How to Perform a Ventriculo-Atrial CSF Shunt

Abstract

The first attempt to shunting CSF from the ventricular space into the jugular vein can be traced back to 1911, through the experience of Payr and Enderlen who used a harvested temporal artery as a bio-implant (Kühnel and Seifert 1998). However, the high burden of morbidity and mortality limited the diffusion of the technique until Pudenz and his engineer Heyer introduced the ventriculo-atrial shunt (VAS) as a valid option in the management of hydrocephalus in 1955. Another merit of Pudenz’s work is the introduction of silicone as tubing material for shunt system. After over 2 years of experimental work to optimize the newly created shunt, the system was implanted in a 3-month-old female with macrocrania in which other shunt procedures priorly failed. A ventricular auriculostomy was then performed through the common facial and jugular vein. A polyvinyl chloride tube with a Teflon transverse sleeve valve was passed from the lateral ventricle to the atrium and worked successfully for over 2 years. Between 1958 and 1960, the watchmaker Schulte joined Pudenz and Heyer and implemented their work, improving the distal slit system with multiple longitudinal slits and developing a diaphragm valve (Pudenz 1966; Konar et al. 2015). Finally, the shunt was patented in the form we keep using in our surgical practice.