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Child's Nervous System

, Volume 35, Issue 9, pp 1557–1560 | Cite as

The ventriculo-cholecystic shunt: does CSF volume matter?

  • Duncan HendersonEmail author
  • Alexandru Budu
  • Michelle Horridge
  • Anthony Jesurasa
  • Saurabh Sinha
  • Shungu Ushewokunze
  • Ross Fisher
Original Article

Abstract

Introduction

The management of hydrocephalus in paediatric patients where the peritoneum has failed can be challenging. One option is to perform a ventriculo-cholecystic shunt. However, little is known about the capacity of the gall bladder to accommodate cerebrospinal fluid (CSF).

Methods

A retrospective case series was performed to include all paediatric patients who received a ventriculo-cholecystic shunt at a single centre, Sheffield Children’s Hospital.

Results

We identified three patients who had a ventriculo-cholecystic shunt inserted. The shunt survived past 1 year in two patients, who had pre-operative external ventricular drain (EVD) outputs of 8 and 10 ml/h respectively. One patient shunt failed at day four post-op due to distal dysfunction, his pre-operative EVD was over 30 ml/h.

Conclusions

When considering a patient for a ventriculo-cholecystic shunt, caution should be taken if a high CSF output is known, for example, as per an EVD measurement.

Keywords

Hydrocephalus Shunt failure Ventriculo-peritoneal shunt Ventriculo-cholecystic shunt 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Ratliff M, Unterberg A, Bachli H (2016) Ventriculo-bipleural shunt as last resort in a 4-year-old child in whom a VP and VA shunt failed. J Neurosurg Pediatr 17:285–288CrossRefGoogle Scholar
  2. 2.
    Irani F, Elkambergy H, Okoli K, Abou DS (2009) Recurrent symptomatic pleural effusion due to a ventriculopleural shunt. Respir Care 54:1112–1114Google Scholar
  3. 3.
    Hanak BW, Bonow RH, Harris CA, Browd SR (2017) Cerebrospinal fluid shunting complications in children. Pediatr Neurosurg 52:381–400CrossRefGoogle Scholar
  4. 4.
    Jones RF, Currie BG, Kwok BC (1988) Ventriculopleural shunts for hydrocephalus: a useful alternative. Neurosurgery 23:753–755CrossRefGoogle Scholar
  5. 5.
    Melamed EFCE, Krieger MD, Berry C, Yashar P, McComb JG (2016) Age as a novel risk factor for revision of ventriculo-pleural shunt in pediatric patients. Neurosurgery 63(Supplement 1):178–179CrossRefGoogle Scholar
  6. 6.
    Pillai A, Mathew G, Nachimuthu S, Kalavampara SV (2017) Ventriculo-ureteral shunt insertion using percutaneous nephrostomy: a novel minimally invasive option in a patient with chronic hydrocephalus complicated by multiple distal ventriculoperitoneal shunt failures. J Neurosurg: 1-5Google Scholar
  7. 7.
    Toma AK, Tarnaris A, Kitchen ND, Watkins LD (2010) Ventriculosinus shunt. Neurosurg Rev 33:147–152 discussion 153CrossRefGoogle Scholar
  8. 8.
    Ming Woo PY, Hung Pang PK, Chan KY, Ching Kwok JK (2015) Ventriculosternal shunting for the management of hydrocephalus: case report of a novel technique. Neurosurgery 11(Suppl 3):371–375 discussion 375CrossRefGoogle Scholar
  9. 9.
    Demetriades AK, Haq IZ, Jarosz J, McCormick D, Bassi S (2013) The ventriculocholecystic shunt: two case reports and a review of the literature. Br J Neurosurg 27:505–508CrossRefGoogle Scholar
  10. 10.
    Girotti ME, Singh RR, Rodgers BM (2009) The ventriculo-gallbladder shunt in the treatment of refractory hydrocephalus: a review of the current literature. Am Surg 75:734–737Google Scholar
  11. 11.
    Rivero-Garvia M, Pancucci G, Morcillo J, Millan A, Marquez-Rivas J (2015) Ventriculobiliary shunts, another option. Pediatr Neurosurg 50:152–156CrossRefGoogle Scholar
  12. 12.
    Aldana PR, James HE, Postlethwait RA (2008) Ventriculogallbladder shunts in pediatric patients. J Neurosurg Pediatr 1:284–287CrossRefGoogle Scholar
  13. 13.
    West KW, Turner MK, Vane DW, Boaz J, Kalsbeck J, Grosfeld JL (1987) Ventricular gallbladder shunts: an alternative procedure in hydrocephalus. J Pediatr Surg 22:609–612CrossRefGoogle Scholar
