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Ventricular gallbladder shunts: an alternative procedure in hydrocephalus
Insights
Ventricular gallbladder shunts offer a viable alternative for treating infant hydrocephalus when other shunt types fail. This study found 70% of patients had functional shunts long-term.
Area of Science:
- Pediatric Neurosurgery
- Surgical Innovation
- Hydrocephalus Management
Background:
- Hydrocephalus is common in infants, often treated with ventriculoperitoneal (VP) or ventriculoatrial (VA) shunts.
- Previous alternative distal shunt sites include the stomach, ureter, and fallopian tube.
- VP and VA shunts can be associated with complications like infection and malfunction.
Purpose of the Study:
- To report the experience with ventricular gallbladder shunts (VGB) in pediatric patients.
- To evaluate the efficacy and long-term outcomes of VGB shunts.
- To identify indications and potential complications of VGB shunts.
Main Methods:
- A retrospective review of 25 children (13 girls, 12 boys) aged 6 months to 16 years who underwent VGB shunt placement between 1970 and 1985.
- Analysis of diagnoses including meningomyelocoele, congenital hydrocephalus, postmeningitic complications, intracranial tumors, and intraventricular hemorrhage.
- Indications for VGB shunts included VP/VA shunt infections, ascites, and distal shunt malfunction.
Main Results:
- Fifteen shunts remained functional at long-term follow-up in 70% of available patients (20/25).
- Early shunt failure occurred in 3 patients due to proximal obstruction or gallbladder atony.
- One case of gallbladder atony was successfully treated with cholecystokinin; two required shunt revision.
Conclusions:
- The ventricular gallbladder shunt (VGB) procedure is a valuable alternative for hydrocephalus management.
- VGB shunts are particularly useful in patients where intraperitoneal and intravascular shunts are not feasible.
- Long-term functional success rates suggest VGB shunts are a viable option in complex cases.
Abstract:
Hydrocephalus is a frequently encountered problem in infancy and is most commonly treated by placement of ventriculoperionteal (VP) or ventriculoatrial (VA) shunts. Other sites for insertion of the distal shunt have included the stomach, ureter, and fallopian tube. This report describes an experience with ventricular gallbladder shunts (VGB) in 25 children performed from 1970 to 1985. There were 13 girls and 12 boys ranging in age from 6 months to 16 years. Diagnosis included meningomyelocoele (7), congenital hydrocephalus (7), postmeningitic complications (5), intracranial tumor (4), and intraventricular hemorrhage (2). Indications for operation included VP shunt infection (15), massive ascites following VP shunt (3), VA shunt infection (4), and distal shunt malfunction due to fibrinous adhesions or cysts (secondary to infection; (3). Three patients had early shunt failure due to proximal obstruction (2) and gallbladder atony (1). Shunt revision was required in two and the atony was successfully treated with cholecystokinin in one. Fourteen shunts remain in place, two patients have been lost to follow-up, and three children died from unrelated causes. Seventy percent of the 20 patients available for long-term follow-up have functional shunts in place. The VGB shunt procedure remains an attractive alternative for patients with hydrocephalus in whom intraperitoneal and intravascular shunts are no longer feasible.