Reevaluation of Ventriculopleural Shunting: Long-Term Efficacy and Complication Rates in the Modern Era.

Abstract

Ventriculopleural shunting (VPLS) is recognized as an alternative method when the standard ventriculoperitoneal shunting (VPS) is not applicable. Nevertheless, there is limited clinical evidence of its effectiveness including long-term patency. Data on 35 consecutive patients who underwent VPLS at a single institution were retrospectively analyzed. The rates of shunt survival and incidence of symptomatic pleural effusion were calculated, and risk factors were evaluated. Mean follow-up after VPLS was 64.1 months. The cumulative overall shunt survival rates were 70%, 44%, and 28% at 1, 3, and 5 years, respectively. Among patients with shunt failure, 3 (8.6%) with overdrainage underwent simple valve replacement (from fixed to programmable valve) and retained a VPLS. If these patients are excluded, shunt survival rates were 76%, 51%, and 34% at 1, 3, and 5 years, respectively, and the median shunt survival time was 3.0 years. No factor was significantly associated with shunt survival. Cumulative rates of symptomatic pleural effusion were 18%, 23%, and 46% at 1, 2, and 3 years, respectively. Median time from VPLS placement to symptomatic pleural effusion was 1.1 years. It seems that VPLS survival has improved with more modern shunt technology. VPLS is a reasonable second-line option when VPS is not feasible. The possibility of pleural effusion is not negligible, but asymptomatic/mild effusions may be managed conservatively.