Child's Nervous System

, Volume 3, Issue 6, pp 342–349 | Cite as

Ventriculojugular shunt against the direction of blood flow

III. Operative technique and results
  • Ismail L. El-Shafei
Original Papers


One hundred hydrocephalic patients were treated over a 5-year period by shunting the cerebrospinal fluid (CSF) to the internal jugular vein (IJV) against the direction of blood flow. The patients were divided into two groups according to rigidity of their craniums. The pressures recorded during the operations confirmed the results of the experiments in Part II of this investigation. Fifteen patients had their shunting catheters removed or died due to infection (14 patients) or hemorrhage inside a brain tumor (1 patient). The shunts of 12 patients were revised due to technical faults that were corrected in 9 cases. There were no failures or complications related to the dynamics of the shunt. In the 82 patients who benefitted from the shunt, the clinical improvement was dramatic. Regression of the ventriculomegaly was inversely proportional to the degree of preoperative ventricular dilatation. In 5 infants the size of the enlarged head was reduced during surgery. Valveless shunting catheters were used in the first 4 patients, and specially designed valved catheters were used in 96 patients. The follow-up period was up to 5 years.

Key words

Hydrocephalus Intracranial pressure Cerebrospinal fluid shunts Ventriculovenous shunts Catheter against blood flow Treatment 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Anderson FM (1952) Subdural haematoma, a complication of operation for hydrocephalus. Pediatrics 10:11–18PubMedGoogle Scholar
  2. 2.
    Anderson H (1966) Craniostenosis as a complication after operation for hydrocephalus. Acta Paediatr Scand 55:192–196CrossRefGoogle Scholar
  3. 3.
    Becker CP, Nulsen EE (1968) Control of hydrocephalus by valve regulated venous shunt: avoidance of complications in prolonged shunt maintenance. J Neurosurg 28:215–226CrossRefGoogle Scholar
  4. 4.
    Cushing H (1926) Studies in intracranial physiology and surgery. Oxford University Press, LondonGoogle Scholar
  5. 5.
    Davidoff MM, Feiring EH (1953) Subdural haematoma occurring in surgically treated hydrocephalic children with a note on a method of handling persistent accumulations. J Neurosurg 10:557–563CrossRefGoogle Scholar
  6. 6.
    Davson H (1967) The cerebrospinal fluid pressure. In: Dason H (ed) Physiology of the cerebrospinal fluid. Churchill Livingstone, London, pp 337–382Google Scholar
  7. 7.
    El-Shafei IL (1975) Ventriculo-venous shunt to the proximal segment of an occluded neck vein. Surg Neurol 3:237–244PubMedGoogle Scholar
  8. 8.
    El-Shafei IL (1985) Ventriculovenous shunt against the direction of blood-flow: a new approach for shunting the cerebrospinal fluid to the venous circulation. Child's Nerv Syst 1:200–207CrossRefGoogle Scholar
  9. 9.
    Emery JL, Hilton HB (1961) Lung and heart complications of the treatment of hydrocephalus by ventriculo-auriculostomy. Surgery 50:309–314PubMedGoogle Scholar
  10. 10.
    Erdohazi M, Eckstein HB, Crome L (1966) Pulmonary embolization as a complication of ventriculo-atrial shunt inserted for hydrocephalus. Dev Med Child Neurol [Suppl] 11:36–44Google Scholar
  11. 11.
    Foltz EL (1966) The first seven years of a hydrocephalus project. In: Schulman K (ed) Workshop in hydrocephalus. University of Pennsylvania Press, PhiladelphiaGoogle Scholar
