title: Ultrasound guided placement of the distal catheter in paediatric ventriculoatrial shunts-an appraisal of efficacy and complications.
abstract: OBJECTIVE
  Ventriculoatrial (VA) shunts are commonly used as a second-line treatment of hydrocephalus when the peritoneum is an unsuitable site for the distal catheter. Many centres now utilise ultrasound and interventional radiology techniques to aid placement of the distal catheter. The purpose of this study was to conduct a contemporary audit of VA shunting in children using interventional radiology techniques for placement of the distal catheter.
  
  
  METHODS
  A retrospective analysis of all patients who had VA shunts inserted between June 2000 and June 2010 was conducted using a prospectively updated surgical database and case notes review.
  
  
  RESULTS
  Ninety-four VA shunts were inserted in 38 patients. Thirty-seven patients had been treated initially with ventriculoperitoneal (VP) shunts. Twenty-two patients required at least 1 shunt revision (58 %). The 6-month, 1- and 2-year shunt survival rates were 53, 43 and 27 %, respectively. Blockage was the commonest reason for shunt failure (68 %). The site of failure was proximal (ventricular catheter +/- valve) in 32 % and distal (atrial catheter) in 21 % of cases. The overall infection rate was 6 % per procedure and 11 % per patient. There were 7 deaths, of which 3 were shunt related.
  
  
  CONCLUSIONS
  VA shunting provides a viable second-line option for shunt placement in complex hydrocephalus. The causes of shunt failure (blockage, infection and equipment failure) are similar to VP shunting though shunt survival rates are inferior to VP shunts. Ultrasound guided VA shunt placement provides a relatively safe, second-line alternative to the placement of a ventriculoperitoneal shunt when this route is unsuitable.
authors.affiliation: Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Clark
authors.affiliation: Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK.
authors.forename: Aabir
authors.initials: A
authors.lastname: Chakraborty
authors.affiliation: Department of Interventional Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Roebuck
authors.affiliation: Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK. dominic.thompson@gosh.nhs.uk.
authors.forename: Dominic N P
authors.initials: DN
authors.lastname: Thompson
mesh_terms: D000293:Adolescent; D057785:Catheters / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004868:Equipment Failure / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging* / Q000601:surgery*; D007223:Infant; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D010537:Peritoneum / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D055815:Young Adult
keywords: CSF shunt; Cerebrospinal fluid; Hydrocephalus; Paediatric; Ventriculoatrial