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Case Report

Retrograde Partial Migration of Ventriculo-Peritoneal Shunt With its Chamber: Review of Causative Factors and Its Prevention

Manish Jaiswal** , Harsha A. Huliyappa* , Manish Jaiswal** , Sunil Kumar Singh*** , Bal Krishna Ojha**** , Anil Chandra*** , Chhitij Srivastava*****

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International Journal of Neurology and Neurosurgery 9(1):p 41-44, January - June 2017. | DOI: DOI: http://dx.doi.org/10.21088/ijnns.0975.0223.9117.7

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Abstract

 Distal migration of shunt is a very common occurrence. Proximal migration of shunt is rare and possible pathophysiological mechanisms to explain this unusual complication is rarely attempted. A 5-month-old child shunted for posttraumatic hydrocephalus presented 1.5 years later with raised intracranial pressure (ICP) and seizures. Imaging showed subdural hygroma, partial intracranial migration of shunt / chamber. On endoscopy, choroid plexus was adherent to shunt tip and some pericranial tissue was found in the anchoring suture(intraventricularly displaced). Endoscopic retrieval of migrated shunt along with CSF diversion was established by endoscopic third ventriculostomy (ETV) with symptoms free follow-up. Hostrelated and surgical factors have been postulated. Tug-of – tie effect on the anchoring suture and collapsing cortex are the possible mechanisms that explain proximal migration in our case. Three-point fixation of the chamber to pericranium, small burr hole with a smaller durotomy, can prevent shunt migration. Proximal Shunt migrations should be dealt with endoscopy so as to avoid complications.

Keywords: Shunt Chamber Migration; Neuroendoscopy; V-P Shunt; ETV.

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DOI: DOI: http://dx.doi.org/10.21088/ijnns.0975.0223.9117.7

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