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Ventriculoperitoneal shunt is one of the most common neurosurgical procedures in the treatment of hydrocephalus. There are reports of migration of the distal catheter to the breast pocket where cerebrospinal fluid then collects and can develop into a pseudocyst. There exist case reports in the literature of patients with prior breast augmentation who present with distal catheter migration from the peritoneal space into the breast tissue. We present a case series of 3 patients with preexisting breast augmentation who returned with unilateral breast enlargement after ventriculoperitoneal shunt. In all 3 patients, the distal catheter migrated out of the peritoneal space and was found to be coiled around the breast prosthesis. Additionally, we offer recommendations for managing these complications and a review of the literature. We performed a systematic review without meta-analysis of studies involving management of shunt migration in the setting of preexisting breast implants. We present a case series of 3 patients whom we treated with breast cerebrospinal pseudocyst after migration of the distal catheter into the breast tissue. A total of 17 studies, dating from 2002 to 2022, met our inclusion and exclusion criteria and were selected for full review. Catheter migration occurred between 2 weeks and 9 months of initial shunt placement. All patients presented with unilateral breast enlargement and cerebrospinal fluid pseudocyst formation. All patients underwent revision shunt surgery. Surgical treatment strategies used included reimplantation of the distal catheter into the pleural space or ipsilateral or contralateral peritoneal space or complete removal of the entire shunt system. Breast-related ventriculoperitoneal shunt complication is a rare entity that is increasingly seen as more patients receive breast augmentation. Breast-related shunt complications most commonly present with cerebrospinal fluid pseudocyst formation in the breast. It is important for neurosurgeons to be aware of an underlying breast implant before placing a ventriculoperitoneal shunt. For patients who have migration of the distal catheter into the breast, a protocol for managing these situations should be followed to ensure no shunt infection and avoidance of future catheter migration complications with subsequent shunt revisions. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Abdominal pseudocyst is a rare complication of ventriculoperitoneal (VP) shunt placement. Ventriculopleural shunt (VPL) can be an effective treatment option for the recurrent complications of VP shunt failure. Abdominal pseudocyst (APC) is a rare complication of ventriculoperitoneal (VP) shunt placement for the treatment of congenital hydrocephalus. This case report presents a two‐and‐a‐half‐year‐old male child who underwent VP shunt placement for aqueductal stenosis‐related hydrocephalus. The patient subsequently developed recurrent shunt failure and an APC, which was managed initially by surgical excision of the cyst and repositioning of the catheter. However, shunt failure recurred. The patient underwent ventriculopleural (VPL) shunt conversion as a more viable option for recurrent blockage. Postoperatively, the patient developed respiratory distress with massive pleural effusion, which was treated with chest tube insertion. This case highlights the complexity of managing congenital hydrocephalus and its rare complication, APC. Prompt recognition and appropriate management of APC can lead to improved outcomes and minimize the need for invasive procedures. VPL shunt conversion can be considered an alternative treatment option when other treatments have failed. Further research is needed to establish guidelines for the management of APC and determine the long‐term effectiveness of VPL shunting. [ABSTRACT FROM AUTHOR]

Key Clinical Message Abdominal pseudocyst is a rare complication of ventriculoperitoneal (VP) shunt placement. Ventriculopleural shunt (VPL) can be an effective treatment option for the recurrent complications of VP shunt failure. Abstract Abdominal pseudocyst (APC) is a rare complication of ventriculoperitoneal (VP) shunt placement for the treatment of congenital hydrocephalus. This case report presents a two‐and‐a‐half‐year‐old male child who underwent VP shunt placement for aqueductal stenosis‐related hydrocephalus. The patient subsequently developed recurrent shunt failure and an APC, which was managed initially by surgical excision of the cyst and repositioning of the catheter. However, shunt failure recurred. The patient underwent ventriculopleural (VPL) shunt conversion as a more viable option for recurrent blockage. Postoperatively, the patient developed respiratory distress with massive pleural effusion, which was treated with chest tube insertion. This case highlights the complexity of managing congenital hydrocephalus and its rare complication, APC. Prompt recognition and appropriate management of APC can lead to improved outcomes and minimize the need for invasive procedures. VPL shunt conversion can be considered an alternative treatment option when other treatments have failed. Further research is needed to establish guidelines for the management of APC and determine the long‐term effectiveness of VPL shunting.

