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Afornali S, Beraldo RF, Maeda AK, Mattozo CA, Brito RN, Ergen A, Pereira MC, Chaurasia B. Ventriculo-gallbladder shunt: case series and literature review. Childs Nerv Syst 2024; 40:1525-1531. [PMID: 38329505 DOI: 10.1007/s00381-024-06297-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND The ventriculoperitoneal shunt (VPS) is the gold-standard surgical technique to treat hypertensive hydrocephalus; however, it may fail in 20 to 70% of cases. The present study shows an alternative for patients with contraindications to VPS. METHODS A case series of nine patients. The medical records of all patients under 17 years of age who underwent ventriculo-gallbladder (VGB) shunt at a pediatric hospital from January 2014 to October 2022 were reviewed. RESULTS There were 6 (66.7%) males and 3 (33.3%) females. The average age of 73.6 months or 6.1 years at the time of surgery. They had undergone, on average, 5.1 VPS reviews before the VGB shunt. Five (55.5%) had complications of VGB shunt: infection (11.1%), atony (11.1%), hypodrainage (11.1%), and ventriculoenteric fistula (22.2%); all these patients got better at surgical reapproach, and in two of them, the VGB shunt was re-implanted. CONCLUSION This case series shows a lower risk of death and a similar risk of complications compared to other alternative shunts. This article spotlighted VGB as a viable alternative when VPS fails or has contraindications.
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Affiliation(s)
- Sandrieli Afornali
- Department of Neurosurgery, Pequeno Príncipe Hospital, Curitiba, Paraná, Brazil
- Department of Neurosurgery, Pontifical Catholic University of Paraná, Curitiba, Paraná, Brazil
| | - R Fedatto Beraldo
- Department of Neurosurgery, Pontifical Catholic University of Paraná, Curitiba, Paraná, Brazil
| | - A Keijiro Maeda
- Department of Neurosurgery, Pequeno Príncipe Hospital, Curitiba, Paraná, Brazil
- Department of Neurosurgery, Pontifical Catholic University of Paraná, Curitiba, Paraná, Brazil
| | - C Alberto Mattozo
- Department of Neurosurgery, Pequeno Príncipe Hospital, Curitiba, Paraná, Brazil
- Department of Neurosurgery, Pontifical Catholic University of Paraná, Curitiba, Paraná, Brazil
| | - R Nascimento Brito
- Department of Neurosurgery, Pontifical Catholic University of Paraná, Curitiba, Paraná, Brazil
| | - Anil Ergen
- Department of Neurosurgery, Derince Research Hospital, Kocaeli, Turkey
| | - M Charles Pereira
- Department of Otolaryngology - Head and Neck Surgery, Albany Medical Centre, Albany, NY, USA
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birta, Birgunj, 44300, Nepal.
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Hadhri MM, Souei Z, Boukhit M, Mosbahi S, Ben Nsir A, Darmoul M. Can we consider ventriculo-gallbladder shunt a first-line treatment in selected patients? Case report of a successful management. Childs Nerv Syst 2023; 39:1963-1968. [PMID: 36933013 DOI: 10.1007/s00381-023-05923-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION Ventriculo-gallbladder shunt (VGS) has been recognized as a last-resort alternative to treat hydrocephalus when the peritoneum and/or other distal sites can no longer receive shunts. In some specific conditions, it may be conceded as a first-line treatment. CASE PRESENTATION We report the case of a 6-month-old girl with progressive post-hemorrhagic hydrocephalus who presented a concomitant chronic abdominal symptom. Specific investigations ruled out acute infection and led to the diagnosis of chronic appendicitis. Both problems were managed in a one-stage salvage procedure consisting of laparotomy sanctioning to treat the abdominal pathology and seize the opportunity to perform a VGS as a first option since the abdomen is prone to ventriculoperitoneal shunt (VPS) failure. CONCLUSION Only few cases have reported the use of VGS as the first option to handle uncommon complex cases due to abdominal or cerebrospinal fluid (CSF) conditions. We wish to draw attention to VGS as an effective procedure not only in children with multiple shunt failures but also as first-line management in some selected cases.
