Hydrothorax Due to Ventriculopleural Shunting in a Child with Spina Bifida on Chronic Dialysis: Third Ventriculostomy as an Alternative of Cerebrospinal Diversion

Abstract

The purpose of this paper is to describe the risks of ventriculopleural shunt in patients with spina bifida and end-stage-renal-diseases (ESRD), and to describe endoscopic third ventriculostomy as an alternative for the combination of cerebrospinal shunt and dialysis modality. We report a 16-year-old boy with spina bifida on chronic dialysis with a massive unilateral hydrothorax and respiratory distress complicating a ventriculopleural (VPL) shunt. Two thoracocenteses were performed, draining 3200 ml of a clear fluid. The VPL shunt was removed and revised successfully to a third ventriculostomy (TVE). Peritoneal dialysis (PD) was the initial dialysis modality. After 12 months on PD, the patient was transferred to hemodialysis (HD) because of refractory peritonitis. Hydrothorax developed while the patient was on PD, reaching its maximum 2 months after the transference to HD. To our knowledge there has been no other report of ventriculopleural (VPL) shunt failure, and endoscopic TVE, as a cerebrospinal fluid (CSF) diversion alternative in patients on chronic dialysis.

Pleural effusion following ventriculo-pleural shunt: Case reports and review of the literature

“…Two hypotheses can explain the hydrothorax complicating the VPLS: (a) impaired pleural absorptive capacity, due to pleural damage secondary to prior infection and/or chronic exposure to CSF and (b) excessive drainage of CSF into the pleural space. [9] A symptomatic pleural effusion can occur at anytime during the course, as a result of a change in valve pressure or absorptive capacity of the parietal pleura, as seen in one of our patients, at 5 years.…”

“…[89] We retrospectively reviewed charts of all five patients who underwent VPLS placement at our institution. The purpose of our study was to study the outcomes and pulmonary complications associated with the VPLS.…”

Tension Hydrothorax in a Pediatric Patient with a Ventriculopleural Shunt

“…The distal tip of a ventricular shunt can reside in cavities such as the peritoneum, the pleura, or the right atrium of the heart. Hydrothoraces are known complications of all types of ventricular shunts (1)(2)(3)(4). It is postulated that shunt-associated hydrothoraces occur secondary to inadequate absorption of cerebrospinal fluid in the thorax or unanticipated increases in cerebrospinal fluid production.…”

Cerebrospinal Fluid Shunting in Children on Renal Dialysis

“…Because of the low numbers of children undergoing both CSF diversion and renal dialysis, it is difficult to estimate the complication rate and thereby advise patients and their families on management strategies. No large series of patients have been reported in the medical literature to our knowledge [3,4,5]. We report here on 2 cases and discuss the complications and relevant management issues.…”