Background: Cerebrospinal fluid diversion is one of the most frequent neurosurgical procedures across the world and can be challenging in select patients who fail standard distal drainage sites.
Objective: To present the case of a woman after failing peritoneal, pleural, and atrial distal drainage sites who underwent a thoracoscopic-assisted ventriculo-azygous vein shunt placement.
Methods: A 32-year-old woman presented to our hospital with long-standing history of hydrocephalus and shunt dependence. She had failed peritoneal and atrial shunts secondary to infection, scarring, and clot formation. At presentation, she had a pleural shunt in place and developed a large pleural effusion with shortness of breath.
Results: She was taken to the operating room where a thoracoscopic-assisted ventriculo-azygous vein shunt was placed through a mini-thoracotomy. Postoperatively, she has not required a shunt revision in >2 years of follow-up.
Conclusion: When other distal sites fail, our case report illustrates a novel surgical technique capable of being performed through a multidisciplinary approach.