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Affiliation(s)
- Mohamed Maher Hadhri
- Department of Neurosurgery, Fattouma Bourguiba University Hospital, Avenue Farhat Hached, 5000, Monastir, Tunisia.
- Research Unity Interventional Radiology LR18SP08, University of Monastir, Monastir, Tunisia.
| | - Zohra Souei
- Department of Neurosurgery, Fattouma Bourguiba University Hospital, Avenue Farhat Hached, 5000, Monastir, Tunisia
| | - Mohamed Boukhit
- Department of Neurosurgery, Fattouma Bourguiba University Hospital, Avenue Farhat Hached, 5000, Monastir, Tunisia
| | - Sana Mosbahi
- Department of Pediatric Surgery, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Atef Ben Nsir
- Department of Neurosurgery, Fattouma Bourguiba University Hospital, Avenue Farhat Hached, 5000, Monastir, Tunisia
- Research Unity Interventional Radiology LR18SP08, University of Monastir, Monastir, Tunisia
| | - Mehdi Darmoul
- Department of Neurosurgery, Fattouma Bourguiba University Hospital, Avenue Farhat Hached, 5000, Monastir, Tunisia
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Casajús Ortega A, Vázquez Míguez A, Zazpe Cenoz I, de Frutos Marcos D. Double ventriculo-gallbladder shunt in the treatment of giant suprasellar arachnoid cyst with secondary hydrocephalus. NEUROCIRUGIA (ENGLISH EDITION) 2023; 34:40-43. [PMID: 35534409 DOI: 10.1016/j.neucie.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/07/2021] [Accepted: 11/21/2021] [Indexed: 02/01/2023]
Abstract
Ventriculo-gallbladder shunt is described as an effective alternative procedure in the treatment of hydrocephalus. We present the case of a 19-year-old patient diagnosed with suprasellar arachnoid cyst since his childhood and hydrocephalus, with a double shunt; ventriculo peritoneal and peritoneal cyst shunt. After several replacements due to peritoneal failure, he underwent ventriculoatrial shunt, with associated complications and subsequent repositioning to the peritoneum. After new valve dysfunction due to peritoneal complications, ventriculo-gallbladder shunt was proposed as an alternative treatment for this patient, which was safe and effective in resolving the patient's symptoms, and the patient was discharged, maintaining clinical stability in the follow-up more than 2 years later.
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Casajús Ortega A, Vázquez Míguez A, Zazpe Cenoz I, de Frutos Marcos D. Doble derivación ventrículo y cisto biliar en el tratamiento de quiste aracnoideo gigante supraselar con hidrocefalia secundaria. Neurocirugia (Astur) 2022. [DOI: 10.1016/j.neucir.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ogagan CO, Kulkarni N, Owusu-Adjei B, Karam AR, Cataltepe O. Ventriculogallbladder Shunt: Percutaneous Transhepatic Placement of the Distal Catheter. Oper Neurosurg (Hagerstown) 2022; 22:e75-e79. [PMID: 35007272 DOI: 10.1227/ons.0000000000000053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 09/13/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ventriculogallbladder (VGB) shunts are currently placed as a salvage procedure in treatment of hydrocephalus when all other options are exhausted. Although VGB shunts work well when successfully implanted, they are still rarely used because of the technical challenges with the traditional surgical technique. OBJECTIVE To implant VGB shunts using a minimally invasive technique that is safer and less technically challenging. METHODS We discussed our utilization of a percutaneous transhepatic approach to placement of the distal catheter into the gallbladder as a new technique that offers a solution to the established but surgically demanding current approach. We presented a complex patient with multiple failed shunts who underwent placement of a VGB shunt. RESULTS The shunt was successfully placed and did not incur any complications or require any revisions in 5 yr. CONCLUSION Given the safety and ease of this minimally invasive approach, we believe percutaneous transhepatic approach in VGB shunts should be considered as a reasonable option in patients with complex hydrocephalus.
