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Case Reports
Intra-reservoir administration of alteplase to treat a distal ventriculo-atrial shunt obstruction.
- Nader Delavari, Monica C Mureb, Amanda Yaun, Jeffrey H Wisoff, David H Harter, and E Teresa Hidalgo.
- Department of Neurosurgery, New York University School of Medicine, New York, New York, USA. Electronic address: Teresa.Hidalgo@nyumc.org.
- World Neurosurg. 2020 Mar 1; 135: 259-261.
BackgroundVentriculoatrial 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 DescriptionA 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.ConclusionsIntrareservoir 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.Copyright © 2019 Elsevier Inc. All rights reserved.
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