Ventriculopleural Shunt Surgery in A Patient with Multiple Skeletal and Neurodevelopmental Anomalies: A True Perioperative Challenge

Abstract

Introduction: Ventriculopleural shunt placement for decompression of hydrocephalous is an uncommon procedure. The usual indications are adhesions, infection, thrombosis or obliteration of the more commonly done ventriculoperitoneal shunt or an anatomical non-availability of the peritoneum. We present a clinical case of a patient with congenital hydrocephalous complicated by multiple skeletal and neurodevelopmental anomalies who presented for thoracoscopic placement of a ventriculopleural shunt. The anesthetic challenges and perioperative management constituted a complex multi-disciplinary challenge. Case presentation: We present a clinical case of a 42 years old woman with congenital hydrocephalous complicated by multiple skeletal and neurodevelopmental anomalies who presented for thoracoscopic placement of a ventriculopleural shunt. Some of the perioperative concerns included initiation and maintenance of one-lung ventilation in a patient with short stature, dysmorphic skeletal features, severe kyphoscoliosis, restrictive underlying lung disease and multiple neurodevelopmental midline defects. Conclusion: Our presentation highlights the special challenges in this patient based on the need for lung collapse in a severely short statured individual with a dysmorphic severely kyphoscoliotic thoracic cavity along with underlying restrictive lung disease and background neurodevelopmental midline defects.