  12. 12.
    Foltz EL, Shurtleff DB (1966) Conversion of communicating hydrocephalus to stenosis or occlusion of the aqueduct during ventricular shunt. J Neurosurg 24:520–529CrossRefGoogle Scholar
  13. 13.
    Forrest DM, Cooper W (1968) Complications of ventriculoatrial shunts: a review of 455 cases. J Neurosurg 29:508–512CrossRefGoogle Scholar
  14. 14.
    Forrest JL, Hilton HB (1961) Lung and heart complications of the treatment of hydrocephalus by ventriculo auriculostomy. Surgery 50:309–314Google Scholar
  15. 15.
    Fox JL, McCullough DC, Green RC (1973) Alterations in CSF pressures following insertion of CSF shunts for hydrocephalus. 5th International Congress of Neurological Surgery, Tokyo 1973. (Excerpta Medica, no 293) Excerpta Medica, Amsterdam, p 43Google Scholar
  16. 16.
    Fox JL, McCullough DC, Green RC (1973) Effect of CSF shunts on intracranial pressure and CSF dynamics. II. A new technique of pressure measurement, results and concepts. J Neurol Neurosurg Psychiatry 36:302–312CrossRefGoogle Scholar
  17. 17.
    Fox JL, Portnoy HD, Shulte RR (1973) Cerebrospinal fluid shunts: an experimental evaluation of flow rates and pressure values in the antisiphon valve. J Surg Neurol 1:299–302Google Scholar
  18. 18.
    Griffiths DJ (1971) Steady flow through veins and collapsible tubes. Med Biol Eng 9:597–601CrossRefGoogle Scholar
  19. 19.
    Griffiths DJ (1972) Negative resistance effects in flow through collapsible tubes. Med Biol Eng 13:785–792CrossRefGoogle Scholar
  20. 20.
    Haynes IS (1913) Congenital internal hydrocephalus. Its treatment by drainage of the cysterna magna into the cranial sinuses. Ann Surg 57:449–484CrossRefGoogle Scholar
  21. 21.
    Haynes IS (1914) Further experience in the treatment of hydrocephalus by cisterna sinus drainage (author's operation). NY State J Med 16:174–181Google Scholar
  22. 22.
    Haynes IS (1915) Hydrocephalus — later experiences in its treatment by cisterna drainage. NY Med Rev 87:751–752Google Scholar
  23. 23.
    Holt JP (1941) The collapse factor in the measurement of venous pressure. Am J Physiol 134:292–297CrossRefGoogle Scholar
  24. 24.
    Holt JP (1969) Flow through collapsible tubes and through in situ veins. IEEE Trans Biomed Eng 16:274–277CrossRefGoogle Scholar
  25. 25.
    Horwitz NH, Rizzoli HV (1967) Postoperative complications in neurosurgical practice: recognition, prevention and management. Williams & Wilkins, BaltimoreGoogle Scholar
  26. 26.
    Ilingsworth RD (1970) Subdural hematoma after treatment of chronic hydrocephalus by ventriculo caval shunts. J Neurosurg Psychiatry 33:95–99CrossRefGoogle Scholar
  27. 27.
    Illingsworth RD, Logue V, Symon L (1971) The ventriculo caval shunt in the treatment of adult hydrocephalus: results and complications in 101 patients. J Neurosurg 35:681–695CrossRefGoogle Scholar
  28. 28.
    Ingraham FD, Matson DD, Alexander E Jr, Woods RP (1948) Studies in the treatment of experimental hydrocephalus. J Neuropathol Exp Neurol 7:123–143CrossRefGoogle Scholar
  29. 29.
    Kanaval AB (1910) Discussion. Surg Gynecol Obstet 10:327Google Scholar
  30. 30.
    Kloss JL (1968) Craniosynostosis secondary to ventriculo atrial shunt. Am J Dis Child 116:315–317PubMedGoogle Scholar
  31. 31.
    McCabe WL, Smith JC (1967) Fluid flow phenomenon, chap 3, 2nd edn.. In. Unit operations of chemical engineering. McGraw Hill, New York, pp 47–67Google Scholar
