furthermore, VA shunt has many advantages such as; (1) narrow operative field that can reduce infection rate, (2) no influence of obesity, (3) no influence of intra-abdominal high pressure that may be a cause of shunt dysfunction, (4) low intra-atrial pressure may guarantee constant flow, and (5) low flow resistance because of short catheter length. I have performed 284 VA shunts without shunt infection. I have made it a rule to insert the atrial catheter directly through internal jugular vein. However, it was not easy to puncture internal jugular vein in a small number of cases. The external jugular vein (EJV) is used to keep a central vein and it was used in pediatric shunt surgery (Neurosurgery 14; 74, 1984). I used the external jugular vein in the VA shunt for iNPH. The purpose of this study is to show the results of this procedure.
Methods: In a series of 284 VA shunts, EJV was used in only 6 cases (male : female = 5 : 1). All of them were operated on because of gait disturbance. They also had dementia or urinary incontinence. The post-operative chest roentgenogram was examined to confirm the position of the atrial catheter tip and neurological signs were evaluated.
Results: The mean age was 77.8 years old and the mean operation time was 35.3 minutes. There were no post-operative complications. Atrial catheter tips were in the vena cava superior in 5 cases. In 2 cases, the catheter tips were not in the vena cava superior or in the atrium. However, gait disturbance was improved in all cases.
Conclusions: The EJV is easy to find and insert. The insertion of the atrial catheter through EJV was useful in VA shunts. The results of this study indicate that the position of the atrial catheter tip may not influence the results of the VA shunt. It is recommended to use the EJV when the preservation of the internal jugular vein is difficult.
