Skip to main content
SpringerLink
Log in

Complications Specific to Pleural Type of CSF Shunt

  • Chapter
  • First Online:
Complications of CSF Shunting in Hydrocephalus

  • 1330 Accesses

Abstract

Most pediatric patients with hydrocephalus are treated with ventriculoperitoneal shunt placement. When the peritoneum is not feasible or is a suboptimal option, there are other anatomical alternatives for distal placement of the cerebrospinal fluid drainage catheter, such as the pleural cavity. Ventriculopleural shunting has become an alternative preferred method in most clinical centers. Despite the wide acceptance of ventriculopleural shunting, there are significant and variable complications specifically associated with this technique. Shunt malfunction, such as shunt obstruction or migration, is commonly seen in everyday practice and is usually caused by mechanical failure; nonetheless, other manifested problems, such as pleural effusions, pneumothorax, and empyema, have complicated the natural history of these shunts, with uneven frequency. From here, imaging analysis is an essential adjunct to the clinical evaluation of patients with suspected ventriculopleural shunt malfunctions or complications. As with any kind of shunted hydrocephalus, despite advances in diagnostics and surgical techniques, the avoidance of complications and the prevention of malfunction are still under discussion.

The aim of this chapter is, precisely, the discussion of the inherent problems associated with this technique.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

CSF:

Cerebrospinal fluid

VPS:

Ventriculoperitoneal shunt

VAS:

Ventriculoatrial shunt

VPL:

Ventriculopleural shunt

References

  1. Arsalo A, Louhimo I, Santavuori P, Valtonew S (1977) Subdural effusion: results after treatment with subdural pleural shunts. Childs Brain 3:79–86

    CAS  PubMed  Google Scholar 

  2. Beach C, Manthey DE (1998) Tension hydrothorax due to ventriculopleural shunting. J Emerg Med 16:33–36

    Article  CAS  PubMed  Google Scholar 

  3. Brust JC, Moiel RH, Rosenberg RN (1968) Glial tumor metastases through a ventriculo-pleural shunt. Resultant massive pleural effusion. Arch Neurol 18(6):649–653

    Article  CAS  PubMed  Google Scholar 

  4. 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(1):68–71

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Chiang VL, Torbey M, Rigamonti D, Williams MA (2001) Ventriculopleural shunt obstruction and positive-pressure ventilation. Case report. J Neurosurg 95(1):116–118

    Article  CAS  PubMed  Google Scholar 

  6. Davidson RI, Zito J (1982) Acute cerebrospinal fluid hydrothorax: a delayed complication of subdural-pleural shunting. Neurosurgery 10:503–505

    Article  CAS  PubMed  Google Scholar 

  7. Detwiler PN, Porter RW, Rekate HL (1999) Hydrocephalus – clinical features and management. In: Choux M, Di Rocco C, Hockley A, Walker M (eds) Pediatric neurosurgery. Churchill- Livingstone, London, pp 253–274

    Google Scholar 

  8. Fein JM, Rovit RL (1973) The ventriculo-pleural fenestration shunt. Surg Neurol 1(4):205–208

    CAS  PubMed  Google Scholar 

  9. Fry WA, Paape K (2000) Pneumothorax. In: Shields TW (ed) General thoracic surgery, vol 1. Lippincott Williams & Wilkins, Philadelphia, pp 675–679

    Google Scholar 

  10. Gerbeaux J, Baculard A, Laugier J, Combe P, Grimfeld A, Van Effenterre R (1977) Pleurisy with clear liquid. Rare complication of ventriculo-cardiac shunt: Pudenz valve [Article in French]. Ann Med Interne (Paris) 128(3):289–294

    CAS  Google Scholar 

  11. Grunberg J, Rébori A, Verocay MC, Ramela V, Alberti R, Cordoba A (2005) Hydrothorax due to ventriculopleural shunting in a child with spina bifida on chronic dialysis: third ventriculostomy as an alternative of cerebrospinal diversion. Int Urol Nephrol 37(3):571–574

    Article  PubMed  Google Scholar 

  12. Gupta AK, Berry M (1994) Ventriculo-peritoneal shunt presenting with recurrent pleural effusion: report of a new complication. Pediatr Radiol 24:147

    Article  CAS  PubMed  Google Scholar 

  13. Hadzikaric N, Nasser M, Mashani A, Ammar A (2002) CSF hydrothorax–VP shunt complication without displacement of a peritoneal catheter. Childs Nerv Syst 18(3–4):179–182, 2001

    Article  CAS  PubMed  Google Scholar 

  14. Haret DM, Onisei AM, Martin TW (2009) Acute-recurrent subcutaneous emphysema after ventriculopleural shunt placement. J Clin Anesth 13:352–354