Purpose: The aim of this study is to analyze rates of ventriculopleural (VPL) shunt failure and complications among patients with pediatric hydrocephalus, and to analyze which factors may predict early (< 1 year) or late (> 1 year) VPL shunt failure in this sample. Methods: A retrospective chart review was conducted of all consecutive VPL shunt placements from 2000 to 2019 at our institution. Data was collected on patient characteristics, shunt history, and shunt type. Primary endpoints include rates of VPL shunt survival and rates of symptomatic pleural effusion. The Kaplan–Meier method was used to calculate shunt survival, and Fisher's exact test and t-test were used to compare differences between categorical variables and means, respectively (p < 0.05). Results: Thirty-one patients with pediatric hydrocephalus underwent VPL shunt placement (mean age 14.2 years). Of the 27 patients with long-term follow-up (mean 46 months), VPL shunt revision was required in 19, seven of which were due to pleural effusion. Overall shunt survival rates at 1, 3, 5, and 7 years were 76%, 62%, 55%, and 46%, respectively. Mean duration of shunt survival was 26.74 months. Overall pleural effusion rate was 26%. No patient-specific factors, including shunt valve type, were significantly associated with shunt survival, risk of early revision, or risk of pleural effusion. Conclusions: Our results are comparable to those reported in the literature and represent one of the largest case series on the topic. VPL shunts are a viable second-line option when ventriculoperitoneal (VP) shunt placement is not possible or desirable, though there are high rates of shunt revision and pleural effusion. [ABSTRACT FROM AUTHOR]

Objective: When the peritoneal cavity cannot serve as the distal shunt terminus, nonperitoneal shunts, typically terminating in the atrium or pleural space, are used. The comparative effectiveness of these two terminus options has not been evaluated. The authors directly compared shunt survival and complication rates for ventriculoatrial (VA) and ventriculopleural (VPl) shunts in a pediatric cohort., Methods: The Hydrocephalus Clinical Research Network Core Data Project was used to identify children ≤ 18 years of age who underwent either VA or VPl shunt insertion. The primary outcome was time to shunt failure. Secondary outcomes included distal site complications and frequency of shunt failure at 6, 12, and 24 months., Results: The search criteria yielded 416 children from 14 centers with either a VA (n = 318) or VPl (n = 98) shunt, including those converted from ventriculoperitoneal shunts. Children with VA shunts had a lower median age at insertion (6.1 years vs 12.4 years, p < 0.001). Among those children with VA shunts, a hydrocephalus etiology of intraventricular hemorrhage (IVH) secondary to prematurity comprised a higher proportion (47.0% vs 31.2%) and myelomeningocele comprised a lower proportion (17.8% vs 27.3%) (p = 0.024) compared with those with VPl shunts. At 24 months, there was a higher cumulative number of revisions for VA shunts (48.6% vs 38.9%, p = 0.038). When stratified by patient age at shunt insertion, VA shunts in children < 6 years had the lowest shunt survival rate (p < 0.001, log-rank test). After controlling for age and etiology, multivariable analysis did not find that shunt type (VA vs VPl) was predictive of time to shunt failure. No differences were found in the cumulative frequency of complications (VA 6.0% vs VPl 9.2%, p = 0.257), but there was a higher rate of pneumothorax in the VPl cohort (3.1% vs 0%, p = 0.013)., Conclusions: Shunt survival was similar between VA and VPl shunts, although VA shunts are used more often, particularly in younger patients. Children < 6 years with VA shunts appeared to have the shortest shunt survival, which may be a result of the VA group having more cases of IVH secondary to prematurity; however, when age and etiology were included in a multivariable model, shunt location (atrium vs pleural space) was not associated with time to failure. The baseline differences between children treated with a VA versus a VPl shunt likely explain current practice patterns.

