Ventricular cholecystic shunts in children

Hydrocephalus is a prevalent pediatric problem, and ventricular peritoneal shunting is the preferred procedure for surgical treatment. A system may become dysfunctional if the distal end of the catheter fails to drain because of intraabdominal adhesions, cerebral spinal fluid cysts, or peritonitis. Then additional revisions become necessary. Pediatric surgeons can come to the aid of their neurosurgical colleagues by placing the distal end of the catheter into the pleural space, cardiac atrium, ureter, stomach, or fallopian tube. These have all met with limited success. The ventricular cholecystic shunt has been used in some difficult-to-manage cases of hydrocephalus, and our experience with the procedure is described. In the complicated patient, we have had success placing the distal catheters in the gallbladder. Between 1986 and 1995 sixteen patients have had ventriculocholecystic shunts placed. The mean age was 10.8 years, ranging from 0.9 to 23 years. Prior shunting procedures averaged 4.1 (range 0 to 11). The follow-up period ranged from 4 weeks to 7.5 years, with a median follow-up of 3 years. No shunts were removed or revised specifically because of gallbladder complications such as infected bile, stones, or distal catheter occlusion. Seven patients experienced other shunt-related problems that were not caused by distal catheters, ie, staphylococcal infections and intracerebral problems. Eleven of the original shunts are still functioning. Two patients died of causes not related to the ventriculoperitoneal shunt. Because of their simplicity of placement, low incidence of complication, and similarity to ventriculoperitoneal shunts, the ventricular cholecystic shunt should be considered when other sites are unattainable.