Ventriculo-humeral shunt: a cadaveric feasibility study with application to treating hydrocephalus
Intraosseous vascular access is often used when vascular access is difficult. However, the use of this space for a receptacle for cerebrospinal fluid (CSF) diversion has been scantly considered.
Materials and methods
Six upper limbs of fresh frozen cadavers were used for this study. In the supine position, a small hole was drilled through the outer cortex of the proximal humerus and into the medullary cavity. A 16-gauge needle was placed into the hole in the humerus and 150 cc of saline infused. Next, the adjacent axillary vein and tributaries were dissected to observe dilation or the presence of the blue-colored saline. For part two of the study, shunt tubing was passed subcutaneously from a supraclavicular incision to the hole made in the humerus. Range of motion of the shoulder was then performed.
On all sides, all 150 cc of fluid was easily infused into the humerus. No specimen was found to have leakage from the drill hole site or into the extravascular soft tissues. With dissection of the axillary vein and its tributaries, all sides were found to have engorgement of these vessels. No tension was placed on the distal shunt tubing with full range of motion of the shoulder.
Based on our study, the humerus is another option available to the neurosurgeon for CSF diversion.
KeywordsVentricular shunts Humerus Hydrocephalus Intraosseous
Compliance with ethical standards
As a cadaveric study, our institution does not require IRB approval. However, ethical considerations were in accord with the Declaration of Helsinki.
Conflict of interest
The authors have no conflicts of interest.
- 2.Canale D, Longo L (1990) Harvey Cushing and pediatric neurosurgery. Neurosurgery:602–610. https://doi.org/10.1097/00006123-199010000-00017
- 9.Leidel B, Kirchhoff C, Bogner V, Stegmaier J, Mutschler W, Kanz K, Braunstein V (2009) Is the intraosseous access route fast and efficacious compared to conventional central venous catheterization in adult patients under resuscitation in the emergency department? A prospective observational pilot study. Patient Saf Surg 3(1):24. https://doi.org/10.1186/1754-9493-3-24 CrossRefGoogle Scholar
- 10.Leidel B, Kirchhoff C, Braunstein V, Bogner V, Biberthaler P, Kanz K (2010) Comparison of two intraosseous access devices in adult patients under resuscitation in the emergency department: a prospective, randomized study. Resuscitation 81(8):994–999. https://doi.org/10.1016/j.resuscitation.2010.03.038 CrossRefGoogle Scholar
- 20.Santos D, Carron P, Yersin B, Pasquier M (2013) EZ-IO® intraosseous device implementation in a pre-hospital emergency service: a prospective study and review of the literature. Resuscitation 84(4):440–445. https://doi.org/10.1016/j.resuscitation.2012.11.006 CrossRefGoogle Scholar
- 27.Warren D, Kissoon N, Sommerauer J, Rieder M (1993) Comparison of fluid infusion rates among peripheral intravenous and humerus, femur, malleolus, and tibial intraosseous sites in normovolemic and hypovolemic piglets. Ann Emerg Med 22(2):183–186. https://doi.org/10.1016/s0196-0644(05)80199-4 CrossRefGoogle Scholar