Ventriculopleural Shunts for Hydrocephalus: A Useful Alternative

Prince of Wales Children's Hospital, Randwick, New South Wales, Australia.
Neurosurgery (Impact Factor: 3.62). 01/1989; 23(6):753-5. DOI: 10.1227/00006123-198812000-00012
Source: PubMed


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.

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    • "In 1988, Jones reported a series of 29 children who were treated with VPLS in which only 7 shunts worked for more than a year. Three patients developed shunt infection, in four patients catheters became blocked by adhesions, one required substitution with VPS for a large recurrent symptomatic effusion while one patient in whom the shunt was functioning, died of unrelated causes.[18] On the contrary, Portnoy reported a series of 52 patients who were managed with VPLS with an anti-siphon device. "
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    ABSTRACT: Ventriculo-pleural shunt (VPLS) is an acceptable alternative in the management of hydrocephalus. Imbalance between the production and absorption of cerebrospinal fluid an lead to formation of pleural effusion in patient with VPLS and on occasion produce symptoms. Pleural effusion could be a transudate or a non-specific exudate. We report our experience with this modality in relation to formation of pleural effusion and review the literature to make recommendation for its management. Information related to patients' demographics, smoking history, prior pulmonary and occupational history, indication, duration and complications of the VPLS and their management was gathered to substantiate current recommendation with our experience.
    07/2010; 5(3):166-70. DOI:10.4103/1817-1737.65048
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    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 · 1.77 Impact Factor
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    ABSTRACT: A complication of ventriculopleural shunting in which the pleural end of the catheter retracted out of the pleural cavity is described. Continued drainage of the cerebrospinal fluid into the subcutaneous and breast tissue led to the development of breast enlargement and drainage via the nipple. The mechanism of production and guidelines to avoid this complication are discussed, and a brief review of ventriculopleural shunting complications is presented.
    Surgical Neurology 10/1994; 42(3):227-30. DOI:10.1016/0090-3019(94)90267-4 · 1.67 Impact Factor
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