Ventriculo caval shunt: a salvage alternative

Abstract Hydrocephalus management is particularly challenging in patients with contraindications to conventional cerebrospinal fluid (CSF) diversion pathways. We report the case of a 37-year-old woman with obstructive hydrocephalus and a complex surgical history, including multiple shunt failures, extensive venous thrombosis and impaired peritoneal absorption. After exhaustion of standard options, an extraperitoneal ventriculocaval shunt (VCS) was performed with distal catheter placement in the inferior vena cava. The patient showed sustained clinical and radiological improvement during two years of follow-up. This case suggests that VCS may represent a feasible salvage alternative in carefully selected patients when traditional distal sites are unavailable.