Case series of ventriculopleural shunts in adults: a single-center experience

Abstract

OBJECTIVE The peritoneal cavity is widely used as the destination of choice for cerebrospinal fluid shunts. Various alternative sites have been used, particularly in the presence of certain contraindications. The pleural cavity has been used; however, a paucity of evidence details ventriculopleural (VPL) shunt survival, complication, and revision rates in adults. The aim of this study was to present a single center's experience with VPL shunts, identifying complication, revision, and survival rates. METHODS A single-center, retrospective case series analysis was conducted for VPL shunt insertions and revisions over a period of 5 years. Demographic as well as clinical data were collected. Ventriculopleural shunt survival was assessed using Kaplan-Meier curves and the log rank (Cox-Mantel) test. RESULTS Twenty-two VPL shunts were inserted in 19 patients. Median survival of the VPL shunts was 14 months. Pathological indication for the VPL shunt did not significantly affect survival. A total of 10 complications was observed: 2 infections, 2 cases of overdrainage, 2 obstructions, 1 distal catheter retraction, 2 symptomatic pleural effusions, and 1 asymptomatic pleural effusion. CONCLUSIONS Ventriculopleural shunting is a safe and viable second-line procedure for cases in which ventriculoperitoneal shunts are unsuitable. While VPL shunts have a high revision rate, their complication rate is comparable to that of VP shunts. Ventriculopleural shunt survival can be improved by careful patient selection and the implementation of a combination of valves with antisiphon devices.

Worsening respiratory failure in an adult hydrocephalic patient with a ventriculo‐pleural shunt

“…A smaller single‐centre case series reported on 19 adult patients who received VPL shunting—at five‐year follow‐up, three pleural effusions were diagnosed, of which two were symptomatic and required surgical revision. This suggests an 11% incidence of pleural effusions in adult hydrocephalic patients [14]. This differs from Hoffman et al who demonstrated a pleural effusion prevalence of 20% in 59 children undergoing VPL shunt insertion [15].…”

Case Series of Ventriculoatrial Shunt placement in Hybrid Room: Reassessment of Ventriculoatrial Shunt

“…The pleura is also not a good option for long term distal catheter placement. 3) Of course, placement in the atrium can also have complications similar to other distal placements; obstruction, infections, and malfunction can occur. However, in a recent comparative study on long term outcome of VPS, the incidence of complications of VAS is not higher than VPS.…”

Shunt-Bronchial Fistula with Coughing Up and Swallowing of Cerebrospinal Fluid: Rare Complication of Ventriculopleural Shunt

“…Ventriculoatrial shunting may be complicated by migration into the pericardium to cause cardiac tamponade or into the pulmonary system to create a bronchovenous fistula as late as 5 years after initial shunt implantation 21 , 22 . With regard to ventriculopleural shunts, complications described include pleural effusion, pneumothorax, hydrothorax, intrapleural pseudocysts, cardiac tamponade with heart failure, respiratory failure, or trapped lung 23, 24, 25, 26, 27, 28, 29, 30, 31, 32. A case report from 1962 described a patient with a ventriculopleural shunt who presented with severe headache in addition to long-standing irritating and constant desire to cough for several weeks.…”