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Updated: Oct 24, 2025
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Ventriculopleural shunts in a pediatric population: a review of 170 consecutive patients
Eisha A Christian1, Jeffrey J Quezada2, Edward F Melamed2
11Department of Neurological Surgery, Kaiser Permanente Medical Center, Los Angeles.
Insights
Ventriculopleural shunts are effective for pediatric hydrocephalus, but younger children (<10 years) face higher pleural effusion risks. Complication rates are comparable to ventriculoperitoneal shunts.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Biomedical Engineering
Background:
- Hydrocephalus management often requires cerebrospinal fluid (CSF) diversion.
- Ventriculoperitoneal (VP) and ventriculoatrial (VA) shunts are common, but alternative distal termini are sometimes necessary.
- The pleural space serves as a less common alternative distal site for CSF shunts.
Purpose of the Study:
- To evaluate the outcomes and complications of using the pleural space as the distal terminus for ventricular CSF-diverting shunts in pediatric patients.
- To compare complication rates of ventriculopleural (VPl) shunts with other shunt types.
- To identify risk factors for VPl shunt complications, particularly pleural effusion.
Main Methods:
- A retrospective review of 170 pediatric patients who underwent VPl shunt insertion or revision between 1978 and 2018.
- Data collected included patient demographics, hydrocephalus etiology, shunt history, reasons for VPl shunt use, valve types, and complication occurrences.
- Analysis focused on shunt revisions, reasons for revision, shunt infections, and pleural effusion development.
Main Results:
- Of 170 patients, 73 (43%) required shunt revision, most commonly for proximal obstruction (44%).
- Pleural effusion occurred in 22 patients (30%), necessitating distal terminus revision; it was more common in shunts without an antisiphon valve.
- Children under 10 years had a significantly higher rate of pleural effusion (24%) requiring revision compared to older children (11%).
- Shunt infection rate was 4.2% per procedure and 8.2% per patient.
Conclusions:
- VPl shunts in children under 10 years are associated with a higher incidence of symptomatic pleural effusion requiring revision.
- Overall complication rates for VPl shunts are comparable to those of VP shunts.
- For patients over 10 years, VPl shunts are a viable alternative to VA shunts when the peritoneal cavity is unsuitable.
Objective:
The authors sought to determine the outcome of using the pleural space as the terminus for ventricular CSF-diverting shunts in a pediatric population.
Methods:
All ventriculopleural (VPl) shunt insertions or revisions done between 1978 and 2018 in patients at Children's Hospital Los Angeles were identified. Data recorded for analysis were age, sex, weight, etiology of hydrocephalus, previous shunt history, reason for VPl shunt insertion or conversion from a ventriculoperitoneal (VP) or ventriculoatrial (VA) shunt, valve type, nature of malfunction, presence of shunt infection or pleural effusion, and conversion to a different distal site.
Results:
A total of 170 patients (mean age 14 ± 4 years) with a VPl shunt who were followed up for a mean of 57 ± 53 months were identified. The reasons for conversion to a VPl shunt for 167 patients were previous shunt infection in 57 (34%), multiple abdominal procedures in 44 (26%), inadequate absorption of CSF in 34 (20%), abdominal pseudocyst in 25 (15%), and obesity in 7 (4%). No VPl revisions were required in 97 (57%) patients. Of the 73 (43%) patients who did require revision, the most common reason was proximal obstruction in 32 (44%). The next most frequent complication was pleural effusion in 22 (30%) and included 3 patients with shunt infection. All 22 patients with a clinically significant pleural effusion required changing the distal end of the shunt from the pleural space. Pleural effusion was more likely to occur in VPl shunts without an antisiphon valve. Of the 29 children < 10 years old, 7 (24%) developed a pleural effusion requiring a revision of the distal catheter to outside the pleural space compared with 15 (11%) who were older (p = 0.049). There were 14 shunt infections with a rate of 4.2% per procedure and 8.2% per patient.
Conclusions:
VPl shunts in children younger than 10 years of age have a significantly higher rate of symptomatic pleural effusion, requiring revision of the shunt's terminus to a different location. VPl shunt complication rates are similar to those of VP shunts. The technical difficulty of inserting a VPl shunt is comparable to that of a VP shunt. In a patient older than 10 years, all else being equal, the authors recommend that the distal end of a shunt be placed into the pleural space rather than the right atrium if the peritoneal cavity is not suitable.
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