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Affiliation(s)
- Charles O Ogagan
- Department of Neurological Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Nichita Kulkarni
- Department of Neurological Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Brittany Owusu-Adjei
- Department of Neurological Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,UMass Memorial Health, Worcester, Massachusetts, USA
| | - Adib R Karam
- Department of Diagnostic Imaging, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Oguz Cataltepe
- Department of Neurological Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,UMass Memorial Health, Worcester, Massachusetts, USA
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Morosanu CO, Priscu A, Florian IS. Evaluation of the ventriculocholecystic shunt-an overview of present practice in adult and pediatric hydrocephalus. Neurosurg Rev 2021; 44:2533-2543. [PMID: 33481136 PMCID: PMC8490219 DOI: 10.1007/s10143-021-01472-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 01/14/2023]
Abstract
In the context of hydrocephalus, there are a multitude of therapeutic options that can be explored in order to improve patient outcomes. Although the peritoneum is the current elected clinical solution, various receptacles have been utilized when experiencing contraindications. Along with the ventriculoatrial or ventriculopleural, the ventriculocholecystic shunt was also described as an alternative. In order to make a decision on a place for drainage, the surgeon must be knowledgeable on details from modern literature. The main target of this review was to summarize the currently available information on this topic and assess the status of the gallbladder as a viable option for cerebrospinal fluid diversion.
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Affiliation(s)
| | - Adelina Priscu
- Department of Internal Medicine, Indiana University Health Ball Memorial Hospital, Muncie, IN, USA
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Alraee S, Alshowmer S, Alnamshan M, Azzubi M. Management of ventriculo-gallbladder shunt in the presence of gallstones. BMJ Case Rep 2020; 13:13/6/e234775. [PMID: 32587118 PMCID: PMC7319722 DOI: 10.1136/bcr-2020-234775] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Hydrocephalus is a prevalent health problem that is frequently encountered by paediatric neurosurgeons during infancy and childhood. We report a case of an 11-year-old boy with high cerebrospinal fluid protein hydrocephalus secondary to optic glioma that required a ventriculoperitoneal (VP) shunt. The patient had multiple failures of VP shunt and developed massive ascites. Alternatively, the hydrocephalus was treated by ventriculo-gallbladder (VG) shunt in the presence of sludge which was removed from the gallbladder before placement of the shunt. After VG shunt insertion, the patient expressed signs of infection with elevated liver profile, which emphasised the presence of gallstones. While the shunt was kept in its place without any complications, the gallstones were successfully removed by an endoscopic retrograde cholangiopancreatography. In conclusion, the presence of sludge is not a contraindication for VG shunt placement, and, if the VG shunt was complicated with gallstones, it could be treated without the need for cholecystectomy.
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Affiliation(s)
- Sondus Alraee
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sahar Alshowmer
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammad Alnamshan
- Department of Pediatric Surgery, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Moutasem Azzubi
- Department of Pediatric Neurosurgery, National Guard Health Affairs, Riyadh, Saudi Arabia
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The ventriculo-cholecystic shunt: does CSF volume matter? Childs Nerv Syst 2019; 35:1557-1560. [PMID: 31350574 DOI: 10.1007/s00381-019-04317-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 07/18/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The management of hydrocephalus in paediatric patients where the peritoneum has failed can be challenging. One option is to perform a ventriculo-cholecystic shunt. However, little is known about the capacity of the gall bladder to accommodate cerebrospinal fluid (CSF). METHODS A retrospective case series was performed to include all paediatric patients who received a ventriculo-cholecystic shunt at a single centre, Sheffield Children's Hospital. RESULTS We identified three patients who had a ventriculo-cholecystic shunt inserted. The shunt survived past 1 year in two patients, who had pre-operative external ventricular drain (EVD) outputs of 8 and 10 ml/h respectively. One patient shunt failed at day four post-op due to distal dysfunction, his pre-operative EVD was over 30 ml/h. CONCLUSIONS When considering a patient for a ventriculo-cholecystic shunt, caution should be taken if a high CSF output is known, for example, as per an EVD measurement.
