Breast-Related CSF Shunt Complications: Literature Review with Illustrative Case

Abstract

In this article, we discuss and classify breast-related ventriculoperitoneal (VP) cerebrospinal fluid (CSF) shunt complications, and provide a literature review. Shunt complications related to pre-existing breast implants comprise nearly half of the breast-related shunt complications reported thus far. We present a complication of shunt failure in a 61-year-old woman who had previously undergone mastectomies for breast cancer with implant reconstruction. Following shunting, she developed headaches, fever, and right-sided breast swelling and erythma consequent to breast implant rupture, distal shunt migration, and CSF pseudocyst. This case is unique in that it involved rupture of a breast implant from VP shunt insertion. For complication avoidance, neurosurgeons should be aware of the potential pitfalls in shunting patients with breast implants.

Penetration of a divided cystoperitoneal shunt catheter into the transverse colon inducing acute mastitis

“…Several factors have been found to be responsible for this rare complication, including chronic irritation of the gastrointestinal tract, prior abdominal surgery or silicone allergy [2, 3]. Breast-related complications involving the thoracic segment of catheter are also rare [4]. CSF leakage and retrograde flow from the peritoneal cavity to the breast may cause breast-related complications.…”

“…Bowel perforation by the shunt catheter is uncommon and accounts for 0.01–0.07% of all abdominal complications [1–3]. Breast-related complications represent a class of thoracic shunt complication and are characterized by breast cerebrospinal fluid (CSF) pseudocyst formation, CSF galactorrhoea and shunt obstruction [4]. We report a rare case of acute mastitis caused by enteric organisms passing through a CP shunt catheter, which had penetrated the transverse colon, and was related to a previous failed attempt to remove the shunt resulting in a divided catheter.…”

Breast cancer in association with a ventriculoperitoneal shunt: An unexpected discovery

“…Breast related VP shunt complications including; shunt migration, CSF pseudocyst, CSF 'galactorrhea' and shunt obstruction, are well documented in literature and represent a class of thoracic shunt complications [5]. To date however, only five cases of breast cancer adjacent to a ventriculoperitoneal shunt have been described.…”

Neurosurgical transection of the breast: an unexpected extracranial complication of ventriculoperitoneal shunt insertion

“…5,9 Ventriculoperitoneal (VP) shunt placement and revision are among the most common surgical procedures performed by neurosurgeons, and complications relating to the thoracic portion of the shunt are relatively rare compared with those of its other components. 4,8 Injury to the developing breast in pediatric surgical procedures involving thoracostomy or thoracotomy is well described. 1,2,6 We detail a previously unreported complication of primary breast development disruption secondary to insertion of a VP shunt in the neonatal period of a female patient.…”