ABSTRACT
I previously used a shunt fashioned from a pediatric No. 8 feeding tube cut 15 cm in length. As we have said, this style shunt is now manufactured as a “Loftus shunt” (see Fig. 3-50). A preexisting black dot at the middle of the tube becomes the midpoint of the shunt after it is placed. The dot serves as a marker for positioning in the center of the lumen to prevent unnoticed cephalad migration. I find this less cumbersome than placing a string around the shunt, which may interfere with the repair. The shunt is secured by a Rummel tourniquet in the CCA (Fig. 3-36) and by a small Javid clamp or the Loftus pinch clamp in the distal ICA, as previously described (Figs. 3-34 and 3-35). The handheld Doppler probe can be applied to this exposed shunt tubing, and an audible flow signal will be faintly heard, confirming shunt patency. Shunt function is also assessed by noting return of monitoring parameters to baseline (whether EEG, TCD, SSEP, or other methods are used).
