Ventriculo-Atrial Shunt via the Innominate Vein: A Novel Approach in Bilateral Internal Jugular Vein Stenosis

Ventriculoatrial (VA) shunts remain as one of the valid options for the treatment of hydrocephalus, especially in patients in whom ventriculoperitoneal (VP) shunts fail. Atrial shunt revision surgeries are sometimes difficult due to venous occlusion and are impossible in bilateral stenosis or thrombosis of internal jugular vein. There is not substitute technique in these situations. Here, a new technique for the insertion of ventriculoatrial shunt via innominate vein in bilateral internal jugular vein stenosis is described.Case Report:We performed a new technique for treating a 20-years old man with dysfunctional bilateral ventriculo-atrial shunt. The surgery was performed with cooperation of vascular surgery and neurosurgery teams. Initially, previous shunt was removed by neurosurgery team and patient was underwent implantation of flow-regulating shunt OSVII (Orbis Sigma Valve). Then, partial sternotomy was done by team of vascular surgery and innominate vein was explored. Following purse string suture and perforation of vein, end of catheter was inserted in the innominate vein and the tip of catheter was placed in the right atrium. Correct positioning of the distal end of the catheter in the right atrium was evaluated by C-arm portable radiography.This technique should be considered for use in patients with a history of failed ventriculo-atrial shunts due to internal jugular vein occlusion.