# Surgical Nuances in Ultrasound-Guided Percutaneous Distal Catheter Placement in Pediatric Ventriculoatrial Shunts

## TL;DR

This paper describes a successful alternative shunt placement in a child with complex brain anatomy and multiple shunt failures.

## Contribution

The study presents a novel ultrasound-guided approach for ventriculoatrial shunt placement in pediatric patients with non-functional peritoneal cavities.

## Key findings

- Ultrasound-guided internal jugular vein cannulation enabled successful VAS placement in a child with multiple VPS failures.
- Image-guided VAS is a viable alternative for patients with impaired peritoneal CSF absorption and complex neuroanatomy.
- The Seldinger technique facilitated fluoroscopy-assisted endovascular catheter placement in this salvage intervention.

## Abstract

Currently, there is no universally accepted consensus regarding the optimal site for distal catheter placement in patients with congenital hydrocephalus and a non-functional peritoneal cavity, as therapeutic strategies must be meticulously individualized based on each patient’s unique anatomical and physiological considerations. We report a complex case involving a one-year-old male infant, born prematurely, with alobar holoprosencephaly (HPE) and congenital hydrocephalus, who experienced multiple ventriculoperitoneal shunt (VPS) failures. These complications were attributed to impaired peritoneal absorption of cerebrospinal fluid (CSF), recurrent shunt infections, and occlusion of an external ventricular drainage system. As a salvage intervention, a ventriculoatrial shunt (VAS) was successfully established using ultrasound-guided internal jugular vein cannulation, followed by fluoroscopy-assisted endovascular placement of a modified distal catheter via the Seldinger technique. This approach underscores the utility of image-guided VAS as a viable alternative in cases of VPS failure secondary to peritoneal CSF resorption insufficiency, particularly in patients with complex neuroanatomical profiles.