Ventriculovenous shunt to the proximal segment of a ligated neck vein. A new surgical technique for shunting the cerebrospinal fluid to the venous circulation (preliminary report)

Abstract

The author proposes ventriculovenous shunts to a ligated neck vein (external jugular or facial) for the treatment of hydrocephalus. He postulates that the ligated neck vein is filled with CSF and becomes an extension of the shunt tube, which prevents venous thrombosis. The pressure of the shunt at the venous tube was shown to be about 90 mm H2O avoiding excessive ventricular decompression. Reflux of blood to the ventricle can occur if the infant's cranium is compressible and must be prevented by protecting the cranium from external pressure with a bandage or helmet or by incorporating a one-way valve into the shunt. 31 cases of advanced hydrocephalus were thus treated during a 4-year period. Ages ranged from 15 days to 55 years, the cranium was rigid in 13 and compressible in 18. A valve was used in only two cases. Shunts were patent 7-10 days after surgery, as shown at autopsies in two early postoperative deaths. In two cases meningitis occurred, one of them died. The shunt was removed in one case on account of meningitis and in 4 cases due to cervical CSF leakage. The former and three of the latter were reoperated with success. Three cases had distal shunt obstruction, two due to kinking of the tube, and one due to reflux of blood. One of the former died. 23 patients benefited from the operation, 5 of which were operated on twice. The follow-up period was from 0.5-44 months (average 11.5 months). The last two cases were operated on using one-way valve and a spiral wire in the venous segment of the tube. They are well 2 and 3 months, respectively, following surgery.