# Case Report: A modified approach to converting ventriculoperitoneal shunt to ventriculoatrial shunt due to recurrent encapsulation of the peritoneal catheter

## TL;DR

This case report describes a new, minimally invasive method to convert a VP shunt to a VA shunt in a patient with recurring peritoneal catheter blockage.

## Contribution

A rapid exchange technique that avoids exposing the shunt valve and reduces surgical trauma during shunt conversion.

## Key findings

- The patient experienced four episodes of VP shunt dysfunction due to omental encapsulation.
- The rapid exchange technique successfully converted the VP shunt to a VA shunt with improved patient outcomes.
- Postoperative follow-up showed significant improvement in hydrocephalus symptoms.

## Abstract

Hydrocephalus is a condition characterized by the accumulation of cerebrospinal fluid (CSF) in the ventricular system due to various causes, including excessive CSF production, impaired circulation, or absorption dysfunction. This condition is often accompanied by ventricular enlargement, compression of brain parenchyma, and increased intracranial pressure. Ventriculoperitoneal (VP) shunting is the first-line treatment for hydrocephalus; however, when the peritoneal catheter becomes obstructed due to encapsulation, the procedure may need to be converted to a ventriculoatrial (VA) shunt, which serves as a second-line treatment. Here, we present a case that demonstrates a rapid, simple, and minimally invasive technique for converting a VP shunt to a VA shunt. This approach eliminates the need to expose the retroauricular valve or disconnect the valve from the catheter, significantly reducing operative time and minimizing trauma.

A 61-year-old male patient presented with typical clinical features of hydrocephalus, including urinary dysfunction, gait instability, and gradually worsening cognitive decline over the course of a year, as well as corresponding imaging findings. The patient subsequently underwent a VP shunt procedure. However, within six months postoperatively, the patient experienced four episodes of shunt dysfunction due to omental encapsulation of the peritoneal catheter, leading to catheter obstruction and worsening hydrocephalus. During the first three episodes, the shunt catheter was released from omental encapsulation through laparoscopic surgery, providing temporary relief of hydrocephalus after each procedure. Following the fourth episode of peritoneal shunt dysfunction, we employed a rapid exchange technique to relocate the peritoneal catheter to the superior vena cava while preserving the ventricular catheter and shunt valve. Postoperatively, the patient's hydrocephalus-related symptoms gradually improved. At the three-month follow-up, the patient's hydrocephalus showed significant improvement, and he had returned to independent daily living.

The rapid exchange technique is a fast, simple, and minimally invasive method for converting a VP shunt to a VA shunt, offering significant benefits in clinical practice.