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<p>Ventriculo-pyeloureteral (VPU) shunting is a rare salvage procedure for hydrocephalus when traditional ventriculoperitoneal (VP) and ventriculoatrial (VA) shunts fail. We report the successful use of a self-expanding, nitinol-based ureteral stent (Allium Medical Solutions, Israel) to facilitate VPU shunting in a toddler with complex multicystic hydrocephalus. A premature infant born with duodenal atresia developed severe post-hemorrhagic hydrocephalus resistant to multiple VP and VA shunt revisions due to extensive peritoneal adhesions and recurrent atrial thrombosis. A VPU shunt was attempted as a last resort but was complicated by urinoma formation and obstruction due to the small caliber of the toddler’s ureter relative to the catheter. To salvage the procedure, a large-caliber Allium ureteral stent was deployed to passively dilate the ureter, creating a protected channel for the shunt catheter. At 7 months follow-up, the patient demonstrated stable neurological function, effective CSF drainage, and no vesicoureteral reflux. This case highlights that VPU shunting combined with an Allium stent is a viable last-resort option, preventing ureteral obstruction by the shunt catheter.</p>

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Ventriculo-Pyelo-“Allium” shunt as last resort procedure for complex pediatric hydrocephalus - first case described

  • 期刊论文

  • 发表日期：

    2026年5月13日

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  • Ben Hefer,
  • Mickey Gideon,
  • Sivan Bezalel,
  • Nir Kleinmann,
  • Rabea Moed,
  • Yarden Zohar,
  • Nicola Mabjeesh,
  • Jonathan Wagmaister

摘要

Ventriculo-pyeloureteral (VPU) shunting is a rare salvage procedure for hydrocephalus when traditional ventriculoperitoneal (VP) and ventriculoatrial (VA) shunts fail. We report the successful use of a self-expanding, nitinol-based ureteral stent (Allium Medical Solutions, Israel) to facilitate VPU shunting in a toddler with complex multicystic hydrocephalus. A premature infant born with duodenal atresia developed severe post-hemorrhagic hydrocephalus resistant to multiple VP and VA shunt revisions due to extensive peritoneal adhesions and recurrent atrial thrombosis. A VPU shunt was attempted as a last resort but was complicated by urinoma formation and obstruction due to the small caliber of the toddler’s ureter relative to the catheter. To salvage the procedure, a large-caliber Allium ureteral stent was deployed to passively dilate the ureter, creating a protected channel for the shunt catheter. At 7 months follow-up, the patient demonstrated stable neurological function, effective CSF drainage, and no vesicoureteral reflux. This case highlights that VPU shunting combined with an Allium stent is a viable last-resort option, preventing ureteral obstruction by the shunt catheter.