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Table of Contents    
CORRESPONDENCE
Year : 2018  |  Volume : 66  |  Issue : 1  |  Page : 286-287

Authors' Reply: In defence of subgaleoatrial shunt!


Section of Neurosurgery, Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India

Date of Web Publication11-Jan-2018

Correspondence Address:
Dr. Ari G Chacko
Section of Neurosurgery, Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.222837

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How to cite this article:
Abraham AP, Gandham EJ, Prabhu K, Chacko AG. Authors' Reply: In defence of subgaleoatrial shunt!. Neurol India 2018;66:286-7

How to cite this URL:
Abraham AP, Gandham EJ, Prabhu K, Chacko AG. Authors' Reply: In defence of subgaleoatrial shunt!. Neurol India [serial online] 2018 [cited 2019 Jun 18];66:286-7. Available from: http://www.neurologyindia.com/text.asp?2018/66/1/286/222837




Sir,.

We thank Bhaskar and Garg for their interest in our article, “Subgaleoatrial shunt: Further progress in the management of iatrogenic cranial pseudomeningoceles.”[1] We agree that the pleural cavity is a viable site for a cerebrospinal fluid diversion and may have been an option in our case in view of the previous episodes of infection that our patient had.

On the other hand, we do not agree that it is easier or has fewer complications than ventriculatrial shunts. In fact, the article quoted by Bhaskar and Garg, namely “Case series of ventriculopleural shunts in adults: A single-center experience” by Craven et al.,[2] makes it quite clear that all shunts are fraught with complications. They report complications in 45% of their 22 patients undergoing ventriculopleural shunts, including 3 pleural effusions and 1 shunt retraction. They also had a 45% incidence of shunt revision with a median time to shunt failure of 7.5 months, both of which do not fare better than what is reported for ventriculoatrial shunts.[3] Furthermore, over-drainage in view of the negative intrathoracic pressure, seen in 2 of their patients, mandates the use of an anti-siphon device.

While the peritoneal cavity is unanimously considered the first option, the right atrium and pleural cavity are the second and third options in patients in whom the peritoneum is not conducive to repeated shunt revisions, such as in our case. Finally, patient and surgeon preferences play a crucial role in the decision making process particularly since most of these patients have already undergone repeated surgeries. We chose the procedure most familiar to us, namely the subgaleoatrial shunt that could easily be performed via the facial vein about 15 centimeters away from the cranial end.

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
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2.
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; 126:2010-16.  Back to cited text no. 2
    
3.
Borgbjerg BM, Gjerris F, Albeck MJ, Hauerberg J, Børgesen SV. A comparison between ventriculo-peritoneal and ventriculo-atrial cerebrospinal fluid shunts in relation to rate of revision and durability. Acta Neurochir (Wien). 1998;140:459-65.  Back to cited text no. 3
    




 

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