Introduction: Alternate approaches such as ventriculoatrial (VA) or ventriculopleural (VPL) procedures still have a place in the surgical armamentarium for patients with recurrent ventriculoperitoneal (VP) shunt failures related to defective absorption, infections, or frequent malfunctions.Methods: We reviewed the literature and our experience with these techniques, and offered suggestions for safely performing these operations. Historical perspectives were also included to facilitate an improved understanding of the technical developments.Results: Our findings and the available medical literature suggest VA and VPL options are safe and effective alternatives for managing the complex patient with hydrocephalus. Potential issues and complications were discussed along the technical advances for a safer operation.Conclusion: The VA and VPL options should be considered for patients with recurrent VP shunt issues. They are safe and effective options for managing complex hydrocephalus patients. [ABSTRACT FROM AUTHOR]

Ventriculopleural shunting (VPLS) is recognized as an alternative method when the standard ventriculoperitoneal shunting (VPS) is not applicable. Nevertheless, there is limited clinical evidence of its effectiveness including long-term patency. Data on 35 consecutive patients who underwent VPLS at a single institution were retrospectively analyzed. The rates of shunt survival and incidence of symptomatic pleural effusion were calculated, and risk factors were evaluated. Mean follow-up after VPLS was 64.1 months. The cumulative overall shunt survival rates were 70%, 44%, and 28% at 1, 3, and 5 years, respectively. Among patients with shunt failure, 3 (8.6%) with overdrainage underwent simple valve replacement (from fixed to programmable valve) and retained a VPLS. If these patients are excluded, shunt survival rates were 76%, 51%, and 34% at 1, 3, and 5 years, respectively, and the median shunt survival time was 3.0 years. No factor was significantly associated with shunt survival. Cumulative rates of symptomatic pleural effusion were 18%, 23%, and 46% at 1, 2, and 3 years, respectively. Median time from VPLS placement to symptomatic pleural effusion was 1.1 years. It seems that VPLS survival has improved with more modern shunt technology. VPLS is a reasonable second-line option when VPS is not feasible. The possibility of pleural effusion is not negligible, but asymptomatic/mild effusions may be managed conservatively. [ABSTRACT FROM AUTHOR]

Ventriculopleural (VPL) shunts are used infrequently in management of hydrocephalus. The main complication associated with these shunts is pleural effusion. A 28-year-old man with a history of congenital hydrocephalus had a VPL shunt inserted. Two years later, he noticed a soft bulging in the surgical scar area of the chest, suggestive of fluid accumulation. The scar subsequently opened up spontaneously exposing the distal catheter, which extruded through the opening. Chest radiographs and computed tomography scan showed an important pleural effusion on the same side. The VPL shunt was removed, and a contralateral shunt was inserted. To our knowledge, spontaneous extrusion of the distal catheter of a VPL shunt has not been previously reported in the literature. Physicians treating patients with hydrocephalus must be aware of this potential complication when a VPL shunt is inserted. [ABSTRACT FROM AUTHOR]

Isolated fourth ventricle syndrome is an uncommon entity due to obstruction of both inlet and outflow foramina. The resulting mass effect from the progressively expanding fourth ventricle may cause symptoms from both cerebellar and brainstem compression. Although a variety of treatment modalities have been advocated for this condition, an in-depth description of placement of a fourth ventriculopleural (VPL) shunt from a single-stage prone approach has not yet been published in the literature. We describe here a case of successful placement of a fourth VPL shunt in a 22-year-old female with a history of a prior posterior fossa pilocytic astrocytoma resection who presented with symptomatic isolated fourth ventricular hydrocephalus [ABSTRACT FROM AUTHOR]

Although hydrocephaly has been recognized for years, its treatment and follow-up remain obscure. Ventriculoperitoneal shunt application is the most common treatment used in recent years. However, revision incidence and mortality are very high due to infection, overdrainage or underdrainage, and obstruction. 62 years old female patient was operated and ventriculopleural shunt performed in our clinic. Fifth day after operation persistant dyspneic complaints exists. Chest graphia performed and bilateral pleural effusion was seen. In this report, we present a case of hydrothorax after ventriculopleural shunt operation. Ventriculopleural shunting was preferred in this patient because peritoneal absorption disorder developed after recurrent ventriculoperitoneal shunt operations and revisions. The tension hydrothorax that developed is discussed in light of the relevant literature. [Cukurova Med J 2014; 39(4.000): 905-908]

