CASE REPORT Ventriculo-femoro-caval shunt: a salvage surgery Bashar Abuzayed 1 & Nabil Al-zoubi 2 & Ziad Bataineh 3 & Khaled Alawneh 4 & Majdi Al Qawasmeh 5 & Liqaa Raffee 6 Received: 21 April 2020 /Accepted: 5 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020 Abstract Ventriculo-femoral vein shunts have been described in few case reports as an alternative for treating complex cases of hydro- cephalus in which other accesses are discarded. To our best knowledge, only 6 cases have been reported in the literature to date. We present a case of a 2-year-old female patient with hydrocephalus secondary to neonatal sepsis and meningitis. Patient was operated with various types of shunting procedures, such as ventriculo-peritoneal (V-P) shunt, ventriculo-atrial (V-A) shunt, ventriculo-pleural (V-PL) shunt, ventriculo-vesical shunt, ventriculo-superior sagittal sinus (V-SSS) shunt, and ventriculo-caval (V-C) shunt. All previous procedures were unsuccessful in treating the hydrocephalus. Finally, right ventriculo-femoro-caval shunt procedure was performed. Distal catheter was inserted into the right femoral vein and passed toward inferior vena cava under fluoroscopy guidance. The early postoperative period was uneventful. Late postoperative complications consisting of few periods of shunt dysfunction and distal obstruction were managed as an outpatient with injection for diluted heparin in the shunt valve, resulting in recovery of the shunt function. This was the management until the age of 4 when the femoral vein shunt was removed and right ventriculo-pleural shunt was placed. The patient tolerated this surgery and long-term follow-up showed good neurological status without episodes of shunt dysfunction. Keywords Femoral vein . Hydrocephalus . Inferior vena cava . Shunt . Superior sagittal sinus Introduction A variety of modalities exists for the management of hydro- cephalus. Ventriculo-peritoneal (V-P), ventriculo-atrial (V-A) and ventriculo-pleural (V-PL) shunts are the most widely used methods for this indication [1]. For more rare situations, ventriculo-superior sagittal sinus (V-SSS), ventriculo-caval (V-C), ventriculo-vesicular (V-V), and ventriculo-biliary shunts are reported to be used for draining CSF in selected patients when conventional sites are not suitable either due to adhesions, infection, thrombosis, or obliteration [1]. In this article, the authors present a case of ventriculo-femoro-caval (V-F-C) shunt. To our best knowledge, only 6 cases have been reported in the literature to date [2–4]. * Bashar Abuzayed sylvius@live.com Nabil Al-zoubi dr_nabeil_z3bi@yahoo.com Ziad Bataineh ziadaba@just.edu.jo Khaled Alawneh kzalawneh0@just.edu.jo Majdi Al Qawasmeh dr_alqawasmeh@yahoo.com Liqaa Raffee laraffee5@just.edu.jo 1 Consultant Neurosurgeon, Gardens Hospital, Al Sab Bin Jathamah St, P.O.Box: 930186, Amman, Jordan 2 Department of Surgery, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan 3 Department of Surgery and Pediatric Surgery, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan 4 Department of Radiology, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan 5 Department of Neuroscience, Division of Neurology, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan 6 Department of Accident and Emergency, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan Child's Nervous System https://doi.org/10.1007/s00381-020-04919-6