Ventriculosinus shunts: their role in selected patients

OBJECTIVE Ventriculoperitoneal shunt placement is the most common treatment for hydrocephalus. However, most patients will require multiple shunt revisions over time. In cases of peritoneal shunt failure, the pleura and heart are alternative distal sites. Sinus shunts have been described but are not commonly used. The potential vascular complications, as well as inexperience with these shunts, make these tools less attractive. The goal of this study was to share the authors’ experience with ventriculosinus shunts (VSSs) in selected patients. METHODS Between December 2018 and February 2022, a total of 7 patients (1 adult, 6 children) underwent 11 surgeries for the placement of a VSS at the authors’ institution. Data regarding complications and shunt function were retrospectively collected and assessed, and a review of the literature was conducted. RESULTS The mean (± standard deviation) age at surgery was 11.9 ± 12.8 years (range 1.3–38.2 years). All patients had had previous shunt systems that failed and systemic conditions that made other distal sites less desirable. In all cases, a low-pressure differential valve was installed. Over a mean follow-up of 18 ± 9.8 months (range 9–39 months), 4 of the 7 patients underwent additional shunt revisions, 2 of whom had shunts placed at other sites. One patient had symptomatic partial sinus thrombosis, managed conservatively. During follow-up, 5 patients showed improvement in their symptoms of high intracranial pressure using the VSS. There were no severe complications of air embolism, bleeding, or infection. CONCLUSIONS VSSs may have a role to play in selected patients in whom more commonly used distal shunt locations have failed. Significant complications with these shunts are rare. Additional experience is needed to better understand the ideal catheter and placement locations.