Although cerebrospinal fluid (CSF) shunt placement is the most common procedure performed by pediatric neurosurgeons, shunts remain among the most failure-prone life-sustaining medical devices implanted in modern medical practice. This article provides an overview of the mechanisms of CSF shunt failure for the 3 most commonly employed definitive CSF shunts in the practice of pediatric neurosurgery: ventriculoperitoneal, ventriculopleural, and ventriculoatrial. The text has been partitioned into the broad modes of shunt failure: obstruction, infection, mechanical shunt failure, overdrainage, and distal catheter site-specific failures. Clinical management strategies for the various modes of shunt failure are discussed as are research efforts directed towards reducing shunt complication rates. As it is unlikely that CSF shunting will become an obsolete procedure in the foreseeable future, it is incumbent on the pediatric neurosurgery community to maintain focused efforts to improve our understanding of and management strategies for shunt failure and shunt-related morbidity. [ABSTRACT FROM AUTHOR]

We present two cases of cerebral shunts - a ventriculopleural shunt and a ventriculoperitoneal shunt, with their associated complications. We also hope to provide a comprehensive literature review on various imaging modalities, including nuclear medicine studies in evaluating cerebral shunt complications. [ABSTRACT FROM AUTHOR]

Although hydrocephaly has been recognized for years, its treatment and follow-up remain obscure. Ventriculoperitoneal shunt application is the most common treatment used in recent years. However, revision incidence and mortality are very high due to infection, overdrainage or underdrainage, and obstruction. 62 years old female patient was operated and ventriculopleural shunt performed in our clinic. Fifth day after operation persistant dyspneic complaints exists. Chest graphia performed and bilateral pleural effusion was seen. In this report, we present a case of hydrothorax after ventriculopleural shunt operation. Ventriculopleural shunting was preferred in this patient because peritoneal absorption disorder developed after recurrent ventriculoperitoneal shunt operations and revisions. The tension hydrothorax that developed is discussed in light of the relevant literature. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to describe the risks of ventriculopleural shunt in patients with spina bifida and end-stage-renal-diseases (ESRD), and to describe endoscopic third ventriculostomy as an alternative for the combination of cerebrospinal shunt and dialysis modality. We report a 16-year-old boy with spina bifida on chronic dialysis with a massive unilateral hydrothorax and respiratory distress complicating a ventriculopleural (VPL) shunt. Two thoracocenteses were performed, draining 3200 ml of a clear fluid. The VPL shunt was removed and revised successfully to a third ventriculostomy (TVE). Peritoneal dialysis (PD) was the initial dialysis modality. After 12 months on PD, the patient was transferred to hemodialysis (HD) because of refractory peritonitis. Hydrothorax developed while the patient was on PD, reaching its maximum 2 months after the transference to HD. To our knowledge there has been no other report of ventriculopleural (VPL) shunt failure, and endoscopic TVE, as a cerebrospinal fluid (CSF) diversion alternative in patients on chronic dialysis. [ABSTRACT FROM AUTHOR]

Hidrosefali yıllardan beri bilinen bir hastalık olmasına rağmen takip ve tedavisinde halen bilinmeyen noktalar bulunmaktadır. Hidrosefali tedavisinde alen ventriküloperitoneal şant cerrahisi en sık kullanılan tedavi yöntermidir. Ancak revizyon insidansı ve mortalitesi; enfeksiyon, fazla/az drenaj , tıkanma nedeniyle oldukça yüksektir. 62 yaşında bayan hasta kliniğimizde opere edilerek ventriküloplevral şant uygulandı. Ameliyat sonrası beşinci günde hastada ilerleyici tipte nefes darlığı ve siyanoz şikayetleri ortaya çıktı. Hastanın çekilen akciğer grafisinde solda plevral effüzyon tespit edildi.. Ventriküloplevral şant cerrahisi rekürren ventriküloperitoneal şant operasyonları ve revizyonları sonrası görülebilen peritoneal absorbsiyon bozuklukları nedeniyle tercih edilmektedir. Bu raporda ventriküloplevral şant sonrası gelişen tansiyon hidrotorakslı bir olgu sunulmuş ve literatür eşliğinde tartışılmıştır.

