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Lee CB, Park J. Distal Ventriculoperitoneal Shunt Catheter Migration into the Pulmonary Vasculature and Cardiac Chamber: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:934-940. [PMID: 37559803 PMCID: PMC10407080 DOI: 10.3348/jksr.2022.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/20/2022] [Accepted: 11/13/2022] [Indexed: 08/11/2023]
Abstract
Ventriculoperitoneal shunting is the most common neurosurgical procedure for treatment of hydrocephalus. Shunt-related complications are relatively common and associated with a high rate of shunt revision. However, migration of the distal ventriculoperitoneal shunt, especially into the cardiac and intravascular regions, has rarely been reported. Awareness of this rare but potentially hazardous complication is important owing to its significant morbidity, which can be prevented by prompt management. Here, we introduce a case of a 23-year-old male with migration of the distal shunt catheter through the left internal jugular vein into the cardiac chamber and both pulmonary arteries, which occurred 2 months after receiving ventriculoperitoneal shunting. Furthermore, we discuss the possible mechanisms and management of this condition.
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Hamed EA, Mohammad SA, Awadallah SM, Abdel-Latif AMM, Abd-Elhameed AM. MRI as a one-stop destination for evaluation of CSF shunt malfunction. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2023. [DOI: 10.1186/s43055-023-00991-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Abstract
Background
Despite the high-frequency rate of cerebrospinal fluid shunt malfunction, radiological evaluation of CSF shunts has remained deficient, focusing mainly on demonstrating secondary signs of shunt failure rather than evaluating the shunt tube itself. We aimed to study the utility of different MR pulse sequences in evaluating the cranial and abdominal ends of CSF shunts in order to identify the potential cause of shunt failure and its impact on patient management.
Results
Twenty-five patients (18 males, 7 females, median age 2.5 years, IQR 0.75–15) were enrolled in the study, having 28 ventriculo-peritoneal shunts and single ventriculo-gallbladder shunt. The catheter lumen and fine intraventricular septae were only demonstrated in 3D-DRIVE sequences (p < 0.001). Except for three patients (having cranial end-related complications), all patients with cranial and/or abdominal end-related complications received surgery (p < 0.001, positive likelihood and negative likelihood ratios = 7.27, 0.3, respectively, sensitivity = 0.7 and specificity = 0.9). MRI findings (luminal occlusion, disconnection, CSF collection, or migration) were consistent with operative data. There is no significant difference between patients who underwent surgery and those with conservative management, or symptomatic and asymptomatic patients in terms of the prevalence of ventricular dilatation or white matter signal abnormality. The results of the abdomino-pelvic fat-suppressed T2-WI showed excellent agreement with ultrasound findings (Cohen’s Kappa 0.9). Quantitative PC could give insights into CSF dynamics, which depend on the site and cause of shunt malfunction.
Conclusions
MRI could be a one-stop destination for evaluating patients with suspected non-acute shunt malfunction. It was found to have clinical relevance in terms of accurately locating the exact site and possible cause of shunt-related complications.
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Lee C, Chiu L, Mathew P, Luiselli G, Ogagan C, Daci R, Owusu-Adjei B, Carroll RS, Johnson MD. Evidence for increased intraabdominal pressure as a cause of recurrent migration of the distal catheter of a ventriculoperitoneal shunt: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE2032. [PMID: 36034506 PMCID: PMC9394158 DOI: 10.3171/case2032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 09/29/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Placement of a ventriculoperitoneal (VP) shunt is an effective treatment for several disorders of cerebrospinal fluid flow. A rare complication involves postoperative migration of the distal catheter out of the intraperitoneal compartment and into the subcutaneous space. Several theories attempt to explain this phenomenon, but the mechanism remains unclear. OBSERVATIONS The authors report the case of a 37-year-old nonobese woman who underwent placement of a VP shunt for idiopathic intracranial hypertension. Postoperatively, the distal catheter of the VP shunt migrated into the subcutaneous space on three occasions despite the use of multiple surgical techniques, including open and laparoscopic methods of abdominal catheter placement. Notably, the patient repeatedly displayed radiographic evidence of chronic bowel distention consistent with increased intraperitoneal pressure. LESSONS In this case, the mechanism of catheter migration into the subcutaneous space did not appear to be caused by pulling of the catheter from above but rather by expulsion of the catheter from the peritoneum. Space in the subcutaneous tissues caused by open surgical placement of the catheter was permissive for this process. Patients with chronic increased intraabdominal pressure, such as that caused by bowel distention, obesity, or Valsalva maneuvers, may be at increased risk for distal catheter migration.