    Article  Google Scholar 

  15. Heile B (1914) Sur chirurgischen Behandlung des Hydrocephalus internus durch Ableitung der Cerebrospinalflüssigkeit nach der Bauchhöhle und nach der Pleurakuppe. Arch Klin Chir 105:501–516

    Google Scholar 

  16. Hoffman HJ, Hendrick EB, Humphreys RP (1983) Experience with ventriculopleural shunts. Childs Brain 10:404–413

    CAS  PubMed  Google Scholar 

  17. Huggins JT, Sahn SA (2003) Duro-pleural fistula diagnosed by beta-2- transferrin. Respiration 70:423–425

    Article  PubMed  Google Scholar 

  18. Ingraham FD, Sears RA (1949) Further studies on the treatment of experimental hydrocephalus; attempts to drain the cerebrospinal fluid into the pleural cavity and the thoracic duct. J Neurosurg 6(3):207–215

    Article  CAS  PubMed  Google Scholar 

  19. Iosif G, Fleischman J, Chitkara R (1991) Empyema due to ventriculopleural shunt. Chest 99:1538–1539

    Article  CAS  PubMed  Google Scholar 

  20. Johnson MC, Maxwell MS (1995) Delayed intrapleural migration of a ventriculoperitoneal shunt. Childs Nerv Syst 11:348–350

    Article  CAS  PubMed  Google Scholar 

  21. Jones RF, Currie BG, Kwok BC (1988) Ventriculopleural shunts for hydrocephalus: a useful alternative. Neurosurgery 23:753–755

    Article  CAS  PubMed  Google Scholar 

  22. Khan TA, Khalil-Marzouk JF (2008) Fibrothorax in adulthood caused by a cerebrospinal fluid shunt in the treatment of hydrocephalus. J Neurosurg 109:478–479

    Article  PubMed  Google Scholar 

  23. Kircher LT Jr, Swartzel RL (1954) Spontaneous pneumothorax and its treatment. J Am Med Assoc 155(1):24–29

    Article  PubMed  Google Scholar 

  24. Krasna MJ (1996) Introduction to thoracoscopic surgery: indications, basic techniques, and instrumentation. Semin Laparosc Surg 3(4):201–210

    PubMed  Google Scholar 

  25. Küpeli E, Yilmaz C, Akçay S (2010) Pleural effusion following ventriculopleural shunt: case reports and review of the literature. Ann Thorac Med 5(3):166–170

    Article  PubMed Central  PubMed  Google Scholar 

  26. Kurschel S, Eder HG, Schleef J (2003) Ventriculopleural shunt: thoracoscopic placement of the distal catheter. Surg Endosc 17:1850

    Article  CAS  PubMed  Google Scholar 

  27. Landreneau RJ, Keenan RJ, Hazelrigg SR, Mack MJ, Naunheim KS (1996) Thoracoscopy for empyema and hemothorax. Chest 109(1):18–24

    Article  CAS  PubMed  Google Scholar 

  28. Lesur O, Delorme N, Fromaget JM, Bernadac P, Polu JM (1990) Computed tomography in the etiologic assessment of idiopathic spontaneous pneumothorax. Chest 98(2):341–347

    Article  CAS  PubMed  Google Scholar 

  29. Light RW (2000) Physiology of pleural fluid production and benign pleural effusion. In: Shields TW (ed) General thoracic surgery, vol 1. Lippincott Williams & Wilkins, Philadelphia, pp 687–693

    Google Scholar 

  30. Light RW, Girard WM, Jenkinson SG, George RB (1980) Parapneumonic effusions. Am J Med 69(4):507–512

    Article  CAS  PubMed  Google Scholar 

  31. Martínez-Lage JF, Torres J, Campillo H, Sanchez-del-Rincón I, Bueno F, Zambudio G, Poza M (2000) Ventriculopleural shunting with new technology valves. Childs Nerv Syst 16:867–871

    Article  PubMed  Google Scholar 

  32. McLaughlin JS, Krasna MJ (2000) Parapneumonic empyema. In: Shields TW (ed) General thoracic surgery, vol 1. Lippincott Williams & Wilkins, Philadelphia, pp 703–708

    Google Scholar 

  33. Megison DP, Benzel EC (1988) Ventriculo- pleural shunting for adult hydrocephalus. Br J Neurosurg 2:503–505

    Article  CAS  PubMed  Google Scholar 

  34. Milhorat TH (1972) Hydrocephalus and the cerebrospinal fluid. Williams & Wilkins, Baltimore, pp 208–210

    Google Scholar 

  35. Moron MA, Barrow DL (1994) Cerebrospinal fluid galactorrhea after ventriculo- pleural shunting: case report. Surg Neurol 42:227–230

    Article  CAS  PubMed  Google Scholar 

  36. Munshi I, Lathrop D, Madsen JR, Frim DM (1998) Intraventricular pressure dynamics in patients with ventriculopleural shunts: a telemetric study. Pediatr Neurosurg 28:67–69

