Complete intracranial migration of ventriculoperitoneal shunt: a common procedure with a rare complication

Maha Irfan,Sameer Saleem Tebha,Soha Zahid,Hammad Mehtab,Ahtesham Khizar

doi:10.1186/s41984-021-00125-x

Abstract

BackgroundVentriculoperitoneal shunt insertion is widely used in the treatment of different kinds of hydrocephalus. Shunt failure is one of the most common complications; however complete intracranial shunt migration is rarely reported.Case presentationWe report a case of an eleven-month-old girl with complete intracranial migration of Ventriculoperitoneal Shunt (Chhabra Shunt). We removed this intracranially migrated shunt with the help of an endoscope (GAAB) and inserted a new Ventriculoperitoneal Shunt (Medtronic Shunt) on the opposite side. She had a good clinical outcome.ConclusionComplete intracranial shunt migration is an extremely rare complication. It is likely due to raised intra-peritoneal pressure, strong head movements, and inadequate shunt fixation. The best possible approach to prevent shunt migration would be better patient handling along with appropriate operative techniques.

Highlights

ConclusionComplete intracranial shunt migration is an extremely rare complication
Ventriculoperitoneal shunt insertion is widely used in the treatment of different kinds of hydrocephalus
After a thorough review of the literature, we found twenty-five cases up to date of total intracranial VP shunt migration [Table 1] [2, 3, 9,10,11,12,13]

Summary

Conclusion

Complete intracranial migration of VP shunts is a rare but serious complication in patients with severe hydrocephalus. The best possible approach to prevent migration would be better anchorage of the shunt to the pericranium and peritoneum, a frontal burr hole instead of occipital, and a smaller burr-hole opening. Regular follow ups and educating parents regarding red flags and complications should be readily practiced. VP shunts migration is a serious complication, it is not usually fatal. We recommend a nation-wide assessment of the prevalence, incidence and associating risk factors for VP shunt migration to guide future therapeutic practices

Background

Discussion