Thoracoscopic-Assisted Ventriculo-Azygous Shunt Placement for the Treatment of Hydrocephalus

BACKGROUND: Cerebrospinal fluid diversion is one of the most frequent neurosurgical procedures across the world and can be challenging in select patients who fail standard distal drainage sites. OBJECTIVE: To present the case of a woman after failing peritoneal, pleural, and atrial distal drainage sites who underwent a thoracoscopic-assisted ventriculo-azygous vein shunt placement. METHODS: A 32-year-old woman presented to our hospital with long-standing history of hydrocephalus and shunt dependence. She had failed peritoneal and atrial shunts secondary to infection, scarring, and clot formation. At presentation, she had a pleural shunt in place and developed a large pleural effusion with shortness of breath. RESULTS: She was taken to the operating room where a thoracoscopic-assisted ventriculo-azygous vein shunt was placed through a mini-thoracotomy. Postoperatively, she has not required a shunt revision in >2 years of follow-up. CONCLUSION: When other distal sites fail, our case report illustrates a novel surgical technique capable of being performed through a multidisciplinary approach. ABBREVIATION: SVC, superior vena cava

[1]  M. McGirt,et al.  Cost savings associated with antibiotic-impregnated shunt catheters in the treatment of adult and pediatric hydrocephalus. , 2015, World neurosurgery.

[2]  K. Judy,et al.  Cryptococcal ventriculoperitoneal shunt infection , 2014, Journal of Clinical Neuroscience.

[3]  J. Gliemroth,et al.  Ventriculocisternostomy versus ventriculoperitoneal shunt in the treatment of hydrocephalus: A retrospective, long-term observational study , 2014, Clinical Neurology and Neurosurgery.

[4]  E. Kasper,et al.  Ventriculoperitoneal shunting: Laparoscopically assisted versus conventional open surgical approaches , 2014, Asian journal of neurosurgery.

[5]  G. Caldito,et al.  Long-term outcomes of ventriculoperitoneal shunt surgery in patients with hydrocephalus. , 2014, World neurosurgery.

[6]  G. Mirone,et al.  Third ventriculostomy in shunt malfunction. , 2013, World neurosurgery.

[7]  G. Caldito,et al.  Ventriculoperitoneal shunt surgery and the risk of shunt infection in patients with hydrocephalus: long-term single institution experience. , 2012, World neurosurgery.

[8]  Y. Shoenfeld,et al.  Superior vena cava syndrome – changing etiology in the third millennium , 2012, Lupus.

[9]  J. Farmer,et al.  The use of laparoscopy in ventriculoperitoneal shunt revisions. , 2011, Journal of pediatric surgery.

[10]  Teresa S. Wu,et al.  Tension hydrothorax in a pediatric patient with a ventriculopleural shunt. , 2011, The Journal of emergency medicine.

[11]  Takashi Araki,et al.  Torkildsen shunt: re-evaluation of the historical procedure , 2010, Child's Nervous System.

[12]  C. Qu,et al.  Improved ventriculoatrial shunt for cerebrospinal fluid diversion after multiple ventriculoperitoneal shunt failures. , 2009, Surgical neurology.

[13]  T. Martin,et al.  Acute-recurrent subcutaneous emphysema after ventriculopleural shunt placement. , 2009, Journal of clinical anesthesia.

[14]  C. Murakami,et al.  A case of V-A shunt catheters migration into the pulmonary artery. , 2009, Legal medicine.

[15]  M. Dimopoulos,et al.  Endovascular stenting for the management of port-a-cath associated superior vena cava syndrome , 2009, Emergency Radiology.

[16]  F. Aparici-Robles,et al.  Abdominal cerebrospinal fluid pseudocyst: a complication of ventriculoperitoneal shunts in adults , 2008, Journal of medical imaging and radiation oncology.

[17]  David L McArthur,et al.  Success and complication rates of endoscopic third ventriculostomy for adult hydrocephalus: a series of 108 patients. , 2008, Surgical neurology.

[18]  A. Szold,et al.  Laparoscopic versus non-laparoscopic-assisted ventriculoperitoneal shunt placement in adults. A retrospective analysis. , 2007, Surgical neurology.

[19]  C. Gianatiempo,et al.  Pneumocephalus: a case report and review of article , 2006, International journal of clinical practice.

[20]  J. Gilsbach,et al.  A rare but life-threatening complication of ventriculo-atrial shunt , 2005, Acta Neurochirurgica.

[21]  J. Laurent,et al.  Ventriculoatrial shunting via the azygos vein , 1990, Childs Nervous System.

[22]  S. Obrador,et al.  Hydrothorax: Unusual complication of ventriculoperitoneal shunts , 1977, Acta Neurochirurgica.

[23]  G. Stringel,et al.  Ventriculo-gallbladder shunts in children , 1993, Child's Nervous System.

[24]  H. Hoffman,et al.  Cor pulmonale: a lethal complication of ventriculoatrial CSF diversion , 1989, Child's Nervous System.

[25]  C. E. Koop,et al.  John Holter's shunt. , 2001, Journal of the American College of Surgeons.

[26]  P. Singh,et al.  Intestinal volvulus – a rare complication of ventriculoperitoneal shunt , 1999, Pediatric Surgery International.

[27]  Paul Kremer,et al.  The scientific history of hydrocephalus and its treatment , 1999, Neurosurgical Review.

[28]  D. Barrow,et al.  Cerebrospinal fluid galactorrhea after ventriculopleural shunting: case report. , 1994, Surgical neurology.

[29]  G. Findler,et al.  Fibrothorax associated with a ventriculopleural shunt in a hydrocephalic child. , 1992, Journal of pediatric surgery.

[30]  C. Keirns,et al.  Ventriculoatrial shunts for hydrocephalus and cardiac valvulopathy: an echocardiographic evaluation. , 1991, American heart journal.

[31]  R. Fraser,et al.  Colonic perforation by ventriculoperitoneal shunts. , 1986, Surgical neurology.

[32]  R. Pudenz,et al.  The surgical treatment of hydrocephalus--an historical review. , 1981, Surgical neurology.

[33]  L. Kessler,et al.  The ventriculopleural shunt procedure for hydrocephalus , 1962 .

[34]  L. Kessler,et al.  The ventriculopleural shunt procedure for hydrocephalus. Case report of an unusual complication. , 1962, The Journal of pediatrics.

[35]  R. Pudenz,et al.  Ventriculo-auriculostomy; a technique for shunting cerebrospinal fluid into the right auricle; preliminary report. , 1957, Journal of neurosurgery.