Cases analysis and management strategies for ventricular shunt failure in hydrocephalus

Rationale: This report details 2 complex cases of recurrent ventriculoperitoneal (VP) shunt failure due to peritoneal pathology and infection, highlighting the clinical rationale for utilizing ventriculatrial (VA) shunting as a salvage procedure and the potential for subsequent VP shunt reimplantation after peritoneal recovery. Patient concerns: Case 1: A 57-year-old male presented with recurrent episodes of progressive gait instability, somnolence, cognitive decline, and vomiting over 9 months following initial VP shunt placement, despite multiple surgical revisions. Case 2: A 46-year-old male with a long history of shunt complications presented with worsening gait instability, impaired concentration, episodic dizziness, and intermittent confusion approximately 16 months after a VA shunt was placed as a secondary measure. Diagnoses: Both cases were diagnosed with recurrent hydrocephalus secondary to shunt failure. Case 1 was diagnosed with distal VP shunt obstruction caused by peritoneal adhesions, followed by a subsequent shunt infection confirmed by cerebrospinal fluid analysis. Case 2 was diagnosed with VA shunt valve failure despite correct catheter position, as indicated by shunt pressure monitoring and persistent symptoms. Interventions: Case 1: After multiple unsuccessful peritoneal catheter revisions and externalization for infection control, the patient was converted to a VA shunt. Case 2: Following the failure of VA shunt valve adjustments, abdominal ultrasound confirmed peritoneal recovery. The VA shunt was subsequently replaced with a contralateral VP shunt featuring a more granular adjustable valve. Outcomes: Case 1: Conversion to a VA shunt resulted in full neurological recovery, resolution of hydrocephalus symptoms, and no further complications at follow-up. Case 2: Contralateral VP shunt reimplantation led to the resolution of all neurological symptoms, significant functional recovery, and a return to independent daily activities, with no recurrence at the 6-month follow-up. Lessons: VA shunting is a safe and effective salvage procedure for patients with VP shunt failure attributable to peritoneal complications. Furthermore, these cases demonstrate that the peritoneal cavity can recover over time, allowing for successful VP shunt reimplantation if distal catheter failure recurs. A dynamic and individualized management strategy is essential for complex hydrocephalus cases.