    Article  CAS  PubMed  Google Scholar 

  37. Nixon HH (1962) Ventriculoperitoneal drainage with a valve. Dev Med Child Neurol 4:301–302

    Article  CAS  PubMed  Google Scholar 

  38. Pearson B, Bui CJ, Tubbs RS, Wellons JC III (2007) An unusual complication of a ventriculopleural shunt. J Neurosurg 106(5 suppl):410

    PubMed  Google Scholar 

  39. Piatt JH Jr (1994) How effective are ventriculopleural shunts? Pediatr Neurosurg 21:66–70

    Article  PubMed  Google Scholar 

  40. Ransohoff J (1954) Ventriculopleural anastomosis in treatment of midline obstructional masses. J Neurosurg 11:295–301

    Article  CAS  PubMed  Google Scholar 

  41. Ransohoff J, Marini G, Shulman K (1963) The ventriculo-pleural shunt. Minerva Neurochir 12:68–70, Italian

    CAS  PubMed  Google Scholar 

  42. Rengachary SS (1997) Transdiaphragmatic ventriculoperitoneal shunting: technical case report. Neurosurgery 41(3):695–697; discussion 697–8

    CAS  PubMed  Google Scholar 

  43. Sanders DY, Summers R, Derouen L (1997) Symptomatic pleural collection of cerebrospinal fluid caused by a ventriculoperitoneal shunt. South Med J 90:831–832

    Article  PubMed  Google Scholar 

  44. Tonn P, Gilsbach JM, Kreitschmann-Andermahr I, Franke A, Blindt R (2005) A rare but life-threatening complication of ventriculo-atrial shunt. Acta Neurochir (Wien) 147(12):1303–1304

    Article  CAS  Google Scholar 

  45. Venes JL, Shaw RK (1979) Ventriculopleural shunting in the management of hydrocephalus. Childs Brain 5:45–50

    CAS  PubMed  Google Scholar 

  46. Wakamatsu T, Matsuo K, Kawano S, Teramoto S, Matsumara H (1971) Glioblastoma with extracranial metastasis through ventriculopleural shunt: case report. J Neurosurg 34:697–701

    Article  CAS  PubMed  Google Scholar 

  47. Willison CD, Kopitnik TA, Gustafson R, Kaufman HH (1992) Ventriculoperitoneal shunting used as a temporary diversion. Acta Neurochir (Wien) 115:62–68

    Article  Google Scholar 

  48. Wu TS, Kuroda R (2011) Tension hydrothorax in a pediatric patient with a ventriculopleural shunt. J Emerg Med 40(6):637–639

    Article  PubMed  Google Scholar 

  49. Yellin A, Findler G, Barzilay Z, Simansky DA, Lieberman Y (1992) Fibrothorax associated with a ventriculopleural shunt in a hydrocephalic child. J Pediatr Surg 27:1525–1526

    Article  CAS  PubMed  Google Scholar 

  50. Zaman M, Akram H, Haliasos N, Bavetta S (2011) Cardiac tamponade and heart failure secondary to ventriculo-pleural shunt malfunction: a rare presentation. BMJ Case Rep pii: bcr1220092548. doi:10.1136/bcr.12.2009.2548

Download references

Author information

Authors and Affiliations

  1. Regional Department of Neurosurgery, “Virgen de la Arrixaca” University Hospital, Murcia, Spain

    Marcelo Galarza MD, MSc

  2. Regional Service of Neurosurgery, Hospital Universitario Virgen de la Arrixaca, E-30120, El Palmar, Murcia, Spain

    Marcelo Galarza MD, MSc

  3. Department of Thoracic surgery, “Virgen de la Arrixaca” University Hospital, Murcia, Spain

    Patricia Martínez MD

Authors
  1. Marcelo Galarza MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patricia Martínez MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marcelo Galarza MD, MSc .

Editor information

Editors and Affiliations

  1. Pediatric Neurosurgery, Catholic University Medical School, Rome, Italy

    Concezio Di Rocco

  2. Department of Neurosurgery, Adnan Menderes University School of Medi, Aydin, Turkey

    Mehmet Turgut

  3. Division of Pediatric Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA

    George Jallo

  4. Regional Service of Neurosurgery and Unit of Pediatric Neurosurgery, Virgen de la Arrixaca University Hospital, Murcia, Spain

    Juan F. Martínez-Lage

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Galarza, M., Martínez, P. (2015). Complications Specific to Pleural Type of CSF Shunt. In: Di Rocco, C., Turgut, M., Jallo, G., Martínez-Lage, J. (eds) Complications of CSF Shunting in Hydrocephalus. Springer, Cham. https://doi.org/10.1007/978-3-319-09961-3_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-09961-3_15

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-09960-6

  • Online ISBN: 978-3-319-09961-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation