Ventricular migration of shunt: Chhabra shunt complication

Abstract

We report a rare complication of Intraventricular migration of whole shunt and discuss the causes of this complication. A 9-month-old child presented in OPD with enlarging head and vomiting. The patient had undergone VP shunt twice before due to congenital hydrocephalus. Imaging was done which suggested of Intraventricular migration of complete shunt. The patient was posted for surgery and the shunt was removed from the lateral ventricle. Patient recovered well and has been followed up for 1 year till the writing of this report. After careful review of literature we found twenty reported cases of intra cranial migration of VP shunts. The probable causes of retrograde migration include technical issues like large burr hole and wide opening of Dura. An increasing number of reported cases are from Indian subcontinent and mostly the Chhabra shunt is implicated in this complication. The probable reasons for migration are: 1) Malnourished infant with thin cortical mantle, large ventricles having reduced pressure and raised intraabdominal pressure due to excess amount of CSF not absorbed in peritoneum. 2) Poor anchorage of shunt chamber along with indiscriminate pressing of cylindrical Chhabra shunt reservoir. To prevent it special care must be taken in neonates and infants in making smaller burr holes, smaller chamber area and stronger anchorage of shunt chamber to periosteum. Further instead of using the cylindrical Chhabra chambers which can easily migrate to ventricles, larger spherical chambers may be used.