_{Ventriculoatrial (VA) shunt placement}

The only difference between a VP and a VA shunt placement procedure is the operation performed for placing the distal catheter.

To begin the procedure, your neurosurgeon will place the proximal catheter in the same fashion as described above. The proximal and distal catheters will be connected to opposite ends of the shunt valve and secured in place with non-absorbable sutures.

Next, he will need to make a small incision on your neck to allow him access to either the internal jugular vein or the common facial vein. Using a needle, your neurosurgeon will insert a guide wire and vessel dilator into the chosen vein. The guide wire and vessel dilator allow your neurosurgeon to carefully guide the distal catheter through the wall of the vein and into the right atrium of your heart. In an infant, it will be necessary to briefly expose the facial vein or internal jugular vein in order to insert the shunt.

As with the VP shunt placement, your neurosurgeon will use a tunneling device to pass the distal catheter beneath your skin between the incisions in your head and neck. The tunneling device will be removed, and the distal catheter will be slipped over the guide wire and into the vein in your neck. Your neurosurgeon will then use a fluoroscope (an imaging device that takes X-rays without using films) to ensure that the tip of the distal catheter lies within the right atrium of your heart.

Once the distal catheter is in its proper place, he will remove the guide wire and vessel dilator, and close the incision in your neck, as well as the one on your head. Your neurosurgeon may use either surgical staples or sutures to close the incisions.

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