Innovative approach to the difficult ventricular shunt using pleural access device for maintenance drainage: case report

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Patients with complex medical problems and multiple failed ventricular shunts require continued innovation for hydrocephalus management. The authors report the case of a 4-year-old boy with refractory hydrocephalus and secondary reduced ability to absorb CSF in both the pleural and peritoneal cavities following renal transplantation. A novel management approach was devised with split shunting to pleural and peritoneal targets as well as prophylactic pleural port placement to provide a method for minimally invasive thoracentesis should symptomatic pleural effusions develop. Fluid was successfully aspirated via the pleural port with relief of symptoms over a period of 16 months without complication. The authors demonstrate that a previously undescribed approach to distal shunting can prevent neurological sequelae of shunt failure and permit noninvasive maintenance drainage for patients in whom symptomatic pleural effusion is a recurrent complication.

ABBREVIATIONS POD = postoperative day; VA = ventriculoatrial; VP = ventriculoperitoneal; VPl = ventriculopleural.
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Contributor Notes

Correspondence Howard I. Pryor II: Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD. howard.i.pryor.mil@mail.mil.INCLUDE WHEN CITING Published online January 3, 2020; DOI: 10.3171/2019.10.PEDS19122.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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