Introduction: Ventriculoatrial (VA) shunting for the treatment of hydrocephalus is a common neurosurgical procedure. Complications include shunt failure, infection, and cardiovascular compromise. Superior vena cava syndrome secondary to VA shunting is a devastating complication which has rarely been reported.
Methods: A 37 year-old female with history of Dandy-Walker malformation and congenital hydrocephalus managed by two shunts presented with progressive facial swelling, neck and bilateral upper extremity edema, dysphagia, and headache. Imaging on presentation demonstrated a retropharyngeal fluid collection compromising the airway, extensive venous collaterals in the upper mediastinum and paraspinal regions, a prominent azygous arch, and ventriculopleural catheter disruption. Further studies showed thrombosis of the catheter-bearing SVC and the azygous vein. Direct catheter thrombolysis using tissue plasminogen activator (tPA) was initiated, ultimately leading to resolution of thrombus burden in both vessels with remnant severe SVC stenosis at the catheter tip. Angioplasty and stenting were performed. Patient’s symptoms improved significantly following the procedures.
Results: The etiology of our patient’s SVC thrombosis was believed to be multifactorial, including SVC stenosis secondary to long-term VA catheter implantation and recent OCP initiation. SVC syndrome results from disruption of blood flow through the SVC to the right atrium. There has been a significant increase in benign causes of SVC syndrome over the last two decades, thought to be mainly due to the increase in the use of indwelling central venous catheters and cardiac pacemakers.
Conclusions: Though rare, SVC thrombosis as a consequence of VA shunting is a distressing complication which must be managed emergently.
Patient Care: This research will help improve our ability to manage this potentially devastating complication of VA shunting.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Recognize SVC thrombosis as a potential complication of VA catheterization; 2) Identify the clinical symptomatology of SVC thrombosis due to presence of indwelling catheter; 3) Refresh their knowledge on the correct management of retropharyngeal edema due to SVC thrombosis, an uncommon presentation in Neurosurgery
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