The retrograde ventriculovenous shunts: the El-Shafei retrograde ventriculojugular and ventriculosinus shunts

Abstract

Retrograde ventriculovenous (RVV) shunts utilize the impact pressure of the venous bloodstream to maintain the intraventricular pressure more than the pressure in the draining venous channel and to maintain a continuous flow of cerebrospinal fluid (CSF) to the venous circulation at a rate equal to and dependent upon the rate of its formation regardless of changes in posture or intrathoracic pressure, create impact zones which discourage stagnation and clotting of blood at the venous end of the connection and utilize collapse of the internal jugular vein in the erect posture to prevent siphonage. During the past 40 years, 229 RVV shunts were implanted; 219 of the patients (95.63%) benefited from the shunt, and only 2 of them needed a single shunt revision. The manifestations of increased intracranial pressure disappeared, different degrees of regression of the ventriculomegaly occurred in patients with closed craniums but not in infants and young children with open craniums, and there were no problems related to improper CSF drainage or venous thrombosis. The follow-up period is up to 40 years (mean 9 years 8 months).