Clinical experience with ventriculovesical shunting as a salvage or bridging strategy in children with hydrocephalus when peritoneal diversion was considered unsuitable: a retrospective case series

Abstract

Objective Ventriculoperitoneal (VP) shunting remains a standard cerebrospinal fluid (CSF) diversion procedure for pediatric hydrocephalus. However, peritoneal diversion may be considered unsuitable in selected children because of abdominal infection, severe peritoneal pathology, refractory CSF ascites, or persistent CSF abnormalities. The objective of this study was to describe our institutional experience with ventriculovesical shunting (VVS) as a selective salvage or bridging CSF diversion strategy in such patients. Materials and methods We retrospectively reviewed 36 children with hydrocephalus who underwent VVS at our center between September 2014 and January 2022. The decision to use VVS was individualized according to the clinical circumstances and the treating team's assessment that peritoneal diversion was undesirable or not feasible at that time. Available reasons to avoid peritoneal diversion, postoperative complications and conversion to subsequent VP shunting were reviewed. Results All 36 VVS procedures were technically completed. Follow-up ranged from 6 to 24 months (mean, 13.44 ± 8.21 months). At the most recent available follow-up, radiological improvement of hydrocephalus was reported in 27 patients, while seven remained clinically stable; two patients discontinued treatment and were lost to follow-up. Five patients (13.9%) developed postoperative intracranial infection, including four (11.1%) within the first postoperative month. Three patients (8.3%) developed symptomatic hyponatremia requiring sodium supplementation. Eleven patients (30.6%) were subsequently converted to VP shunting when their clinical circumstances permitted. Urological safety outcomes were incompletely ascertained. Conclusions In this retrospective single-center series, VVS provided internal CSF diversion during the available follow-up period in a highly selected group of children for whom peritoneal diversion was considered unsuitable at the time of treatment. These observations support describing VVS as a potential salvage or bridging strategy. Prospective studies incorporating longer follow-up are required before broader conclusions regarding patient selection and safety can be made.