Distal ventriculoatrial shunt revision in an adult myelomeningocele patient performed via endovascular transvenous approach: a case report.

BACKGROUND: Myelomeningocele patients with shunt-dependent hydrocephalus often require multiple shunt revisions, eventually exhausting first-line distal diversion sites. Ventriculoatrial (VA) shunts are used less commonly than ventriculoperitoneal (VP) shunts, but knowledge of their use and complications is important to the neurosurgeon's armamentarium. VA shunts differ from VP and ventriculopleural shunts in that the ideal distal catheter target is an anatomically small area in comparison to the peritoneal and pleural cavities.

CASE DESCRIPTION: Here we present a case of an adult myelomeningocele patient who experienced migration of a distal VA shunt catheter. A minimally invasive revision technique that does not require recannulation of the vessels or open manipulation of the shunt is presented.

CONCLUSIONS: This is the fourth reported instance of successful distal revision of a migrated VA shunt catheter via transfemoral endovascular snaring. Knowledge of the opportunities afforded by this technique, and collaboration with thoracic surgery colleagues, is of benefit to all neurosurgeons.