  14. 14.
    Stringel G, Turner M, Crase T (1993) Ventriculo-gallbladder shunts in children. Childs Nerv Syst 9:331–333CrossRefGoogle Scholar
  15. 15.
    Olavarria G, Reitman AJ, Goldman S, Tomita T (2005) Post-shunt ascites in infants with optic chiasmal hypothalamic astrocytoma: role of ventricular gallbladder shunt. Childs Nerv Syst 21:382–384CrossRefGoogle Scholar
  16. 16.
    Ketoff JA, Klein RL, Maukkassa KF (1997) Ventricular cholecystic shunts in children. J Pediatr Surg 32:181–183CrossRefGoogle Scholar
  17. 17.
    Pal K, Jindal V (2007) Ventriculo cholecystic shunt in the management of hydrocephalus. Indian Pediatr 44:435–437Google Scholar
  18. 18.
    Woodfield J, Magdum S (2013) Failure of peritoneal and gallbladder shunts in a child with craniopharyngioma. J Pediatr Neurosci 8:221–223CrossRefGoogle Scholar
  19. 19.
    Yasuda T, Tomita T, McLone DG, Donovan M (2002) Measurement of cerebrospinal fluid output through external ventricular drainage in one hundred infants and children: correlation with cerebrospinal fluid production. Pediatr Neurosurg 36:22–28CrossRefGoogle Scholar
  20. 20.
    Drake JM, Sainte-Rose C, DaSilva M, Hirsch JF (1991) Cerebrospinal fluid flow dynamics in children with external ventricular drains. Neurosurgery 28:242–250CrossRefGoogle Scholar
  21. 21.
    Hernanz-Schulman M, Ambrosino MM, Freeman PC, Quinn CB (1995) Common bile duct in children: sonographic dimensions. Radiology 195:193–195CrossRefGoogle Scholar
  22. 22.
    Zhang Y, Wang XL, Li SX, Bai YZ, Ren WD, Xie LM, Zhang SC (2013) Ultrasonographic dimensions of the common bile duct in Chinese children: results of 343 cases. J Pediatr Surg 48:1892–1896CrossRefGoogle Scholar
  23. 23.
    Yoo JH, Kwak HJ, Lee MJ, Suh JS, Rhee CS (2003) Sonographic measurements of normal gallbladder sizes in children. J Clin Ultrasound 31:80–84CrossRefGoogle Scholar
  24. 24.
    Kulkarni AV, Schiff SJ, Mbabazi-Kabachelor E, Mugamba J, Ssenyonga P, Donnelly R, Levenbach J, Monga V, Peterson M, MacDonald M, Cherukuri V, Warf BC (2017) Endoscopic treatment versus shunting for infant hydrocephalus in Uganda. N Engl J Med 377:2456–2464CrossRefGoogle Scholar
  25. 25.
    Zandian A, Haffner M, Johnson J, Rozzelle CJ, Tubbs RS, Loukas M (2014) Endoscopic third ventriculostomy with/without choroid plexus cauterization for hydrocephalus due to hemorrhage, infection, Dandy-Walker malformation, and neural tube defect: a meta-analysis. Childs Nerv Syst 30:571–578CrossRefGoogle Scholar
  26. 26.
    Weil AG, Fallah A, Chamiraju P, Ragheb J, Bhatia S (2015) Endoscopic third ventriculostomy and choroid plexus cauterization with a rigid neuroendoscope in infants with hydrocephalus. J Neurosurg Pediatr:1–11Google Scholar
  27. 27.
    Fallah A, Weil AG, Juraschka K, Ibrahim GM, Wang AC, Crevier L, Tseng CH, Kulkarni AV, Ragheb J, Bhatia S (2017) The importance of extent of choroid plexus cauterization in addition to endoscopic third ventriculostomy for infantile hydrocephalus: a retrospective North American observational study using propensity score-adjusted analysis. J Neurosurg Pediatr 20:503–510CrossRefGoogle Scholar
  28. 28.
    Carrion E, Hertzog JH, Medlock MD, Hauser GJ, Dalton HJ (2001) Use of acetazolamide to decrease cerebrospinal fluid production in chronically ventilated patients with ventriculopleural shunts. Arch Dis Child 84:68–71CrossRefGoogle Scholar
  29. 29.
    Fountas KN, Kassam MA, Grigorian AA (2007) A rare, delayed complication of a ventriculogallbladder shunt. Case report and review of the literature. Neurosurg Focus 22: E12Google Scholar
  30. 30.
    Surfield GA, Klein RL (2006) Case report of symptomatic cholelithiasis after ventricular cholecystic shunt. J Pediatr Surg 41:1933–1934CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Sheffield Children’s HospitalSheffieldUK

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