title: Case series of ventriculopleural shunts in adults: a single-center experience.
abstract: OBJECTIVE The peritoneal cavity is widely used as the destination of choice for cerebrospinal fluid shunts. Various alternative sites have been used, particularly in the presence of certain contraindications. The pleural cavity has been used; however, a paucity of evidence details ventriculopleural (VPL) shunt survival, complication, and revision rates in adults. The aim of this study was to present a single center's experience with VPL shunts, identifying complication, revision, and survival rates. METHODS A single-center, retrospective case series analysis was conducted for VPL shunt insertions and revisions over a period of 5 years. Demographic as well as clinical data were collected. Ventriculopleural shunt survival was assessed using Kaplan-Meier curves and the log rank (Cox-Mantel) test. RESULTS Twenty-two VPL shunts were inserted in 19 patients. Median survival of the VPL shunts was 14 months. Pathological indication for the VPL shunt did not significantly affect survival. A total of 10 complications was observed: 2 infections, 2 cases of overdrainage, 2 obstructions, 1 distal catheter retraction, 2 symptomatic pleural effusions, and 1 asymptomatic pleural effusion. CONCLUSIONS Ventriculopleural shunting is a safe and viable second-line procedure for cases in which ventriculoperitoneal shunts are unsuitable. While VPL shunts have a high revision rate, their complication rate is comparable to that of VP shunts. Ventriculopleural shunt survival can be improved by careful patient selection and the implementation of a combination of valves with antisiphon devices.
authors.affiliation: Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
authors.forename: Claudia
authors.initials: C
authors.lastname: Craven
authors.affiliation: Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
authors.forename: Hasan
authors.initials: H
authors.lastname: Asif
authors.affiliation: Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
authors.forename: Amna
authors.initials: A
authors.lastname: Farrukh
authors.affiliation: Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
authors.forename: Flavia
authors.initials: F
authors.lastname: Somavilla
authors.affiliation: Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
authors.forename: Ahmed K
authors.initials: AK
authors.lastname: Toma
authors.affiliation: Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
authors.forename: Laurence
authors.initials: L
authors.lastname: Watkins
mesh_terms: D000328:Adult; D002557:Cerebrospinal Fluid Shunts; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D035422:Pleural Cavity / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: CSF = cerebrospinal fluid; IAP = intraabdominal pressure; IIH = idiopathic intracranial hypertension; VA = ventriculoatrial; VP = ventriculoperitoneal; VPL = ventriculopleural; cerebrospinal fluid; hydrocephalus; idiopathic intracranial hypertension; ventriculoatrial; ventriculoperitoneal; ventriculopleural