gms | German Medical Science

Objective: The shunting of cerebrospinal fluid into the intrapleural space was first described by Heile in 1914 in form of a tube without any valve. By now this derivation type is rarely used. Only if both, intrapleural and intra-atrial shunting are contraindicated at the same time, for example in case of peritoneal problems like gastroschisis, large (pseudo)cysts, peritonitis, adhesions, reduced absorption capacity, ascites or recent abdominal operations and given the presence of contraindications against intra-atrial shunting like cardiac infection, valvular insufficiency, shunt nephritis or venous thrombosis in the cervical or thoracic area, does intrapleural shunting represents an option. Due to its high risk of early and long-term complications as well as due to the lack of surgical experience, it is infrequently implanted.

Methods: We evaluated retrospectively our clinical data of 13 patients and analysed the current literature. In addition we present the physiological essentials and describe this rather simple surgical approach.

Results: Because of the high negative pressure in the intrapleural cavity and the large pressure amplitude, there is a high risk of overdrainage. It must be pointed out that the intrapleural zone of resorption is less than the intraperitoneal absorption space. In our series 10/13 shunts had to be explanted over time due to symptomatic hydrothorax, an infection, an acquired Chiari in syringo-pleural shunting and other general problems linked to shunts. In this respect our experience meets literature values.

Conclusions: Because of its high failure rate, intrapleural shunting can be recommended only well-founded exceptional cases and only in combination with a valve of high pressure stage to prevent potential overdrainage. However, due to the continuous lower intraventricular pressure relative to other forms of cerebrospinal fluid shunting the intrapleural derivation is still advisable in patients with the need for lower intraventricular pressure. Generally the question of comparability of intrapleural vs. other shunting forms remains unsolved since intrapleural drainage is used only in exceptional cases, if other derivation forms have already been excluded.