Percutaneous ventriculoatrial shunting as a salvage method in the pediatric hydrocephalus patients with peritoneal problems

Abstract

Abstract Purpose Ventriculoperitoneal shunt is preferred and widely applied method in patients who require shunt procedures. However in cases with abdominal complications, another body compartment should be used for the distal catheters and ventriculoatrial shunt is the preferred second-line treatment method. The purpose of this study is to evaluate the efficacy of percutaneous ventriculoatrial shunting as a salvage method in the pediatric patients with abdominal complications. Methods Data obtained from 9 patients with ventriculoperitoneal shunt dysfunctions due to abdominal complications, who underwent ventriculoatrial shunting as a salvage treatment at a single institution between January 2019 and September 2021 were retrospectively reviewed. All of the operations were performed under the guidance of intraoperative fluoroscopy and ultrasound. Results The mean age of the patients was 8.1 ± 1.2 years (2-15 years). Six patients (67%) were male and 3 patients (33%) were female. The mean number of the patients’ ventriculoperitoneal shunt revisions until atrial catheter placement was 7.5 times. Reasons for intraperitoneal catheter failure were; peritoneal adhesions in 4 patients (44.5%), pseudocyst formation in 3 patients (33.3%), and peritonitis in 2 patients (22.2%). Seven patients of the study cohort had no problem after ventriculoatrial shunt placement. Only 1 patient had shunt dysfunction related to ventricular catheter, and ventricular catheter and shunt valve revision was performed 26 months after ventriculoatrial shunt placement. Atrial catheter of the patient was intact. One patient died because of the progression of her primary disease (medulloblastoma in the 4th ventricle), not related to her ventriculoatrial shunt. Conclusion Percutaneous ventriculoatrial shunting under the guidance of intraoperative fluoroscopy and ultrasound provides a safe, effective and easy alternative in the patients with peritoneal complications and multiple operations history.