Shunt Fractures Associated with Intermittent Hydrocephalus: Case Reviews and New Solutions

Abstract

Although ventriculoperitoneal shunt surgery is the most common method for hydrocephalus treatment, it may lead to serious complications and require surgical interventions. Peritoneal catheter fracture is one of the common complications that may cause intermittent hydrocephalus. If patients with peritoneal catheter fracture have symptoms of hydrocephalus and ventricular dilatation, the treatment algorithm is clear. However, the diagnosis and treatment protocol remains unclear otherwise. In this article, the possible mechanisms of hydrocephalic symptoms, the diagnosis, as well as treatment algorithms are examined. Eight patients with a ventriculoperitoneal shunt who had intermittent hydrocephalic symptoms due to peritoneal catheter fracture but without any radiologically significant ventricular dilatation at Niğde Ömer Halisdemir University from 2018 to 2021 were collected. A new diagnostic algorithm was created. Patient follow-up was performed in each patient as a procedure. The method that we determined was successful in all our patients. No complications were observed. We have followed the patients with a normal clinic for at least 6 months. The provocation test we have formulated always revealed the true cause of the clinic. Thus, on the one hand, with a positive provocation test we recommend revision surgery without waiting for the ventricular dilatation or hydrocephalic symptoms in patients with a fractured peritoneal catheter, considering the results of asymptomatic shunt revision surgery have been reported to be better than those with symptomatic shunt dysfunction; on the other hand, patients with negative provocation tests are saved from unnecessary surgical intervention as well as benefit from true etiologic fast treatment.