title: Failed Ventriculoperitoneal Shunt: Is Retrograde Ventriculosinus Shunt a Reliable Option?
abstract: BACKGROUND
  Currently, the treatment of hydrocephalus is mainly carried out through a ventriculoperitoneal shunt (VPS) insertion. However, in some cases, there may be surgical revisions and requirement of an alternative distal site for shunting. There are several described distal sites, and secondary options after VPS include ventriculopleural and ventriculoatrial shunt, which have technical difficulties and harmful complications.
  
  
  OBJECTIVE
  In this preliminary report we describe our initial experience with retrograde ventriculosinus shunt (RVSS) after failed VPS.
  
  
  RESULTS
  In 3 consecutive cases we applied RVSS to treat hydrocephalus in shunt-dependent patients who had previously undergone VPS revision and in which peritoneal space was full of adhesions and fibrosis. RVSS was performed as described by Shafei et al., with some modifications to each case. All 3 patients kept the same clinical profile after RVSS, with no perioperative or postoperative complications. However, revision surgery was performed in the first operative day in 1 out of 3 patients, in which the catheter was not positioned in the superior sagittal sinus.
  
  
  CONCLUSIONS
  We propose that in cases where VPS is not feasible, RVSS may be a safe and applicable second option. Nevertheless, the long-term follow-up of patients and further learning curve must bring stronger evidence.
authors.affiliation: Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery of the Institute of Psychiatry, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil. Electronic address: mafernoliv@yahoo.com.br.
authors.forename: Matheus Fernandes de
authors.initials: MF
authors.lastname: Oliveira
authors.affiliation: Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery of the Institute of Psychiatry, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil; Division of Neurological Surgery, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
authors.forename: Manoel Jacobsen
authors.initials: MJ
authors.lastname: Teixeira
authors.affiliation: Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery of the Institute of Psychiatry, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
authors.forename: Rodolfo Casimiro
authors.initials: RC
authors.lastname: Reis
authors.affiliation: Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery of the Institute of Psychiatry, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil; Division of Neurological Surgery, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
authors.forename: Carlo Emanuel
authors.initials: CE
authors.lastname: Petitto
authors.affiliation: Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery of the Institute of Psychiatry, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil; Division of Neurological Surgery, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
authors.forename: Fernando Campos
authors.initials: FC
authors.lastname: Gomes Pinto
mesh_terms: D000328:Adult; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000601:surgery*; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*; D014696:Ventriculostomy / Q000379:methods*
keywords: Failed ventriculoperitoneal shunt; Hydrocephalus; Neurosurgery; Retrograde ventriculosinus shunt