The ventriculoomental bursa shunt.
OBJECTIVE
The aim of this study is to access the efficacy of the omental bursa (lesser sac) as a receptacle of cerebrospinal fluid (CSF) and to use it as an alternative to the ventriculoatrial or ventriculopleural shunts when the peritoneum reduces or loses its CSF absorption capacity.


METHODS
Three patients with hydrocephalus presented with malfunctioning of ventriculoperitoneal shunts, secondary to peritoneal blockage caused by previous episodes of shunt infections in two and peritonitis in one patient. All patients underwent previous shunt revisions due to ventriculitis and shunt obstruction ranging from three to eight times. In order to keep the peritoneal cavity as the main receptacle of CSF absorption site, the distal catheter was inserted in the omental bursa, through the foramen of Winslow, jointly by a pediatric surgeon. We denominated this new technique of CSF diversion as ventriculoomental bursa (VOB) shunting. The children have been followed at least for 1 year (range 12 to 28 months) with no recurrence of shunt.


CONCLUSIONS
VOB shunting may be considered an acceptable technique to CSF shunting when the anterior peritoneum loses or decreases its CSF absorption capacity.
Matushita
Hamilton
H
Pediatric Neurosurgery, Department of Neurosurgery, University of São Paulo Medical School, Bairro Bela Vista, São Paulo, São Paulo, Brazil. neurosp@uol.com.br
Cardeal
Daniel
D
Pinto
Fernando Campos
FC
Plese
Jose Pindaro Pereira
JP
de Miranda
Jocielle Santos
JS
D000293:Adolescent; D002404:Catheterization / Q000379:methods; D002555:Cerebrospinal Fluid / Q000378:metabolism; D002648:Child; D003560:Cysts / Q000134:cerebrospinal fluid / Q000209:etiology / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007223:Infant; D009852:Omentum / Q000601:surgery*; D010529:Peritoneal Cavity / Q000502:physiology / Q000601:surgery*; D012086:Reoperation; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects / Q000379:methods*