Torkildsen shunt as an option for hydrocephalus associated with optic pathway glioma

Abstract

Hydrocephalus caused by optic pathway glioma (OPG) is most often treated with a ventriculoperitoneal shunt (VPS), but this treatment may present complications such as ascites. Hence, ventriculocisternal shunt is an option worth considering. This article reports a case in which it was decided to place a ventriculocisternal or Torkildsen shunt in a patient with hydrocephalus caused by OPG. Case Report: A 12-year-old girl, amaurotic, with a VPS due to hydrocephalus caused by an OPG, reported to the emergency room with abdominal distension and pain and difficulty in walking. Computed tomography of the abdomen was performed, and a large amount of fluid was evidenced in the peritoneal cavity (ascites). Liver and kidney functions were normal. In the surgical procedure, the distal extremity of the ventriculoperitoneal catheter was exposed, and 3 L of ascites fluid of cerebrospinal origin was drained. After 10 days of antibiotic therapy, a ventriculocisternal or Torkildsen shunt was placed. After 4 years of follow-up, the patient has no complaints. Discussion: Arne Torkildsen was the first to perform a ventriculocisternal shunt in 1937; it is indicated in cases of hydrocephalus with obstruction of the aqueduct or third ventricle. In OPG, increased protein levels in CSF and the use of platinum-based chemotherapy agents would explain the development of ascites after VPS placement. In these cases of hydrocephalus with third ventricle tumor infiltrating the hypothalamus, the ventriculocisternal shunt can be used as an option in specific cases.