Laparoscopic ventricular-cholecystic shunt

Can we consider ventriculo-gallbladder shunt a first-line treatment in selected patients? Case report of a successful management

“…We suggest classifying the predictor factors of VPS failure into two groups: CSF-related disorders and abdominal-related conditions. Indeed, CSF with a high protein concentration, speci cally caused by opticchiasmal hypothalamic glioma [8, 15,17,24], craniopharyngioma [10], plasminogene de ciency [11] and tuberculosis [7,17] may be subject for proteinaceous ascites and therefore VPS failure.In these cases, the gallbladder is an e cient receptacle: CSF will be excreted and then absorbed in the intestinal tract. Nevertheless, the lytic action of bile may catabolize brinous adhesion around the distal shunt tip CSF [7,15,17,22].…”

“…It could be planned with paediatric surgery teams. Furthermore laparoscopic access makes this approach even more valuable [10,17] . Neonatal history of NEC may be recognized as another abdominal-related cause predicting VPS failure by leading to an in ammatory peritoneal disease and a higher incidence of distal shunt obstructions [18].…”

Evaluation of the ventriculocholecystic shunt—an overview of present practice in adult and pediatric hydrocephalus

“…Furthermore, Pancucci et al were the first to describe the successful positioning of a VCS with the assistance of laparoscopic surgery in a 4month-old patient with hydrocephalus secondary to an optic chiasmal hypothalamic glioma [49]. Ignacio et al also used this approach in a 20-month-old patient with increased CSF levels due to a grade 3 ventricular hemorrhage [28]. In the case presented by Pancucci et al, the technique was done with the help of a pediatric surgeon through a three-port laparoscopic approach, and a 7-French pigtail catheter was inserted in the fundus of the gallbladder via the Seldinger technique.…”

“…As their study is focused on laparoscopic placement, the inability of tolerating a pneumoperitoneum is also mentioned. General contraindications such as severe abdominal adhesions would also be a criterion, such as in the case of a VP shunt [28].…”