Innovative approach to the difficult ventricular shunt using pleural access device for maintenance drainage: case report
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Updated: Dec 31, 2025
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Sharon R Weeks1, Carolyn E Gosztyla1, Laurence Davidson2
1Divisions of1General Surgery.
Insights
This study presents a novel split shunting technique for managing refractory hydrocephalus in a pediatric patient with complex medical needs. This innovative approach successfully prevented neurological complications and allowed for noninvasive fluid drainage.
Area of Science:
- Neurosurgery
- Pediatric Medicine
- Fluid Management
Background:
- Hydrocephalus management in patients with complex medical histories, including multiple ventricular shunt failures, presents significant challenges.
- Refractory hydrocephalus can be exacerbated by impaired cerebrospinal fluid (CSF) absorption in body cavities, particularly after procedures like renal transplantation.
- Developing innovative solutions is crucial for managing hydrocephalus in patients with limited treatment options.
Observation:
- A 4-year-old boy with refractory hydrocephalus experienced secondary reduced CSF absorption in pleural and peritoneal cavities post-renal transplantation.
- A novel management strategy involved split shunting to both pleural and peritoneal cavities.
- Prophylactic pleural port placement was incorporated for potential minimally invasive thoracentesis.
Findings:
- The split shunting approach successfully managed hydrocephalus in the patient.
- The pleural port facilitated noninvasive aspiration of fluid, relieving symptoms for 16 months without complications.
- This technique demonstrated effective CSF drainage and prevention of neurological sequelae.
Implications:
- This novel distal shunting approach offers a viable solution for complex hydrocephalus cases with impaired CSF absorption.
- Prophylactic pleural port placement enables noninvasive management of recurrent symptomatic pleural effusions.
- The findings suggest a new paradigm for managing shunt failure and associated complications in pediatric patients.
Abstract:
Patients with complex medical problems and multiple failed ventricular shunts require continued innovation for hydrocephalus management. The authors report the case of a 4-year-old boy with refractory hydrocephalus and secondary reduced ability to absorb CSF in both the pleural and peritoneal cavities following renal transplantation. A novel management approach was devised with split shunting to pleural and peritoneal targets as well as prophylactic pleural port placement to provide a method for minimally invasive thoracentesis should symptomatic pleural effusions develop. Fluid was successfully aspirated via the pleural port with relief of symptoms over a period of 16 months without complication. The authors demonstrate that a previously undescribed approach to distal shunting can prevent neurological sequelae of shunt failure and permit noninvasive maintenance drainage for patients in whom symptomatic pleural effusion is a recurrent complication.
