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Ventricular cholecystic shunts in children
J A Ketoff1, R L Klein, K F Maukkassa
1Department of Surgery, Fairview Health Systems, Cleveland, OH, USA.
Insights
Ventricular cholecystic shunts offer a viable alternative for hydrocephalus treatment when traditional methods fail. This procedure demonstrated success with minimal gallbladder complications in pediatric patients.
Area of Science:
- Pediatric Neurosurgery
- Surgical Innovation
- Hydrocephalus Management
Background:
- Hydrocephalus is a common pediatric condition requiring surgical intervention.
- Ventricular peritoneal shunting is the standard treatment, but distal catheter obstruction is a frequent complication.
- Alternative distal catheter placements have shown limited success.
Purpose of the Study:
- To describe the experience and outcomes of using ventriculocholecystic shunts in pediatric patients.
- To evaluate the efficacy and safety of placing distal shunts in the gallbladder for hydrocephalus management.
- To present ventriculocholecystic shunting as a potential solution for complex hydrocephalus cases.
Main Methods:
- Retrospective review of 16 pediatric patients who underwent ventriculocholecystic shunting between 1986 and 1995.
- Analysis of patient demographics, prior shunting history, follow-up duration, and shunt-related complications.
- Assessment of shunt function and specific complications related to gallbladder placement.
Main Results:
- Eleven of the 16 shunts remained functional at a median follow-up of 3 years.
- No shunts required removal or revision due to gallbladder-specific complications (e.g., stones, infection, occlusion).
- Seven patients experienced other shunt-related issues unrelated to the distal catheter placement.
Conclusions:
- Ventricular cholecystic shunting is a safe and effective option for managing hydrocephalus in challenging cases.
- The procedure offers simplicity, a low complication rate, and comparable outcomes to traditional shunts.
- This technique should be considered when conventional shunting sites are not feasible.
Abstract:
Hydrocephalus is a prevalent pediatric problem, and ventricular peritoneal shunting is the preferred procedure for surgical treatment. A system may become dysfunctional if the distal end of the catheter fails to drain because of intraabdominal adhesions, cerebral spinal fluid cysts, or peritonitis. Then additional revisions become necessary. Pediatric surgeons can come to the aid of their neurosurgical colleagues by placing the distal end of the catheter into the pleural space, cardiac atrium, ureter, stomach, or fallopian tube. These have all met with limited success. The ventricular cholecystic shunt has been used in some difficult-to-manage cases of hydrocephalus, and our experience with the procedure is described. In the complicated patient, we have had success placing the distal catheters in the gallbladder. Between 1986 and 1995 sixteen patients have had ventriculocholecystic shunts placed. The mean age was 10.8 years, ranging from 0.9 to 23 years. Prior shunting procedures averaged 4.1 (range 0 to 11). The follow-up period ranged from 4 weeks to 7.5 years, with a median follow-up of 3 years. No shunts were removed or revised specifically because of gallbladder complications such as infected bile, stones, or distal catheter occlusion. Seven patients experienced other shunt-related problems that were not caused by distal catheters, ie, staphylococcal infections and intracerebral problems. Eleven of the original shunts are still functioning. Two patients died of causes not related to the ventriculoperitoneal shunt. Because of their simplicity of placement, low incidence of complication, and similarity to ventriculoperitoneal shunts, the ventricular cholecystic shunt should be considered when other sites are unattainable.