J Cerebrovasc Endovasc Neurosurg.  2015 Mar;17(1):54-58. 10.7461/jcen.2015.17.1.54.

Ventriculoperitoneal Shunt in a Patient with Ruptured Blister Aneurysm Treated with Pipeline Embolization Device

• Tan LA
• Gerard CS
• Keigher KM
• Moftakhar
• Lopes DK

• KMID: 1963151
• DOI: http://doi.org/10.7461/jcen.2015.17.1.54

Abstract

Cerebral spinal fluid (CSF) diversion is frequently required in patients with aneurysmal subarachnoid hemorrhage who develop subsequent hydrocephalus. Procedures such as external ventricular drain (EVD) and ventriculoperitoneal shunt (VPS) usually carry a very low rate of complications. However, as flow diverting stents such as Pipeline Embolization Device (PED) become more widely available, flow diverters are being used in treatment of some ruptured complex aneurysms. EVD and VPS placement in the setting of dual antiplatelet therapy (DAT) in these patients are associated with a significant risk of intracranial hemorrhage. We describe a management strategy and surgical technique that can minimize hemorrhagic complications associated with VPS in patients on DAT after treatment with flow diverting stents.

Keyword

Ventriculoperitoneal shunt; Stents; Intracranial aneurysm; Subarachnoid hemorrhage

MeSH Terms

Aneurysm*
Blister*
Humans
Hydrocephalus
Intracranial Aneurysm
Intracranial Hemorrhages
Stents
Subarachnoid Hemorrhage
Ventriculoperitoneal Shunt*

Figure

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  Fig. 1 A photograph demonstrating the catheter fixation technique with a "purse-string" stitch at the exit site to anchor the catheter; in addition, a catheter loop is formed with 3 additional fixation points on the scalp to minimize micro-movement of the external ventricular drain catheter intracranially during patient transfer.

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  Fig. 2 (A) Computed tomography (CT) of brain demonstrating diffuse SAH with enlargement of bilateral temporal horns suggesting the presence of hydrocephalus. (B) CT showing external ventricular drain catheter placement and improvement of ventriculomegaly.

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  Fig. 3 (A) Catheter cerebral angiogram demonstrated a 1.5 mm, wide-necked, left supraclinoid internal carotid artery blister aneuysm. (B) cerebral angiograms demonstrating successful treatment of the aneurysm with Pipeline Embolization Device and coiling with resultant Raymond grade I aneurysm occlusion.

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  Fig. 4 Cerebral angiogram performed at 6-month follow-up again demonstrating Raymond I occlusion of the left internal carotid artery blister aneurysm.

Reference

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