Article

Ventriculopleural Shunts for Hydrocephalus: A Useful Alternative

Prince of Wales Children's Hospital, Randwick, New South Wales, Australia.
Neurosurgery (Impact Factor: 3.03). 01/1989; 23(6):753-5. DOI: 10.1227/00006123-198812000-00012
Source: PubMed

ABSTRACT From 1969 to 1979, ventriculopleural shunts were inserted in 29 children with progressive hydrocephalus. A standard Pudenz pump with a Raimondi catheter was used for all but 1 child for whom a Holter valve was used. The shunt functioned adequately in 7, but in 18 it had to be changed as a result of symptomatic pleural effusion. From 1979 to 1982, a further series of 52 other patients received ventriculopleural shunts, and these cases have recently been reviewed. The apparatus used was a Portnoy ventricular catheter or a medium or high pressure Heyer Schulte pump with an antisiphon device and a Salmon distal catheter. Three patients developed a shunt infection. One died with a functioning shunt. Four catheters became blocked by adhesions, and in only 1 patient was a peritoneal shunt substituted as a result of symptomatic effusion.

1 Follower
 · 
270 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Due to the limited absorptive capacity of the pleural cavity, infants and young children are not generally ideal candidates for ventriculopleural shunts. We report using chest cavities as alternate for temporary diversion of CSF in a young child. Venous access to the cervical region could not be utilized because of scarring from previous procedures, while peritoneal access was contraindicated due to repeated pseudocyst formation. Pleural effusions were removed by thoracentesis when necessary, and the shunt catheter was changed to the opposite side of the chest when the effusions reaccumulated within one week. Utilizing the ventriculopleural shunts allowed us to temporize her non-communicating hydrocephalus for a period of one year, until a definitive CSF procedure by direct intracardiac placement of the distal catheter could be performed.
    Acta Neurochirurgica 02/1992; 115(1-2):67-8. DOI:10.1007/BF01400595 · 1.79 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Tension hydrothorax is rare, with few cases reported in the literature dating back to the late 1960s. We report a case of tension hydrothorax in a patient with a ventriculopleural shunt who improved dramatically after thoracentesis. The discussion includes a brief review of ventriculopleural shunts and pleural physiology.
    Journal of Emergency Medicine 01/1998; 16(1):33-6. DOI:10.1016/S0736-4679(97)00238-2 · 1.18 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Ventriculoperitoneal shunting constitutes the standard procedure for draining cerebrospinal fluid (CSF) in children with hydrocephalus. Ventriculoatrial and ventriculopleural shunting are alternative methods of CSF drainage, which have gained less acceptance. Ventriculopleural shunts are seldom used owing to justified fears of pneumothorax and symptomatic effusions of CSF. The addition of an antisiphon device to standard shunt systems seems to have prevented CSF pleural effusion. From 1988 to 1998, we treated each of six hydrocephalic children with a ventriculopleural shunt. In five cases we used new-technology valves designed to prevent the effects of siphoning with current differential pressure valves. Peritoneal adhesions, recent peritonitis, ascites, and obstruction of a previous ventriculoatrial shunt were the indications for pleural shunting. After a mean follow-up period of 2.5 years all shunts were functioning adequately. Only one patient showed transient symptoms of CSF overdrainage, which were corrected by up-grading the valve setting with the magnet. A late death was unrelated to the pleural shunting procedure. The use of valves of a new design designed to prevent overdrainage seems to account for the satisfactory outcomes observed in this series. We suggest that ventriculopleural shunting should be considered as the preferred alternative to peritoneal drainage in children with intra-abdominal adhesions or with a history of recent peritoneal infection.
    Child s Nervous System 01/2001; 16(12):867-71. DOI:10.1007/PL00007282 · 1.16 Impact Factor
Show more