Ventriculoperitoneal shunt in a patient with ruptured blister aneurysm treated with pipeline embolization device.
Lee A TanCarter S GerardKiffon M KeigherRoham MoftakharDemetrius K LopesPublished in: Journal of cerebrovascular and endovascular neurosurgery (2015)
Cerebral spinal fluid (CSF) diversion is frequently required in patients with aneurysmal subarachnoid hemorrhage who develop subsequent hydrocephalus. Procedures such as external ventricular drain (EVD) and ventriculoperitoneal shunt (VPS) usually carry a very low rate of complications. However, as flow diverting stents such as Pipeline Embolization Device (PED) become more widely available, flow diverters are being used in treatment of some ruptured complex aneurysms. EVD and VPS placement in the setting of dual antiplatelet therapy (DAT) in these patients are associated with a significant risk of intracranial hemorrhage. We describe a management strategy and surgical technique that can minimize hemorrhagic complications associated with VPS in patients on DAT after treatment with flow diverting stents.
Keyphrases
- end stage renal disease
- newly diagnosed
- antiplatelet therapy
- subarachnoid hemorrhage
- ejection fraction
- chronic kidney disease
- peritoneal dialysis
- heart failure
- acute coronary syndrome
- prognostic factors
- risk factors
- spinal cord
- percutaneous coronary intervention
- spinal cord injury
- left ventricular
- atrial fibrillation
- brain injury
- blood brain barrier
- cerebrospinal fluid
- pulmonary hypertension
- robot assisted
- data analysis
- cerebral blood flow