Ikeda Kensuke, Fujii Shoko, Maruyama Keisuke, Yoshida Hiroki, Seiya Yosuke, Takahashi Shoichi, Kagiwata Hiroki, Nagai Jun, Onoda Ryo, Okada Kei, Noguchi Akio, Nakatomi Hirofumi
Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan.
Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Tokyo, Japan.
J Neurosurg Case Lessons. 2024 Dec 16;8(25). doi: 10.3171/CASE24518.
A ventriculoatrial (VA) shunt is an alternative to a ventriculoperitoneal (VP) shunt for managing hydrocephalus, especially when VP shunt insertion is not feasible. Despite its decline in use, the VA shunt remains vital for certain patients. This report highlights a rare complication of bilateral vocal cord paralysis following VA shunt insertion for hydrocephalus secondary to subarachnoid hemorrhage.
A woman in her 60s with a history of hypertension and giant liver cysts developed hydrocephalus after a subarachnoid hemorrhage. Because of her abdominal anatomical problems, VA shunt insertion assisted by transesophageal echocardiography (TEE) was chosen. Postoperatively, she experienced sudden dyspnea and upper airway stridor, diagnosed as bilateral vocal cord paralysis, necessitating an emergency tracheostomy. Gradual improvement was noted over the following month.
Bilateral vocal cord paralysis can be a potential complication of TEE-assisted VA shunt procedures. To mitigate this risk, preoperative assessments of vocal cord function and swallowing are recommended. Alternatives to TEE, such as fluoroscopy or smaller probes, can be considered for patients with risk factors, including severe subarachnoid hemorrhage and prolonged intubation. https://thejns.org/doi/10.3171/CASE24518.
脑室-心房（VA）分流术是治疗脑积水的一种替代脑室-腹腔（VP）分流术的方法，尤其是在无法进行VP分流术置入时。尽管其使用有所减少，但VA分流术对某些患者仍然至关重要。本报告强调了在因蛛网膜下腔出血继发脑积水而进行VA分流术置入后发生双侧声带麻痹这一罕见并发症。
一名60多岁有高血压和巨大肝囊肿病史的女性在蛛网膜下腔出血后发生脑积水。由于其腹部解剖问题，选择了经食管超声心动图（TEE）辅助下的VA分流术置入。术后，她突然出现呼吸困难和上气道喘鸣，诊断为双侧声带麻痹，需要紧急气管切开术。在接下来的一个月里病情逐渐好转。
双侧声带麻痹可能是TEE辅助VA分流术的潜在并发症。为降低此风险，建议术前评估声带功能和吞咽情况。对于有危险因素的患者，包括严重蛛网膜下腔出血和长时间插管患者，可考虑使用TEE的替代方法，如荧光透视或较小的探头。https://thejns.org/doi/10.3171/CASE24518
