Evaluation of ultrasound-guided distal catheter placement in pediatric ventriculoatrial shunts for patients with hydrocephalus: Effectiveness and consequences

Background and aims: Ventriculoatrial (VA) shunts are frequently used for hydrocephalus (HS) management when peritoneal catheter placement is inappropriate. Historically, open surgical cut-down (OSC) on the internal jugular vein has been the standard method for distal catheter insertion. In contrast, percutaneous Seldinger-type ultrasound-guided (USG) venipuncture offers advantages such as reduced operating times and lower postoperative pain. However, its use in pediatric patients is limited. Methods: This study reviewed patients diagnosed with HS who underwent VA shunt procedures (OSC vs USG) at Bambino Gesù Children’s Hospital from January 1, 2014, to February 29, 2024. The analysis focused on surgical times for VA shunt placements and associated neurosurgical operations, as well as catheter replacement rates. Results: Thirteen patients (6 males, 7 females; median age 12 years, range 0.5–14.2) were enrolled, with a total of 23 procedures performed. The mean surgical time for distal VA placement using the USG technique was significantly shorter than for the OSC method (13.36 min vs 30.22 min, p = 0.00001). Conversely, neurosurgical operations performed using OSC had a 15-min reduction in average operative time compared to USG, though this difference was not statistically significant. Catheter replacement was required in 35.7% of the USG group compared to 55.5% in the OSC group (p = ns). Conclusions: USG VA shunt placement demonstrates reduced operating times and lower perioperative complication rates compared to OSC. Our findings indicate that percutaneous VA shunts are technically simpler and do not necessitate specialized pediatric vascular surgery skills, enhancing their applicability in pediatric hydrocephalus management.