Total intraventricular migration of unisystem ventriculo-peritoneal shunt

Abstract

This is a report of an hydrocephalic adult, in whom a unishunt system migrated upwards into the ventricle despite using the appropriate clips (lock and slip). The shunt migration discovered 3 months following its insertion. Several mechanisms contributed to the migration; negative sucking intra-ventricular pressure, positive pushing intra-abdominal pressure, tortuous subcutaneous track and neck movements. It seams that lock and slip clips are not enough fixation. The best way of preventing such shunt migration is interposing a reservoir between the ventricular and peritoneal catheters.

Thecoperitoneal Shunt ‘Cast Away’

“…But, what about the case of intracranial migration??!! Although the mechanism is not will understood several mechanisms have been reported to contribute in this complication: negative sucking intra-ventricular pressure, positive pushing intra-abdominal pressure [11,18]. The majority of patients, like the present one, had been infants and children.…”

“…Management of this condition needs treatment strategy which devised taking into account the cause and the location of CSF fistula. Conservative management is a valid option and surgical treatment includes: transcranial approach [3,4] intracranial approach [5], Trans nasal approach [6], and endoscopic transnasal [7,8] or thecoperitoneal shunt [9,11,18]. Lumboperitoneal shunt has an advantage of being completely extra cranial procedure.…”

Ventricular migration of shunt: Chhabra shunt complication

“…[1][2][3]10,11,13,16,17,19,22 Almost all have reported such cases in malnourished infants with complicated postoperative course. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Heim and Kim have reported migration of ventriculoperitoneal shunt to subgaleal and subdural spaces. 4,5 The probable cause of retrograde migration is a much debated subject with numerous hypothesis forwarded in literature.…”

“…An increasing number of reported cases are from Indian subcontinent and mostly the Chhabra shunt is implicated in this complication. [1][2][3]10,11,13,16,17,19,21,22 The cylindrical soft chamber and the practice of repeated pressing of chamber to flush the chamber may be one of the important causes along with the above ones in pushing the shunt retrogradely into ventricles. A case of intracranial migration has known to cause visual disturbances; maybe due to pressure on optic pathways and raised intracranial pressure.…”

Intractable Seizures Associated With Proximal Migration of a Ventriculoperitoneal Shunt-Case Report-

“…Relatively elevated intra-abdominal pressures might push the shunt system into the ventricle under negative suction. 5) Repeated head impacts might damage the system directly and help the migration process. 14) Second, low resistance to such mechanical forces.…”