title: Ventriculosternal Shunting for the Management of Hydrocephalus: Case Report of A Novel Technique.
abstract: BACKGROUND
  Conventional cerebrospinal fluid diversion such as ventriculoperitoneal or ventriculoatrial shunting for the management of hydrocephalus is one of the commonest neurosurgical procedures. However, in selected patients, surgical options are limited when relative contraindications for these operations exist. A patient who underwent ventriculosternal shunting, a novel procedure, is presented with durable and successful outcomes.
  
  
  OBJECTIVE
  To demonstrate the feasibility, durability, and safety of ventriculosternal shunting for the management of hydrocephalus.
  
  
  METHODS
  A patient with end-stage renal failure and heart failure with recurrent pleural effusion suffered from post-subarachnoid hemorrhage communicating hydrocephalus. Because of the need for continuous ambulatory peritoneal dialysis and the risk of introducing excessive cardiac preloading, conventional shunting was relatively contraindicated. Ventriculosternal shunting was performed by adopting the cancellous matrix of the sternum as the anatomic receptacle for intraosseous cerebrospinal fluid absorption. After placement of the ventricular catheter in the usual manner, the distal end was inserted into the sternum.
  
  
  RESULTS
  There was demonstrable clinical and radiological improvement in hydrocephalus by ventriculosternal shunting. Cerebrospinal fluid intraosseous absorption by this novel procedure translated into both physical and cognitive recovery. The procedure was tolerable, effective, and durable, with the patient suffering no complications 3 years after the procedure.
  
  
  CONCLUSIONS
  Ventriculosternal shunting for the management of hydrocephalus is a feasible, safe, and durable surgical treatment option for selected patients when conventional procedures are contraindicated.
authors.affiliation: Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, China.
authors.forename: Peter Yat
authors.initials: PY
authors.lastname: Ming Woo
authors.forename: Peter Ka
authors.initials: PK
authors.lastname: Hung Pang
authors.forename: Kwong Yau
authors.initials: KY
authors.lastname: Chan
authors.forename: John Kwong
authors.initials: JK
authors.lastname: Ching Kwok
mesh_terms: D002552:Cerebral Ventricles / Q000601:surgery*; D002555:Cerebrospinal Fluid / Q000378:metabolism; D002557:Cerebrospinal Fluid Shunts / Q000379:methods*; D003071:Cognition; D003928:Diabetic Nephropathies / Q000150:complications; D004697:Endocarditis, Bacterial / Q000150:complications; D005260:Female; D006333:Heart Failure / Q000150:complications; D006801:Humans; D006849:Hydrocephalus / Q000523:psychology / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010531:Peritoneal Dialysis, Continuous Ambulatory; D011182:Postoperative Care; D013249:Sternum / Q000601:surgery*; D013345:Subarachnoid Hemorrhage / Q000150:complications; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome