• Pouya Entezami, Neil S Devejian, Sebastian Rubino, Nathan Smith, Patrick Savery, Anica Crnkovic, and Matthew A Adamo.
• Department of Neurosurgery, Albany Medical College, Albany, New York, USA. Electronic address: adamom@amc.edu.
• World Neurosurg. 2020 Dec 1; 144: 15-18.

IntroductionThe popularity of the ventriculoatrial shunt as a means for cerebrospinal fluid diversion was temporally limited, overcome by the success of the peritoneum as a site for distal drainage. Nevertheless, it remains an important tool for patients for whom ventriculoperitoneal shunting is not an option.Clinical PresentationWe present the case of a 9-year-old girl with a ventriculoatrial shunt, who had undergone multiple revisions. Ultimately, she suffered a wound dehiscence, resulting in infectious seeding of the bloodstream and formation of a thrombus, presumed granuloma, at the tip of the distal catheter in the right atrium. She underwent successful removal of the lesion via an open approach by our cardiothoracic colleagues.DiscussionPrevious authors have noted a high number of mortalities as a result of these lesions. A collaborative approach resulted in a successful outcome for our patient. Although limited in utility today, the ventriculoatrial shunt remains a common procedure for neurosurgeons today.ConclusionRecognizing the potential for atrial thrombus formation and using a team approach can help avoid a poor outcome.Published by Elsevier Inc.

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