Turkish Neurosurgery
Percutaneous Ventriculoatrial Shunting as a Salvage Method in the Pediatric Hydrocephalus Patients with Peritoneal Problems
Kadir Oktay1, Sinan Sozutok2, Umur Anil Pehlivan3, Dogu Cihan Yildirim1, Mevlana Akbaba1, Kerem Mazhar Ozsoy1, Nuri Eralp Cetinalp1
1Cukurova University School of Medicine, Neurosurgery Department, Adana,
2Cukurova University School of Medicine, Radiology Department, Adana,
3Baskent University School of Medicine, Radiology Department, Adana,
DOI: 10.5137/1019-5149.JTN.43472-23.2

Aim:Ventriculoperitoneal shunt is preferred and widely applied in patients requiring shunt procedures. However, in cases with abdominal complications, another body compartment is used for the distal catheters and a ventriculoatrial shunt is preferred as the second-line treatment. This study aimed to evaluate the efficacy of percutaneous ventriculoatrial shunting as a salvage method for pediatric patients with abdominal complications.Material and Methods:Data obtained from 9 patients with ventriculoperitoneal shunt dysfunctions owing to abdominal complications, who underwent ventriculoatrial shunting as salvage treatment at a single institution between January 2019 and September 2021 were retrospectively analyzed. All operations were conducted under the guidance of intraoperative fluoroscopy and ultrasound.Results:The mean age of the enrolled patients was 8.1 ± 1.2 years (2-15 years). Six (67%) patients were male and 3 (33%) were female. The mean number of the patients’ ventriculoperitoneal shunt revisions until atrial catheter placement was 7.5 times. The reasons for intraperitoneal catheter failure included peritoneal adhesions in 4 (44.5%) patients, pseudocyst formation in 3 (33.3%), and peritonitis in 2 (22.2%). Seven patients from the study cohort had no problem after ventriculoatrial shunt placement. Only 1 patient had shunt dysfunction related to the ventricular catheter, and ventricular catheter and shunt valve revision was performed 26 months after ventriculoatrial shunt placement. The atrial catheter of the patient was intact. One patient died from the progression of her primary disease (medulloblastoma in the 4th ventricle), which was unrelated to the ventriculoatrial shunt.Conclusion:Percutaneous ventriculoatrial shunting under the guidance of intraoperative fluoroscopy and ultrasound is a safe, effective, and easy alternative in patients with peritoneal complications and a history of multiple operations.

Corresponding author : Kadir Oktay