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Morosanu CO, Filip GA, Nicolae L, Florian IS. From the heart to the bladder-particularities of ventricular shunt topography and the current status of cerebrospinal fluid diversion sites. Neurosurg Rev 2018; 43:847-860. [PMID: 30338415 DOI: 10.1007/s10143-018-1033-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/28/2018] [Accepted: 09/17/2018] [Indexed: 12/01/2022]
Abstract
Hydrocephalus represents the pathological elevation of cerebrospinal fluid (CSF) levels as a consequence of various embryological or acquired defects. Although the classic method of treatment is by means of diverting the CSF from the ventricular system towards the peritoneum, there are other sites of diversion that have proven their efficiency through time, in the context of complications related to the more common option of intraperitoneal insertion. The aim of the review is to assess and organize a database of all the types of shunt locations from the oldest shunt attempts until present, using Pubmed and Medline and to underline the particularities related to technique, indications, complications and associated epidemiological background. Current literature reveals up to 36 sites of diversion of CSF with a diverse topography varying from cephalic regions such as venous sinuses or mastoid bone, thoracic elements such as the heart or the pleura and abdominopelvic segments such as the peritoneum or the urinary bladder. Several atypical locations were studied such as the fallopian and intestinal shunts. Although ventriculoperitoneal and ventriculoatrial shunts are the most commonly used shunts today, there are some systems such as the ventriculosinusal and ventriculolymphatic shunts that prove to be equally as efficient. The successful treatment of hydrocephalus requires a complete comprehension of the indications and therapeutic options and a reliable evaluation of the risks and possible complications. The profile of cerebral ventricular shunts is highly dynamic and the spectrum of cerebrospinal fluid diversion offers multiple solutions in the benefit of the patient.
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Affiliation(s)
- Cezar Octavian Morosanu
- Department of Neurosurgery, North Bristol NHS Trust, Southmead Hospital, Southmead Rd, Westbury-on-Trym, Bristol, United Kingdom.
| | - Gabriela Adriana Filip
- Department of Physiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Liviu Nicolae
- Department of Neurosurgery, North Bristol NHS Trust, Southmead Hospital, Southmead Rd, Westbury-on-Trym, Bristol, United Kingdom
| | - Ioan Stefan Florian
- Department of Neurosurgery, Cluj County Emergency Hospital, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
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Evangelos D, Dimitrios G, Georgios S, Nikolaos E, Filippos P, Marios T. Percutaneous placement of the peripheral catheter to the subclavian vein for a VA shunt. Pan Afr Med J 2017; 27:42. [PMID: 28761618 PMCID: PMC5516673 DOI: 10.11604/pamj.2017.27.42.11374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 05/01/2017] [Indexed: 12/02/2022] Open
Abstract
Hydrocephalus is a common neurosurgical pathology that affects people of all ages and especially the pediatric population. It can be very often a life threatening condition that pediatric neurosurgeons must deal with. Therefore a number of CSF diversion techniques have been established. The gold standard treatment currently is the placement of a ventriculo-peritoneal shunt. Because of hydrocephalus being a lifelong condition, it is almost in daily practice dealing with cases of shunt failures for a number of reasons. Herewith we present a 4 year old child with multiple ventriculo-peritoneal shunt revision surgeries and ventriculo-atrial failure due to distal catheter malfunction that was treated with percutaneous placement of the peripheral catheter in the subclavian vein.
