title: Hydrothorax due to ventriculopleural shunting in a child with spina bifida on chronic dialysis: third ventriculostomy as an alternative of cerebrospinal diversion.
abstract: 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.
authors.affiliation: Unidad de Diálisis Pediátrica, SENNIAD, Hospital Evangélico, P.O. Box 12263, 11300, Montevideo, Uruguay. JoseGrunberg@movinet.com.uy
authors.forename: Jose
authors.initials: J
authors.lastname: Grunberg
authors.forename: Anabella
authors.initials: A
authors.lastname: Rébori
authors.forename: María Cristina
authors.initials: MC
authors.lastname: Verocay
authors.forename: Virginia
authors.initials: V
authors.lastname: Ramela
authors.forename: Ricardo
authors.initials: R
authors.lastname: Alberti
authors.forename: Alvaro
authors.initials: A
authors.lastname: Cordoba
mesh_terms: D000293:Adolescent; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D006876:Hydrothorax / Q000209:etiology* / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D016135:Spinal Dysraphism / Q000453:epidemiology* / Q000628:therapy*; D020542:Third Ventricle / Q000601:surgery*; D014696:Ventriculostomy