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Updated: Jul 6, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Ventriculogallbladder shunts in pediatric patients
Philipp R Aldana1, Hector E James, Richard A Postlethwait
1Department of Neurosurgery, University of Florida Health Science Center, Jacksonville, Florida, USA.
Insights
Ventriculogallbladder shunts offer an alternative for children with hydrocephalus when peritoneal shunts fail. This study shows VGB shunts can be effective when the abdomen is unavailable for cerebrospinal fluid diversion.
Area of Science:
- Pediatric Neurosurgery
- Surgical Innovation
- Hydrocephalus Management
Background:
- Ventriculoperitoneal (VP) shunts are standard for hydrocephalus but can fail due to peritoneal absorption issues or abdominal surgeries.
- Alternative distal termini are needed for patients with compromised peritoneal cavities.
Purpose of the Study:
- To describe the clinical protocol and outcomes of ventriculogallbladder (VGB) shunts in pediatric patients.
- To evaluate VGB shunts as an alternative to VP shunts when the peritoneum is unsuitable.
Main Methods:
- Eighteen pediatric patients received VGB shunts due to VP shunt malfunction (peritoneal failure) or prior abdominal surgeries.
- Preoperative gallbladder imaging (ultrasound or CT) was performed.
- Procedures involved open laparotomy for precise distal catheter placement and gallbladder wall anchoring by pediatric neurosurgical and general surgical teams.
Main Results:
- 13 of 18 patients had functional VGB shunts at a mean follow-up of 2.1 years.
- Three early/late malfunctions occurred (sludge, common bile duct obstruction, gallbladder stones), successfully converted to VP shunts.
- Two shunt infections were successfully treated; two patients required repeat VGB shunt conversions.
Conclusions:
- Ventriculogallbladder shunts are a viable option for pediatric hydrocephalus when the peritoneal cavity is not usable.
- Careful patient selection and surgical technique are crucial for VGB shunt success.
Object:
The authors report a clinical protocol for the application of ventriculogallbladder (VGB) shunts in children who may be unable to maintain or receive ventriculoperitoneal (VP) shunts.
Methods:
Eighteen patients underwent placement of VGB shunts as an alternative to VP shunt therapy for the following reasons: malfunction of the VP shunt due to suspected failure of the peritoneum to absorb cerebrospinal fluid (17 cases) and multiple intraabdominal general surgical procedures (1 case). The patients ranged in age from 4 months to 17 years (mean 6.5 +/- 6.1 years [standard deviation {SD}]). All patients underwent preoperative imaging of the gall-bladder either by ultrasonography or computed tomography scanning. A team consisting of a pediatric neurological surgeon and a pediatric general surgeon performed all operative procedures. The procedures were conducted by open laparotomy to precisely place the appropriate length of distal catheter and to anchor it to the gallbladder wall.
Results:
There were 2 early shunt malfunctions, both obstructions due to "sludge" (1 in the biliary duct and 1 in the common bile duct). A late-onset (5-year) malfunction occurred secondary to gallbladder stones. In all 3 cases of malfunction, the devices were successfully converted to VP shunts. In 1 patient a conversion to a VP shunt was chosen following a general surgical intervention. There were 2 shunt infections (Staphylococcus epidermidis and Haemophilus influenzae). These were successfully treated. Two patients underwent conversion to a VGB shunt on 2 occasions. Thirteen patients had functional VGB shunts at the time of their last follow-up assessment. The follow-up for these 13 patients ranged from 1 to 8 years (mean 2.1 +/- 2.0 years [SD]).
Conclusions:
Ventriculogallbladder shunts may be considered for the treatment of hydrocephalus in children when the peritoneal cavity cannot be used as a distal terminus.