Cerebrospinal fluid (CSF) diversion is among the most commonneurosurgical procedures that are performed worldwide. It is estimated thatapproximately 30,000 ventriculostomies are performed annually in the United States.Ventriculoperitoneal (VP) shunt malfunction rate within the first year of initialimplantation has been reported to be as high as 11–25%. In patients with abdominaladhesions, infections or multiple failed VP shunts, another bodily compartment shouldbe utilized as a substitute for the peritoneal cavity for distal shunt catheter placement.Ventriculopleural (VPL) shunting for hydrocephalus was first introduced by Heile in1914. Since the inception of this idea, VPL shunts have been utilized in select patientswith varying degrees of success. There have been a number of case reports andseries documenting unique complications with VPL shunting, with pleural effusion andpneumothorax being the most common complications. In our review article, we soughtto review the development of VPL shunting, pleuropulmonary physiology, insertiontechniques for VPL shunt, complications associated with VPL shunts, and uniquestrategies to improve VPL shunt tolerance. • VPL shunting for hydrocephalus was first introduced by Heile in 1914. • Pleural effusion is the most common complication associated with VPL shunting. • VPL shunting may offer utility as an alternative treatment for CSF diversion. • The number of studies on VPL shunting remain sparse in the literature. [ABSTRACT FROM AUTHOR]

Cerebrospinal fluid (CSF) diversion procedure has been used for long to treat hydrocephalus in children. The principle of shunting is to establish a communication between the CSF and a drainage cavity (peritoneum, right atrium, and pleura). Ventriculoperitoneal shunt is used most commonly, followed secondly by ventriculopleural shunt (VPLS). Hydrothorax due to excessive CSF accumulation is a rare complication following both the type of shunts and is more frequently seen with VPLS. We report a case of a 6‑year‑old female child presenting with massive CSF hydrothorax with respiratory failure following VPLS. The aim of the article is to highlight early recognition of this rare and life‑threatening condition, which could easily be missed if proper history is not available. [ABSTRACT FROM AUTHOR]

Abstract: Background: Ventriculopleural shunts have been utilized in the management of hydrocephalus since the early 1900s. Shunt malfunctions can lead to fluid accumulation in the pleural space and a tension hydrothorax can develop. Improved diagnostic and therapeutic resources have led to an increasing number of ventriculopleural shunts being utilized in patients with symptomatic hydrocephalus. Emergency physicians are being called upon more frequently to diagnose and help manage many of the critical complications that can arise with ventricular shunts. Objectives: Very little literature exists concerning the evaluation and treatment of patients with a suspected tension hydrothorax secondary to a ventriculopleural shunt malfunction. If left unrecognized and untreated, tension pneumothoraces can progress and result in hemodynamic decompensation and cardiopulmonary arrest. Patient survival depends on early diagnosis and prompt fluid drainage in this clinically challenging scenario. Case Report: This is the first article in the emergency medicine literature to describe the presentation and management of a pediatric patient who presents to the Emergency Department with a rare diagnosis of a tension hydrothorax secondary to a defective ventriculopleural shunt. Conclusion: The increasing number of ventriculopleural shunts being utilized requires emergency physicians to become familiar with the life-threatening complications that can be associated with these types of shunts. Correctly identifying this complication and initiating immediate treatment can lead to improved patient outcomes. [Copyright &y& Elsevier]

Abstract: Ventriculopleural shunts are one of the alternatives to ventriculoperitoneal shunts for draining cerebrospinal fluid. They are used in patients who have failed multiple ventriculoperitoneal shunts because of peritonitis, loculated ascites, or pseudocyst formation, or those who are not optimal candidates for vascular shunts. A case of acute recurrent subcutaneous emphysema around the incision of a ventriculopleural shunt is presented. [Copyright &y& Elsevier]

Ventriculopleural shunts are uncommonly used for the treatment of normal pressure hydrocephalus in adults. Pleural effusion has been reported to complicate the course of these ventriculopleural shunts in children. The pleural effusion should typically resemble the cerebrospinal fluid unless frankly infected. There are few good data on the nature of the pleural effusion. We, report a case of recurrent right-sided pleural effusion, 2 years after a ventriculopleural shunt insertion, for normal pressure hydrocephalus with no evidence of an underlying infection. The effusion abated after ligation of the shunt. We discuss the possible mechanisms in the development of the effusion. It is important to be aware of this unlikely complication of an uncommon procedure. Recognizing the origin of the pleural effusion can help in instituting close follow-up and early referral for revision of the ventriculopleural shunt. [ABSTRACT FROM AUTHOR]