Mechanisms and Major Sites of Distal Catheter Migration in Ventriculoperitoneal Shunting Maneuvers: A Review Article

Abstract

A ventriculoperitoneal shunt (VPS) is a medical device used to deflect cerebrospinal fluid from cerebral ventricles to the peritoneal cavity. Since 1908, ventriculoperitoneal shunts have been considered the best option in hydrocephalus management. Manifestation related to VPS may arise anywhere whilst tunneling the VPS from the ventricle to the peritoneal cavity, but complications associated with the distal catheter are especially common and a leading cause of revision surgeries. Among the many complications associated with peritoneal shunts, migration of the catheter into other parts of the body is still common. Scrotal migration mainly takes place in children aged 4 days to 5 years. Patent processus vaginalis, formation of an inguinal hernia, and increased intraabdominal pressure are leading risk factors associated with migration of the peritoneal catheter into the scrotum. Thoracic migration of peritoneal catheters predominantly occurs in adult patients. Important mechanisms in thoracic migration include (1) iatrogenic perforation of the external or internal jugular veins by the surgeon during tunneling and (2) gradual destruction of the venous structures by the catheter due to routine extension and flexion of the neck. After entering the vessel, negative intrathoracic pressure combined with positive intraabdominal pressure aids migration into the thoracic cavity. Sharp tips or shunt types contribute to intraabdominal migration and perforation.

Management of trans-vaginal extrusion of the distal ventriculoperitoneal shunt catheter: a systematic literature review from 1973 to 2021

“…A total 20 cases on the management of the above-mentioned complication were retrieved. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] A case was excluded from the review, due to the incomplete desired details. 31 A total of 19 cases were recruited for the systematic review and retrieved from the 18 manuscripts.…”

“…31 A total of 19 cases were recruited for the systematic review and retrieved from the 18 manuscripts. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Fifteen manuscripts are available in the English language. 13,14,[17][18][19][20][21][23][24][25][26][27][28][29][30] Three of the manuscripts are available in a language other than English.…”

“…9-12 Extrusion of the distal VPS catheter through the vaginal orifice has also been reported but less frequent, and twenty such cases have been reported to date. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] A systematic literature review was performed for 19 such cases to highlight demographics, clinical characteristics, surgical interventions executed, complications, and the outcome. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]…”

“…[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] A systematic literature review was performed for 19 such cases to highlight demographics, clinical characteristics, surgical interventions executed, complications, and the outcome. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]…”

Neurological diseases caused by coronavirus infection of the respiratory airways

“…These patients may have had an acute ischemic stroke and are more prone to embolic vascular events, having abnormally increased D‐dimers [81, 82, 110]. The neurologist should take different treatment measures, especially in patients with a cerebrovascular disease where anticoagulation therapy is recommended for stroke [111, 112]. As the SARS‐CoV‐2 virus binds to ACE2 receptors [73], some patients with hypertension and COVID‐19 infection may show an abnormal increase in blood pressure and increase the risk of cerebral hemorrhage and ischemic stroke.…”