Ventriculobiliary Shunts, Another Option

Abstract

The basic management of hydrocephalus includes shunts to the peritoneum and atrium. However, there are particularly complex patients in whom it is necessary to look for atypical places for implanting the distal catheter. Since 2000, 1,325 shunts have been implanted in pediatric patients. Only 3 patients required a ventriculobiliary shunt. We report 3 cases: a 7-year-old boy with a surgically treated complex heart disease, a 16-month-old girl with hydrocephalus secondary to a brain tumor and multiple bacteremias secondary to an infection of the central venous reservoir, and a 4-year-old girl with nonreabsorptive hydrocephalus caused by intraventricular bleeding due to premature birth, necrotizing enterocolitis and shunt infections with abdominal pseudocysts, which caused multiple abdominal septations and, finally, a nonreabsorptive peritoneum. At present, cases 1 [45 months after ventriculobiliary shunt (VBS)] and 3 (27 months after VBS) are symptom free, while case 2 (14 months after VBS) died of infectious respiratory complications. The gold standard for the treatment of nonreabsorptive hydrocephalus is a ventriculoperitoneal shunt, the second option is a ventriculoatrial shunt, and the third option is uncertain. In our short experience, a ventriculo-gallbladder shunt is a good option when there is no abdominal hypertension.

Migration of Ventriculoperitoneal Shunt into a Hernia Sac: An Unusual Complication of Ventriculoperitoneal Shunt Surgery in Children

“…Alternatively, for a complicated abdomen secondary to surgery, infection, perforation, and adhesion, other sites such as atria, the pleura, urinary bladder, and gallbladder may be considered depending on one's expertise and facilities available [11]. …”

Evaluation of the ventriculocholecystic shunt—an overview of present practice in adult and pediatric hydrocephalus

“…Although not reported, Demetriades et al also remark that cholecystitis can potentially yield ascending and descending VCS infections [56] as it has been observed in VP shunts [40].…”

“…Most authors report multiple attempts on VP or VA shunts. On a few occasions, more infrequent shunts have been mentioned as previous options, such as ventriculosaphenous [34], ventriculofemoral [56], or ventriculojugular shunt [2]. West described patients that had up to 6 revisions of their VP/VA shunts [70].…”

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

“…Such sites include the aforementioned cardiac atria and peritoneal cavity and the less commonly used venous circulation (retrograde ventriculo-venous including sinuses and jugular veins) and cholecystic, uteretic, and vesicular sites. 1,2,4,7,11,26,28 Each distal site has its own peculiar complications in addition to the heterogeneous structural risks due to catheter migration. 4,10,28,30,35 Ventriculoatrial shunts have associated morbidity (of heterogeneous severity) secondary to complications including shunt nephritis, shunt infection, pulmonary embolism, endocarditis, and cardiac and pulmonary thrombi.…”

“…1,2,4,7,11,26,28 Each distal site has its own peculiar complications in addition to the heterogeneous structural risks due to catheter migration. 4,10,28,30,35 Ventriculoatrial shunts have associated morbidity (of heterogeneous severity) secondary to complications including shunt nephritis, shunt infection, pulmonary embolism, endocarditis, and cardiac and pulmonary thrombi. 19,21,33,36,38 An alternative second-line option is VPL shunting.…”