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Journal of Korean Neurosurgical Society 1980;9(2): 587-594.
A Clinical Analysis of the Ventriculoatrial Shunts in Hydrocephalus.
Duk Yong Kim, Hae Dong Jho, Yung Rak Yoo, Nam Kyu Kim, Hwan Yung Chung
Department of Neurosurgery, School of Medicine, Hanyang University, Seoul, Korea.
The ventriculoatial shunt consists of diverting the cerebrospinal fluid from one lateral ventricle to the right atrium of the heart by means of a subcutaneous valve regulated drainage system. Of the numerous drainage systems so far devised, two, Holter and Pudenz, can be cited as having received widespread acceptance. This study is a clinical investigation of the 18 cases of ventriculoatrial shunts performed at Hanyang University Hospital between May 1972 and December 1978. Of them 17 cases and the Holter System, and one the Pudenz System. Ventricular catheter tip was placed in the frontal horn and cardiac catheter tip in the upper margin of the 6th thoracic vertebra. Postoperatively immediate neurological improvement usually took place in most instances. However, four complications developed. One of them was ventricular catheter obstruction with small brain tissue particles which was removed by revision. The other ventricular catheter obstruction was the result of thickening of the cerebral mantle and reduction in size of the ventricle. This shunt was made patient again byshortening the ventricular catheter to place inside the shrunk ventricle. The third was shunt infection. In this case, the whole shunting system was removed and reapplied into a peritoneal route, after infection subsided. The last was postoperative epidural hematoma developed due to incomplete hemostasis which required emergency surgery. Shunt obstruction was said as an inevitable complication in many instances, but it may easily restored by revision. Shunt infection was also surgically amenable. Although the necessity of revision was inevitable in some instances, ventriculoatrial shunt still seemed to be the most effective method so far devised.
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