Ventriculovesical Shunting As An Alternative Approach For Treating Hydrocephalus With A Technical Note And Case Series
This paper presents a case series and technical note demonstrating that ventriculovesical shunting is a viable and effective alternative to ventriculoperitoneal shunting for managing hydrocephalus in patients with contraindications to peritoneal or atrial drainage, such as those with abdominal complications, peritoneal dialysis dependence, or congenital anomalies.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
The human brain is encased in a protective fluid called cerebrospinal fluid, which constantly circulates to cushion the organ and remove waste. In a healthy body, this fluid is produced and absorbed at a steady pace, maintaining a delicate balance. When this system fails and fluid builds up faster than it can be drained, pressure rises inside the skull, a condition known as hydrocephalus. If left untreated, this pressure can damage brain tissue. For decades, the standard solution has been to insert a thin tube, or shunt, that acts as a drain, carrying the excess fluid from the brain to the belly, where the body can naturally absorb it. This approach works well for many, but for some patients, the belly becomes a hostile environment. Scar tissue, infections, or other medical conditions can block the fluid from being absorbed, causing the drain to fail. When the belly is no longer an option, and draining the fluid into the heart is too risky, doctors must find a new place to send the excess fluid.
A team of neurosurgeons at Harran University recently explored a different destination for this drainage: the urinary bladder. In a report published in September 2026, the researchers described their experience with three young patients for whom the usual treatments had failed or were impossible. These patients had complex medical histories, including severe scarring in the abdomen, kidney failure requiring dialysis, or congenital defects that made the belly unsuitable for fluid absorption. The surgeons decided to reroute the drainage tube directly into the bladder, a method known as a ventriculovesical shunt. The bladder, they reasoned, could serve as a holding tank for the fluid, allowing it to be expelled naturally when the patient urinated. This approach bypasses the problematic abdomen entirely and avoids the risks associated with draining fluid into the bloodstream.
The study details the surgical journey of these three patients. The first was a three-year-old girl whose previous drains had failed repeatedly due to infections and the formation of fluid-filled cysts in her abdomen. The second was a fifteen-year-old girl with kidney failure who relied on a machine to filter her blood three times a week; for her, the standard abdominal drain was an obstacle to her dialysis, and draining into the heart would have overwhelmed her circulatory system with too much fluid. The third was a six-month-old boy born with a missing anal opening and a history of multiple failed shunt surgeries. In each case, the surgical team, working alongside a urologist, placed a catheter into the brain's fluid-filled space and tunneled a second tube down to the lower abdomen. There, they made a small incision to access the bladder and inserted the tip of the tube just above the neck of the bladder, ensuring it sat securely within the organ.
To ensure the procedure would last as the children grew, the surgeons employed a specific technique. They left a small, loose coil of the tube under the skin of the abdomen. As the child grew taller and their body lengthened, this extra length would gradually uncoil, preventing the tube from being pulled out of place or snapping under tension. They also secured the tube firmly to the abdominal muscles to stop it from migrating. The surgeries were completed without immediate complications, and the patients were discharged shortly after the procedures. The second patient, for instance, was discharged on the fourth postoperative day and continued regular dialysis sessions without immediate shunt-related issues. The third patient was discharged one week after surgery with no complications. However, the long-term outcome for the first patient was less clear; two months after the surgery, the shunt was removed at an external center, and the patient did not return for further follow-up. The fluid that had been building up in their brains began to flow freely into their bladders, effectively lowering the dangerous pressure inside their skulls.
The researchers noted that while the procedure was successful in these specific cases, it is not a cure-all and requires careful patient selection. The technique is best suited for those who cannot use the abdomen or the heart for drainage, particularly when the bladder is functioning normally or when the patient has no urine output, as the fluid can be managed medically. The team emphasized that keeping the area clean is vital to prevent infections, and patients require regular monitoring to ensure the tube remains in place and does not cause blockages. While long-term data is still needed to fully understand how this method holds up over many years, these cases suggest that the bladder can serve as a reliable, life-saving alternative when the standard options are closed off. The study concludes that for a small group of patients facing difficult choices, this approach offers a viable path forward, turning a once-unmanageable condition into a manageable one.
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