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6  Imaging of Cerebrospinal Fluid Shunts, Drains, and Diversion Techniques

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6.1.3\ Atypical Ventricular Shunts

6.1.3.1\ Discussion

Other parts of the body can be used as terminals for the distal portions of ventricular shunt catheters. Ventriculoatrial, ventriculopleural, ventriculovesical, and ventriculo-gallbladder shunts are plausible alternatives for diverting cerebrospinal fluid away from the ventricles in patients with hydrocephalus, particularly when ventriculoperitoneal shunts fail.

•\ Ventriculoatrial Shunts (Fig. 6.10): The distal tip of a ventriculoatrial shunt should terminate in the right atrium or even in the superior vena cava. Complications particular to ­ventriculoatrial shunts include pulmonary embolism and endocarditis.

•\ Ventriculopleural Shunts (Fig. 6.11): The terminus is within the pleural space. Variable amounts of cerebrospinal fluid may accumulate in the pleural space, in which up to 20% are symptomatic. This complication is more

a

Fig. 6.10  Ventriculoatrial shunt. Frontal radiograph shows a ventricular shunt tip (arrow) at the level of the atriocaval junction (arrow)

b

Fig. 6.11  Ventriculopleural shunt. Frontal radiograph (a) and axial CT (b) show a shunt catheter with distal end (arrows) located within the left pleural space, where there is cerebrospinal fluid