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Affiliation(s)
- Drosos Evangelos
- Department of Neurosurgery, University of Athens Medical School, "Evangelismos" General Hospital, Athens, Greece
| | - Giakoumettis Dimitrios
- Department of Neurosurgery, University of Athens Medical School, "Evangelismos" General Hospital, Athens, Greece
| | - Sfakianos Georgios
- Department of Neurosurgery, Children's Hospital "Agia Sofia", Athens, Greece
| | | | - Papadopoulos Filippos
- Department of Neurosurgery, University of Athens Medical School, "Evangelismos" General Hospital, Athens, Greece
| | - Themistocleous Marios
- Department of Neurosurgery, University of Athens Medical School, "Evangelismos" General Hospital, Athens, Greece
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Johnson JA, O'Halloran PJ, Crimmins D, Caird J. Thinking outside the shunt-sterile CSF malabsorption in pilocytic astrocytomas: case series and review of the literature. Childs Nerv Syst 2016; 32:2255-2260. [PMID: 27193012 DOI: 10.1007/s00381-016-3112-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/06/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Ventriculoperitoneal (VP) shunt insertion is the most common cerebrospinal fluid (CSF) diversionary procedure used for the treatment of chronic hydrocephalus. Sterile CSF ascites is a rare complication of VP shunt insertion. This can arise from either an overproduction of CSF or inadequate filtration of CSF at the level of the peritoneum. By either mechanism, the development of CSF ascites requires an intact VP shunt. OBJECTIVE The authors discuss two paediatric cases diagnosed with suprasellar pilocytic astrocytomas treated with platinum-based chemotherapy, who subsequently developed sterile CSF ascites. We review the literature with regard to CSF malabsorption and discuss it as a contributing factor to shunt malfunction. CONCLUSION CSF malabsorption with resultant ascites is a rare complication of VP shunting with many etiologies. Two common predisposing factors included the use of platinum-based chemotherapeutic agents, as well as the specific neuropathology. Further analysis of these two entities is needed in order to elucidate their role in contributing to the development of CSF ascites in this patient cohort.
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Affiliation(s)
- J A Johnson
- Department of Neurological Surgery, Cork University Hospital, Corcaigh, Ireland
| | - P J O'Halloran
- Department of Neurological Surgery, Cork University Hospital, Corcaigh, Ireland.
| | - D Crimmins
- Department of Paediatric Neurosurgery, Children's University Hospital, Temple Street, Dublin 1, Ireland
| | - J Caird
- Department of Paediatric Neurosurgery, Children's University Hospital, Temple Street, Dublin 1, Ireland
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Richardson MD, Handler MH. Minimally invasive technique for insertion of ventriculopleural shunt catheters. J Neurosurg Pediatr 2013; 12:501-4. [PMID: 24011369 DOI: 10.3171/2013.8.peds12517] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Cerebrospinal fluid diversion to the pleural space has employed various methods to insert the distal catheter into the pleural space. The authors report on a minimally invasive method of pleural catheter insertion that they have developed and have used safely in a small series of patients. METHODS Pleural shunt catheters were inserted using a split trochar into the pleural space (technique described in further detail in the article). All cases over the previous 10 years in which this technique was employed were reviewed from the existing electronic medical records. Patient age at insertion, sex, reason for hydrocephalus, early and late complications, valve type, and follow-up were recorded. RESULTS Fourteen shunt procedures performed in 10 patients were identified. Two small pneumothoraces were detected on routine postoperative imaging and required no intervention. There were 3 late mechanical complications, including migration of a catheter out of the pleural space, catheter fracture at the insertion point, and the need for a longer catheter due to the patient's growth. CONCLUSIONS The authors describe a safe, minimally invasive method for insertion of pleural shunt catheters along with a series of patients who have undergone placement of a pleural shunt catheter using this method without complication directly attributable to the use of this technique.
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Demetriades AK, Haq IZ, Jarosz J, McCormick D, Bassi S. The ventriculocholecystic shunt: two case reports and a review of the literature. Br J Neurosurg 2013; 27:505-8. [PMID: 23445328 DOI: 10.3109/02688697.2013.771135] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We describe the re-siting of ventriculoperitoneal shunts to the gallbladder in two children. The first child had a rare case of hydrocephalus associated with plasminogen deficiency. She had had multiple VP shunt revisions due to non-absorption of CSF from the peritoneum. The second had craniopharyngioma-related hydrocephalus with once again a non-absorbing peritoneum. We report no surgical complications in the revisions for both the cases, and there has been a subsequent follow-up of 46 and 28 months, respectively, without incident. A review of the relevant literature describing the use and the performance of ventriculocholecystic shunts in comparison with other ventricular shunts is considered.
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Affiliation(s)
- A K Demetriades
- Department of Neurosurgery, King's College Hospital , Denmark Hill, London , UK
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