成人シャント手術—脳室心房シャント（V-A shunt）のTIPS

Indication and Technique of Ventriculo:Atrial Shunt for Normal Pressure Hydrocephalus

Point

・脳室心房シャント（V-A shunt）では術後のシャント機能不全は少ないが，オーバードレナージに注意する必要がある．

・心房カテーテルは胸鎖乳突筋の筋線維を縦割して頚静脈へアプローチすると，小さな傷で挿入可能である．

・V-A shuntは方法やデバイスが普及していないが，患者要因に左右されにくい手技である．

　The type of shunt surgery with the best outcome and lowest complication rate has not been established. Ventriculo-atrial（V-A）shunts have almost been abandoned as the first choice of surgery. However, the V-A shunt has many advantages；the operative site is narrower than in other types of shunt surgery, and intra-atrial pressure is lower than intra-abdominal pressure, which may guarantee constant cerebrospinal fluid flow and less malfunction.

　Since this procedure has been neglected, devices of V-A shunt are scarce. Furthermore, the technique to insert an atrial catheter into the jugular vein is not commonly performed by general neurosurgeons. Herein, we introduce a simple method of V-A shunt for general neurosurgeons.