Ventriculo-Pyelo-"Allium" shunt as last resort procedure for complex pediatric hydrocephalus - first case described

Area of Science:

• Neurosurgery
• Pediatric Surgery
• Urology

Background:

• Hydrocephalus management often requires shunting, with ventriculoperitoneal (VP) and ventriculoatrial (VA) shunts being standard.
• Complex cases with failed VP/VA shunts may necessitate alternative procedures like ventriculo-pyeloureteral (VPU) shunting.
• VPU shunting can be challenging due to potential ureteral complications, such as obstruction by the shunt catheter.

Purpose of the Study:

• To report the successful use of a nitinol-based ureteral stent to facilitate VPU shunting in a pediatric patient.
• To demonstrate a salvage technique for hydrocephalus refractory to conventional shunting methods.
• To highlight the prevention of ureteral obstruction during VPU shunting using a ureteral stent.

Main Methods:

• A toddler with complex hydrocephalus and failed VP/VA shunts underwent VPU shunting.
• A self-expanding nitinol ureteral stent (Allium Medical Solutions) was deployed to dilate the ureter and create a channel for the VPU catheter.
• The VPU shunt catheter was placed within the stented ureter.

Main Results:

• The VPU shunt procedure was successfully salvaged using the Allium ureteral stent.
• The stent prevented obstruction of the ureter by the shunt catheter, resolving urinoma formation.
• At 7-month follow-up, the patient showed stable neurological status, effective cerebrospinal fluid drainage, and no vesicoureteral reflux.

Conclusions:

• Ventriculo-pyeloureteral shunting combined with an Allium ureteral stent is a viable last-resort option for hydrocephalus.
• This technique effectively prevents ureteral obstruction by the shunt catheter.
• Successful VPU shunting with ureteral stenting offers a solution for complex pediatric hydrocephalus cases unresponsive to standard treatments.