Jani, Ronak H

BACKGROUND AND OBJECTIVES: Symptomatic hydrocephalus (HCP) requiring cerebrospinal fluid diversion by shunting is routinely performed through ventriculoperitoneal or ventriculoatrial (VA) shunting. The optimal method of distal catheter placement for a VA shunt is not well defined. We detail a novel surgical technique for VA shunt placement using intraoperative digital subtraction angiography (DSA). METHODS: The aim of this single-institution, retrospective review was to describe a unique technique of distal catheter placement in a series of the initial 50 consecutive adult patients who underwent VA shunt placement with DSA at our institution between 2021 and 2024. Detailed procedural techniques and outcomes are described. RESULTS: Accurate surgical placement of the distal VA shunt was achieved in 48 patients (96%). Five patients required shunt revisions for delayed shearing of distal catheter (1), suboptimal distal catheter placement (3), and suboptimal proximal catheter placement (1). Four instances of post-VA shunt bacteremia were found when patients were routinely cultured for febrile episodes; all completed appropriate antibiotic course, and none resulted in meningitis or required shunt revision. Kaplan-Meier analysis demonstrated overall VA shunt success of 92% at 3 years after initial surgery. CONCLUSION: This series of 50 consecutive patients demonstrated use of intraoperative DSA yields safe and accurate placement VA shunts with acceptable long-term outcomes. As more neurosurgeons have endovascular training, this surgical technique may be more readily adopted.