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Experience of a reference center on ventriculo-gallbladder shunt as an alternative treatment for peritoneal failure
Alick Durão Moreira1, Antônio Bellas2,3, Marcelo Pousa3
1Department of Pediatric Neurosurgery, National Institute of Health for Women, Children and Adolescent Fernandes Figueira/Fiocruz, Rio de Janeiro, Brazil. alickdurao@gmail.com.
Insights
Ventriculo-gallbladder shunt (VGS) is a viable alternative for pediatric hydrocephalus patients with peritoneal shunt failure. This study shows VGS offers good outcomes with manageable complications.
Area of Science:
- Pediatric Neurosurgery
- Cerebrospinal Fluid Shunt Management
Background:
- Ventriculo-peritoneal shunts are standard for hydrocephalus but can fail.
- Peritoneal failure necessitates alternative CSF diversion strategies.
Purpose of the Study:
- To evaluate the ventriculo-gallbladder shunt (VGS) as an alternative for pediatric patients with peritoneal shunt failure.
- To analyze surgical technique and outcomes from a reference center's experience.
Main Methods:
- Retrospective study (2018-2023) of pediatric patients with peritoneal shunt failure.
- Patients underwent ventriculo-gallbladder shunt placement.
- Data collected on patient demographics, hydrocephalus causes, VGS placement, complications, and follow-up.
Main Results:
- 10 of 18 patients with peritoneal failure received VGS.
- Mean age at VGS placement was 35.4 months.
- Temporary complications included diarrhea (n=2) and shunt infections (n=2); infections were successfully treated with new VGS placement.
- Average follow-up was 18.8 months with no further issues.
Conclusions:
- Ventriculo-gallbladder shunt is a feasible option for managing hydrocephalus in cases of peritoneal failure.
- VGS demonstrates promising outcomes and manageable complications in pediatric neurosurgery.
Purpose:
Ventriculo-peritoneal shunt is the gold standard for non-obstructive hydrocephalus. Despite advances in material, infection prevention, and valve technologies, failure can still occur. The aim of this article is to present a comprehensive study based on the experience of a reference center in pediatric neurosurgery in Rio de Janeiro with the use of the ventriculo-gallbladder shunt as an alternative to peritoneal failure.
Methods:
A retrospective study was conducted from January 2018 to December 2023 of patients diagnosed with cerebrospinal fluid shunt dysfunction due to peritoneal failure and submitted to ventriculo-gallbladder shunt as an alternative in a reference center of Rio de Janeiro.
Results:
From 2018 to 2023, 18 peritoneal failures were diagnosed. Among them, 10 patients (55.5%) were selected for ventriculo-gallbladder shunt (VGS). Different causes were responsible for the hydrocephalus in these patients. VGS was placed at a mean age of 35.4 months. Four patients had temporary complications: 2 self-limited diarrheas in the first month and 2 shunt infections. After the resolution of the infection, a new VGS was placed successfully. The average follow-up was 18.8 months (follow-up 9-68 months) without further issues.
Conclusion:
VGS is a viable option for patients facing peritoneal failure. This paper provides valuable insights into the surgical technique and outcomes associated with this alternative.
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