Ventriculojugular Shunt against the Direction of Blood Flow, III: Operative technique and results
One hundred hydrocephalic patients were treated by shunting the cerebrospinal fluid (CSF) to the internal jugular vein (IJV) against the direction of blood flow. The shunting catheter was introduced into the IJV via the common facial vein (CFV). In the last 20 patients, the course of the CFV was changed to make it pass upwards, instead of downwards, to join the IJV. The patients were divided into two groups. Group I included 68 patients with rigid craniums. Group II included 32 infants with compressible craniums. Four patients died, eleven patients had their shunting catheters removed due to infection and the shunt was revised in 12 patients. None of the deaths, complications or revisions were considered related to the dynamics of the shunt. 82 patients benefited from the shunt, 9 of them after shunt revision. In patients with rigid craniums, shunt implantation was easy and the postoperative improvement was satisfactory, both clinically and radiologically. The amount of reduction in the size of the ventricles was inversely proportional to the degree of postoperative ventricular dilatation. In infants with compressible craniums, shunt implantation was difficult due to the thin caliber of the neck veins, the clinical improvement was satisfactory although the head circumference continued to increase at a slower rate than before surgery and there was minimal reduction in the ventriculomegaly.