Acute Intraoperative Ventriculoperitoneal Shunt Failure in a Child with Myelomeningocele: A Case Report.

Abstract

Spinal deformity surgery in patients with myelomeningocele carries a high rate of complications, including wound infection and fusion pseudarthrosis1,2. Most patients with myelomeningocele have a ventriculoperitoneal (VP) shunt with the potential for malfunction either during surgery or in the immediate postoperative period3. Death from shunt malfunction in the early postoperative period also can occur1. In this report, we present a patient with myelomeningocele and severe spinal deformity whose initial spinal surgery was aborted secondary to acute VP shunt malfunction. Subsequent spinal surgery was completed with the aid of continuous intracranial pressure (ICP) monitoring with use of an external shunt tap. The importance of recognizing this potentially lethal complication and a suggested management protocol are presented. The patient and his family were informed that data concerning the case would be submitted for publication, and they provided consent. A fifteen-year-old boy with a thoracic-level myelomeningocele presented to our institution with a severe scoliosis measuring 120° (Figs. 1-A and 1-B). A VP shunt that had been placed at birth had never required any shunt revisions. A preoperative neurosurgical evaluation, including a stable head computed tomography (CT) scan, revealed no evidence of shunt malfunction. He was scheduled for a spinal fusion from T2 to the pelvis in a planned two-stage surgical approach. Stage one included a halo ring application, exposure of the posterior spine with placement of spinal anchors, and multiple Ponte osteotomies (bilateral excision of facets and removal of the ligamentum flavum to improve spinal flexibility), followed by six weeks of halo-gravity traction. Stage two consisted of an apical vertebral column resection as well as completion of the posterior spinal fusion and instrumentation. Fig. 1-A Fig. 1-B Anteroposterior ( Fig. 1-A ) and lateral supine ( Fig. 1-B ) radiographs of a fifteen-year-old boy with myelomeningocele. He has severe scoliosis measuring 120°, thoracolumbar …