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61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

Our experience with ventriculo-pleural shunting

Meeting Abstract

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  • Barbara Vienenkötter - Neurochirurgische Klinik, Universität Heidelberg, Deutschland
  • Alfred Aschoff - Neurochirurgische Klinik, Universität Heidelberg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1780

DOI: 10.3205/10dgnc251, URN: urn:nbn:de:0183-10dgnc2514

Published: September 16, 2010

© 2010 Vienenkötter et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

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.