Ventriculo-sagittal sinus shunt malfunction. Causes of failure, avoidance, and alternatives

This case report highlights causes of failure of the ventriculo-sagittal sinus (V-S) shunt and precautions to avoid them. We present, a 14-year-old girl, a case of post-hemorrhagic hydrocephalus with multiple revisions of ventriculo-peritoneal (V-P) and ventriculo-atrial (V-A) shunts. She developed malfunctioned V-S shunt, and ventriculitis that was complicated with massive cerebellar and brain stem infarction and the patient died. To avoid malfunction, a cardiac catheter with side slits should be used, magnetic resonance angiography is recommended before shunt placement to check the patency of the sinus, and the pressure in the superior sagittal sinus should be measured at the time of surgery. In patients with problematic distal catheters, direct placement of the catheter into the right atrium using thoracoscope could be an alternative to gall bladder or ureter shunts.