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CORRESPONDENCE
Year : 2018  |  Volume : 66  |  Issue : 1  |  Page : 285-286

Subgaleoatrial or subgaleopleural shunt?


Department of Neurosurgery, AIIMS, Jodhpur, Rajasthan, India

Date of Web Publication11-Jan-2018

Correspondence Address:
Dr. Suryanarayanan Bhaskar
Department of Neurosurgery, AIIMS, Jodhpur, Rajasthan - 342 005
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.222883

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How to cite this article:
Bhaskar S, Garg M. Subgaleoatrial or subgaleopleural shunt?. Neurol India 2018;66:285-6

How to cite this URL:
Bhaskar S, Garg M. Subgaleoatrial or subgaleopleural shunt?. Neurol India [serial online] 2018 [cited 2019 Jul 17];66:285-6. Available from: http://www.neurologyindia.com/text.asp?2018/66/1/285/222883




Sir,

We read with interest the article by Abraham AP et al., entitled 'Subgaleoatrial shunt: Further progress in the management of iatrogenic cranial pseudomeningoceles'.[1] The authors have pointed out an important management option in this difficult-to-treat complication that we all encounter in our clinical practice. Why was a subgaleopleural shunt not considered as a treatment option? Interestingly, literature also reveals authors favouring subgaleo-peritoneal, or as in this case, a subgaleoatrial shunt.[2] One needs to consider the pleural space as an alternative site for the cerebrospinal fluid (CSF) diversion. This stems from the fact that ventriculo-pleural shunt has relatively less complications as compared to a ventriculo-atrial shunt.[3] The atrial shunt can have life threatening complications (thrombus formation and cardiac rhythm abnormalities) and that too after significant time has lapsed following the procedure.[4] It is technically also easier to perform a ventriculo-pleural shunt vis-a- vis a ventriculo-atrial shunt.

In this case, the pseudomeningocele was on the left side, and the patient was an adult, therefore, the pleural space might have been an option that could have been considered. We could not see any details in the case summary that suggested that there was the presence of any of those factors in the patient's clinical summary that constituted a contraindication to the performance of a subgaleopleural shunt. Moreoever, the patient in focus had two prior incidences of infection (meningeal and peritoneal). This fact further goes against the use of a ventriculo-atrial shunt considering the dreaded complication of infective endocarditis that may occur following the placement of a ventriculo-atrial shunt.

Traditionally, the ventriculopleural shunt is not recommended in children below 8 years of age and a recent study has shown that age in itself can be a risk factor for shunt failures in pleural shunts (11 years was the age above which the revision rates reduced to a statistically significant number).[5] Our suggestion is that surgeons who face this vexing problem of a pseudomeningocele that does not respond to the conventional measures, can consider the pleural space as an alternative if the first choice, the peritoneal cavity, is not conducive to a CSF diversion procedure.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Abraham AP, Gandham EJ, Prabhu K, Chacko AG. Subgaleoatrial shunt: Further progress in the management of iatrogenic cranial pseudomeningoceles. Neurol India 2017;65:1178-80.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Kiran NAS, Thakar S, Mohan D, Aryan S, Rao AS, Hegde AS. Subgaleoperitoneal shunt: An effective and safer alternative to lumboperitoneal shunt in the management of persistent or recurrent iatrogenic cranial pseudomeningoceles. Neurol India 2013;61:65-8.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Craven C, Asif H, Farrukh A, Somavilla F, Toma AK, Watkins L. Case series of ventriculopleural shunts in adults: A single centre experience. J Neurosurg 2017;126(6):2010-16.  Back to cited text no. 3
    
4.
Natarajan A, Mazhar S. Right heart complications of ventriculoatrial shunt. Eur Heart J. 2011;32:2134.  Back to cited text no. 4
    
5.
Melamed EF, Christian E, Krieger MD, Berry C, Yashar P, McComb JG. Age as a novel risk factor for revision of ventriculopleural shunt in paediatric patients. Neurosurgery 2016;Suppl 1:178-9.  Back to cited text no. 5
    




 

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