Sheth Sameer A, McGirt Matthew, Woodworth Graeme, Wang Paul, Rigamonti Daniele
David Geffen School of Medicine at the University of California, Los Angeles Los Angeles, CA 90024, USA.
Neurol Res. 2009 Apr;31(3):280-2. doi: 10.1179/174313209X380784. Epub 2008 Nov 26.
Ventriculo-atrial (VA) shunts are often used for CSF diversion in situations involving abdominal pathology that preclude the use of ventriculo-peritoneal shunts. Distal (venous) catheters of VA shunts have historically been inserted using a cut-down on the internal jugular vein (IJV). Less invasive placement of atrial catheters may minimize operative times and attenuate post-operative incisional discomfort. We describe a method for atrial catheter placement using ultrasound guidance to visualize the IJV and facilitate percutaneous venous puncture in 17 adult patients (23 total insertions) undergoing treatment for hydrocephalus or pseudotumor cerebri. The IJV and carotid artery were visualized by ultrasound in 23 (100%) cases. Venous penetration and successful atrial catheter placement was achieved on the first attempt in 23 (100%) cases. Pneumothorax, carotid artery puncture or need for venous cut-down occurred in no cases. The utilization of ultrasound guidance for distal VA shunt catheter insertion may increase comfort with this procedure and ultimately decrease complication rate and operative time.
脑室-心房（VA）分流术常用于因腹部病变而无法使用脑室-腹腔分流术的脑脊液引流情况。VA分流术的远端（静脉）导管过去常通过切开颈内静脉（IJV）进行插入。心房导管的微创放置可缩短手术时间并减轻术后切口不适。我们描述了一种在17例接受脑积水或假性脑瘤治疗的成年患者（共进行23次插入）中，使用超声引导来可视化IJV并促进经皮静脉穿刺进行心房导管放置的方法。23例（100%）病例中通过超声可清晰显示IJV和颈动脉。23例（100%）病例首次尝试时即实现了静脉穿刺并成功放置心房导管。无一例发生气胸、颈动脉穿刺或需要进行静脉切开。对VA分流术远端导管插入使用超声引导可能会增加该操作的舒适度，并最终降低并发症发生率和手术时间。
