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| Ahead of print
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Intracranial migration of ventriculoperitoneal shunt: A rare complication
Batuk Diyora, Ashish Dubey
Department of Neurosurgery, Lokmanya Tilak Municipal Medical College and General Hospital (LTMGH), Mumbai, Maharashtra, India
| Date of Submission | 07-Oct-2021 |
| Date of Decision | 28-Nov-2021 |
| Date of Acceptance | 19-Nov-2021 |
| Date of Web Publication | 30-Jan-2023 |
Correspondence Address:
Batuk Diyora,
Department of Neurosurgery, Lokmanya Tilak Municipal Medical College and General Hospital (LTMGH), Sion West, Mumbai 400022, Maharashtra
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/jpn.JPN_197_21
 Abstract | | |
Ventriculoperitoneal shunt is the commonest neurosurgical procedure being performed in the pediatric population. However, the procedure has its own list of complications. We present a case of complete intracranial migration of ventriculoperitoneal shunt in a 2-year-old male child.
Keywords: Cranial cavity, migration, ventriculoperitoneal shunt
A 2-year-old male child brought to us with vomiting and altered sensorium. At the age of 1 year, he had TBM (tuberculous meningitis) with hydrocephalus for that he underwent right-sided ventriculoperitoneal (VP) shunt surgery at a peripheral hospital. He was on antituberculous medication. Radiological evaluation revealed a coiled shunt tube in the skull with the absence of a shunt tube over the chest wall and an empty peritoneal cavity Figure 1]. This was suggestive complete intracranial migration of VP shunt. | Figure 1: X-ray skull AP view showing intracranial migration of VP shunt (coiled VP shunt system) (A) and X-ray skull with chest and abdomen AP view showing no shunt tube over the chest wall and empty peritoneal cavity (B)
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VP shunt is the most common neurosurgical procedure being performed in the pediatric population. Meticulously performed VP shunt procedure has a good clinical outcome. However, the procedure has its own list of complications, which includes infection, distal cavity cyst formation, mechanical obstruction, disconnection, migration, and extrusion. This requires sometimes multiple revision surgeries. Shunt migration is defined as the movement of the shunt system (peritoneal end, cranial end, reservoir, or entire shunt system) toward another anatomical site (such as pleural cavity, scrotal bag, abdominal cavity, bowel, or cranial cavity). Incidence of shunt migration is approximately 0.1% and can occur in either cranial or caudal direction.[1],[2]
Complete intracranial migration of shunt is very rare and comprises only 0.1%–0.4% of total migrations. It is more common in the pediatric age group than in adults. Various factors responsible are growth spurt, overdrainage (sucking effect), malnourishment, and cortical atrophy. Type of shunt system used, poor surgical technique, and raised intra-abdominal pressure also predispose to shunt migration. Intracranial shunt migration can subgaleal, intraventricular, intraparenchymal, or subdural.[3],[4] Patient can present with either raised intracranial pressure (if shunt dependent) or seizure, neurological deficit due to involvement of brain parenchyma. Management includes removal of shunt by craniotomy (in the case of intraparenchymal or subdural migration) or endoscopic procedure (in the case of intraventricular migration). If shunt-dependent patients require a new shunt system, the previous surgical site should be avoided.[5]
| Financial support and sponsorship | |  |
Nil.
| Conflicts of interest | | |
There are no conflicts of interest.
| References | | |
| 1. | Kast J, Duong D, Nowzari F, Chadduck WM, Schiff SJ. Time-related patterns of ventricular shunt failure. Childs Nerv Syst 1994;10:524-8.  |
| 2. | Gupta PK, Dev EJ, Lad SD. Total migration of a ventriculo-peritoneal shunt into the ventricles. Br J Neurosurg 1999;13:73-4. |
| 3. | Chatterjee S, Kaushik S. Coiling of ventriculo-peritoneal shunt in the subdural space: a possible etiology. J Pediatr Neurosci 2006;1:31. [Full text] |
| 4. | Nadkarni TD, Menon RK, Dange NN, Desai KI, Goel A. Cranial migration of complete ventriculo-peritoneal shunt assembly. J Clin Neurosci 2007;14:92-4. |
| 5. | Harischandra LS, Sharma A, Chatterjee S. Shunt migration in ventriculoperitoneal shunting: a comprehensive review of literature. Neurol India 2019;67:85-99. [ PUBMED] [Full text] |
[Figure 1]
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