Intrareservoir Administration of Alteplase to Treat a Distal Ventriculoatrial Shunt Obstruction.
World Neurosurg 2019;
135:259-261. [PMID:
31715416 DOI:
10.1016/j.wneu.2019.11.013]
[Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 11/04/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND
Ventriculoatrial shunts can be afflicted with distal malfunctions due to thrombus formation at the distal tip. Distal tip thrombus formation may occur more commonly in oncologic patients who are predisposed to hypercoagulability.
CASE DESCRIPTION
A patient who had a ventriculoatrial shunt placed for leptomeningeal carcinomatosis presented with headaches and confusion and was found to have a partial distal shunt obstruction. Intrareservoir administration of alteplase resulted in resolution of her symptoms. Nuclear medicine shunt patency test demonstrated restoration of distal flow.
CONCLUSIONS
Intrareservoir administration of alteplase can be a useful nonoperative treatment strategy for ventriculoatrial shunt malfunction. This strategy may be particularly useful in cases with higher perioperative risk, such as patients with advanced metastatic cancer.
Collapse