Day 25 of National Hydrocephalus Awareness Month: Ventriculoatrial shunt placement enables cerebrospinal fluid (CSF) to flow from the cerebral ventricular system to the atrium of the heart. The preferred distal site is the peritoneal space (ventriculoperitoneal shunt), as this space is generally safely accessible and possesses more than adequate absorptive capacity for the CSF volume produced by a given person. In rare cases, the peritoneal space is inadequate, necessitating an alternative distal site. The most common alternative sites are the cardiac atrium (ventriculoatrial shunt) and the pleural space (ventriculopleural shunt). Common reasons for this include previous intra-abdominal infection and scarring due to prior procedures or intra-abdominal pathology. Once the peritoneum is ruled out, the surgeon must verify that the atrium is an acceptable target. Tell Someone and Raise Awareness! #PHFHAM2015