  32. 32.
    McCullough DC, Fox JL (1974) Negative intracranial pressure hydrocephalus in adults with shunts and its relationship to the production of subdural hematoma. J Neurosurg 40:372–375CrossRefGoogle Scholar
  33. 33.
    McCullough DC, Fox JL, Curl FD (1972) Effect of CSF shunts on intracranial pressure and CSF dynamics. In: Harbert JC (ed) Cisternography and hydrocephalus. Thomas, Springfield, Ill, pp 335–342Google Scholar
  34. 34.
    McLure RD (1909) Hydrocephalus treated by drainage into a vein in the neck. Johns Hopkins Hosp Bull 20:110–113Google Scholar
  35. 35.
    Matson DD (1969) Neurosurgery of infancy and childhood, 2nd edn. Thomas, Springfield, IllGoogle Scholar
  36. 36.
    Milhorat TH (1972) Hydrocephalus and cerebrospinal fluid. Williams & Wilkins, BaltimoreGoogle Scholar
  37. 37.
    Noonan JA, Ehmke DA (1963) Complications of ventriculovenous shunts for control of hydrocephalus. Report of three cases with thrombo emboli to the lungs. N Engl J Med 265:70–74CrossRefGoogle Scholar
  38. 38.
    Noordergraaf AL (1978) Circulatory system dynamics, chap 5. Academic Press, New York LondonGoogle Scholar
  39. 39.
    Nugent GR, Lucas R, Judy M (1966) Thrombo-embolic complications of ventriculo-atrial shunts: angio cardiographic and pathologic correlations. J Neurosurg 24:34–42CrossRefGoogle Scholar
  40. 40.
    Nulsen FE, Becker DP (1967) Control of hydrocephalus by valve-regulated shunt. J Neurosurg 26:362–374CrossRefGoogle Scholar
  41. 41.
    Overton MC III, Snodgrass SR (1965) Ventriculo-venous shunts for infantile hydrocephalus. A review of five years experience with this method. J Neurosurg 23:517–521CrossRefGoogle Scholar
  42. 42.
    Portnoy HD, Croissant PD (1973) New devices for hydrocephalus shunts. 5th International Congress of Neurological Surgery, Tokyo 1973. (Excerpta Medica, no 293) Excerpta Medica, Amsterdam, p 44Google Scholar
  43. 43.
    Portnoy HD, Schulte RR, Fox JL (1973) Antisiphon and reversible occlusion valves for shunting in hydrocephalus and preventing post shunt subdural hematomas. J Neurosurg 38:729–738CrossRefGoogle Scholar
  44. 44.
    Pudenz RH, Russell FE, Hurd AH, Cheldon CH (1957) Ventriculo-auriculostomy. A technique for shunting cerebrospinal fluid into the right auricle. Preliminary report. J Neurosurg 14:171–179CrossRefGoogle Scholar
  45. 45.
    Samuelson S, Long DM, Chou SN (1972) Subdural hematoma as a complication of shunting procedures for normal pressure hydrocephalus. J Neurosurg 37:548–551CrossRefGoogle Scholar
  46. 46.
    Sperling DR, Ratrick JR, Anderson FM, Fyler DC (1964) Corpulmonale secondary to ventriculo-auriculostomy. Am J Dis Child 107:308–315PubMedGoogle Scholar
  47. 47.
    Streeter VL (1962) Viscous effects — fluid resistance. In: Fluid mechanics, 3rd edn. McGraw Hill, New York, pp 293–206Google Scholar
  48. 48.
    Strenger L (1963) Complications of ventriculo-venous shunts. J Neurosurg 20:219–224CrossRefGoogle Scholar
  49. 49.
    Van Buskirk C (1959) Neuromedical conditions resembling surgical problems. In: Jackson IJ, Thompson RK (eds) Pediatric neurosurgery. Blackwell, Oxford, pp 75–98Google Scholar

Copyright information

© Springer-Verlag 1987

Authors and Affiliations

  • Ismail L. El-Shafei
    • 1
  1. 1.Department of Neurosurgery, Manial University HospitalCairo UniversityCairoEgypt

Personalised recommendations