title: Use of tissue plasminogen activator in the treatment of shunt blockage secondary to intraventricular haemorrhage.
abstract: A 51-year-old woman with a history of idiopathic aqueduct stenosis, treated initially with insertion of a ventriculo peritoneal shunt, presented to our institution with shunt dysfunction. She had previously undergone multiple shunt revisions for shunt infection, shunt blockage and low-pressure symptoms, most recently with conversion to a ventriculo atrial (VA) shunt. Her VA shunt was again revised, with replacement of the ventricular catheter, however surgery was complicated by a large intraventricular haemorrhage (IVH) requiring placement of an external ventricular drain (EVD). Prior to eventual removal of her EVD it was determined that the VA shunt had blocked as a result of the IVH. Subsequently alteplase, a recombinant tissue plasminogen activator (tPA), was administered into the shunt reservoir, resulting in successful return of shunt function, therefore avoiding the need for further shunt revision. This is the first description of the use of tPA to unblock a shunt obstructed by blood.
authors: Department of Neurosurgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3050, Australia. Electronic address: jones.jordanj@gmail.com.
authors: J
authors: J
authors: Jones
authors: Department of Neurosurgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3050, Australia.
authors: P
authors: P
authors: Schweder
authors: Department of Neurosurgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3050, Australia; Department of Surgery, University of Melbourne, Royal Parade, Parkville, VIC 3010, Australia.
authors: K J
authors: KJ
authors: Drummond
authors: Department of Neurosurgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3050, Australia; Department of Surgery, University of Melbourne, Royal Parade, Parkville, VIC 3010, Australia.
authors: A H
authors: AH
authors: Kaye
mesh_terms: D002543:Cerebral Hemorrhage / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D002552:Cerebral Ventricles / Q000473:pathology / Q000601:surgery*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D008875:Middle Aged; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000494:pharmacology*; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*
chemical_list: D005343:Fibrinolytic Agents; C067262:PLAT protein, human; D010959:Tissue Plasminogen Activator
keywords: Hydrocephalus; Intraventricular haemorrhage; Shunt obstruction; Tissue plasminogen activator; Ventriculo atrial shunt; Ventriculo peritoneal shunt blockage