Suprahepatic space as an alternative site for distal catheter insertion in pseudocyst-associated ventriculoperitoneal shunt malfunction

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  • 1 Departments of Neurosurgery and
  • 2 Pediatric Surgery, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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OBJECTIVE

Distal catheter malfunction due to pseudocyst formation or intraabdominal adhesion is a significant problem, especially in pediatric patients who have limited sites for distal catheter insertion. In this study, the authors present a series of 12 patients with intractable distal shunt malfunctions due to peritoneal pseudocyst formation who underwent distal catheter replacement in the suprahepatic space to reduce the risk of distal catheter malfunction.

METHODS

Twelve consecutive patients with shunt malfunction due to pseudocyst formation who had undergone ventriculosuprahepatic shunting from 2014 to 2019 were identified. According to medical records, after primary evaluations, shunt removal, and antibiotic therapy, they underwent revision surgeries with placement of a distal catheter into the suprahepatic space.

RESULTS

Nine boys and 3 girls, ranging in age from 5 months to 14 years, with one or more episodes of pseudocyst formation, underwent shunt revision with placement of a distal catheter into the suprahepatic space. After a median follow-up of 31 months, none of the patients experienced further distal malfunction.

CONCLUSIONS

The suprahepatic space appears to be a safe place to secure the distal end of a ventricular catheter following pseudocyst formation, with less risk of re-adhesion. This lower risk might be attributable to the lack of omentum in the suprahepatic space.

ABBREVIATIONS ETV = endoscopic third ventriculostomy; LOC = loss of consciousness; NEC = necrotizing enterocolitis; VA = ventriculoatrial; VP = ventriculoperitoneal.

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Contributor Notes

Correspondence Zohreh Habibi: Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran. z-habibi@sina.tums.ac.ir.

INCLUDE WHEN CITING Published online May 15, 2020; DOI: 10.3171/2020.3.PEDS19772.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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