Ultrasound-guided percutaneous brachiocephalic vein cannulation for ventriculoatrial shunt placement in a child
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TECHNICAL NOTE
Ultrasound-guided percutaneous brachiocephalic vein cannulation for ventriculoatrial shunt placement in a child Valentina Baro 1
&
Nicola Zadra 2 & Luca Sartori 1 & Luca Denaro 1
Received: 27 March 2020 / Accepted: 31 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objective As far as the ventriculoatrial shunt placement in children is concerned, the percutaneous approach to the internal jugular vein under ultrasonographic control has been hitherto strongly recommended. Unfortunately, children still represent a challenge, having them peculiar characteristics for which the internal jugular vein cannulation shows some disadvantages. Methods In this manuscript, we describe a percutaneous placement of ventriculoatrial shunt via right brachiocephalic vein under intraoperative ultrasonographic control. Conclusions Brachiocephalic vein cannulation in surgery provides notable advantages in paediatric population and it may be considered as the first choice in younger children. Keywords Hydrocephalus . Atrial catheter . Shunt . Brachiocephalic vein . Children
Abbreviations BCV Brachiocephalic vein CSF Cerebrospinal fluid CVC Central venous catheter IJV Internal jugular vein SCV Subclavian vein US Ultrasound VAS Ventriculoatrial shunt
Introduction Ventriculoatrial shunt (VAS) is generally considered a secondline treatment for hydrocephalus, which still represents a challenge in paediatric patients. In recent literature, VAS represents less than 2% of shunt insertion, of which about 94% are secondline therapy after previous VPS [16]. Over the decades, percutaneous techniques via internal jugular vein (IJV) or subclavian vein (SCV) outperformed open surgical approaches, reducing * Valentina Baro [email protected] 1
Academic Neurosurgery, Department of Neurosciences, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
2
Department of Anesthesia and Intensive Care, Azienda Ospedaliera di Padova, University of Padova, Padova, Italy
surgical time and complications [1, 4, 5, 8, 10–13, 19, 21]. Moreover, many neurosurgical centres currently apply the ultrasound (US)-guided positioning of the atrial catheter [7, 9, 14, 17], which is a standard technique for central venous catheter (CVC) placement, resulting in a higher success rate in paediatric patients [6]. IVJ and SCV cannulation therefore discloses important limitations, especially in younger children, leading to the evaluation of new approaches [2]. We illustrate herein a percutaneous placement of ventriculoatrial shunt via right brachiocephalic vein (BCV) under intraoperative US control. Indications and advantages of this technique are discussed.
Technique We treated a 5-year-old boy who previously underwent VPS positioning for a post-haemorrhagic hydrocephalus complicated by peritonitis leading to the necessity of a VAS placement. We took advantage of a technique routinely applied in our Paediatric Department, and the patient did not present any complication so far (1 year of follow-up). This approach a
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