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Affiliation(s)
- Christopher Lee
- Department of Neurological Surgery, University of Massachusetts Medical School, Worcester, Massachusetts; and
| | - Lucinda Chiu
- Department of Neurological Surgery, University of Massachusetts Medical School, Worcester, Massachusetts; and
| | - Pawan Mathew
- Department of Neurological Surgery, University of Massachusetts Medical School, Worcester, Massachusetts; and
| | - Gabrielle Luiselli
- Department of Neurological Surgery, University of Massachusetts Medical School, Worcester, Massachusetts; and
| | - Charles Ogagan
- Department of Neurological Surgery, University of Massachusetts Medical School, Worcester, Massachusetts; and
| | - Rrita Daci
- Department of Neurological Surgery, University of Massachusetts Medical School, Worcester, Massachusetts; and
| | - Brittany Owusu-Adjei
- Department of Neurological Surgery, University of Massachusetts Medical School, Worcester, Massachusetts; and
| | - Rona S. Carroll
- Department of Neurological Surgery, University of Massachusetts Medical School, Worcester, Massachusetts; and
| | - Mark D. Johnson
- Department of Neurological Surgery, University of Massachusetts Medical School, Worcester, Massachusetts; and
- UMass Memorial Health Care, Worcester, Massachusetts
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Dong C, Liu L, Chen L, Liu L. Exteriorization of the distal catheter for ventriculoperitoneal shunt protruding through the peritoneal space: experience with 1 case. Br J Neurosurg 2019; 35:229-230. [PMID: 31452388 DOI: 10.1080/02688697.2018.1441367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Ventriculoperitoneal (VP) shunting is the most widely used procedure for diverting cerebrospinal fluid (CSF) for hydrocephalus. Migration of the distal catheter of VP shunts has been reported but extrusion through the abdominal wall is rare. We report a case involving distal catheter extrusion. The catheter was exteriorized without compromising CSF flow while awaiting reoperation. This controlled hydrocephalus and allowed confirmation of CSF sterility prior to shunt replacement.
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Affiliation(s)
- Chengyuan Dong
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Liang Liu
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Ligang Chen
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Luotong Liu
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Carnevale JA, Ahmedli N, Morrison JF, Asaad WF, Klinge P, Telfeian A. T-Connector Modification for Reducing Recurrent Distal Shunt Failure: Report of 2 Cases. Oper Neurosurg (Hagerstown) 2017; 13:E33-E36. [PMID: 29186599 DOI: 10.1093/ons/opx050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 02/17/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Cerebrospinal fluid shunt placement is used to treat the various causes of hydrocephalus by redirecting the cerebrospinal fluid to the body, most commonly from the ventricle to the peritoneum. Distal catheter displacement from the peritoneal cavity can occur as a complication, necessitating reoperation. CLINICAL PRESENTATION We report 2 such cases in obese patients involving retropulsion of the distal tubing. To address this complication, we implanted a T-connector to the distal catheter construct. CONCLUSION This study supports the use of a T-connector catheter construct to decrease and prevent the possibility of distal peritoneal catheter retropulsion in cases of elevated intra-abdominal pressure, both prophylactically and in revisions.
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Affiliation(s)
- Joseph A Carnevale
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Nigar Ahmedli
- Department of Otolaryngology, Albert Einstein College of Medicine, Bronx, New York
| | - John F Morrison
- Department of Neurosurgery, University at Buffalo, Buffalo, New York
| | - Wael F Asaad
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Petra Klinge
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Albert Telfeian
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Wang G, Yu J, Luan Y, Han Y, Fu S. Novel type of peritoneocentesis trocar-assisted distal ventriculoperitoneal shunt placement with supervision via a one-port laparoscope. Exp Ther Med 2017; 14:3413-3418. [PMID: 29042927 PMCID: PMC5639304 DOI: 10.3892/etm.2017.4926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 03/23/2017] [Indexed: 11/06/2022] Open
Abstract
Ventriculoperitoneal shunts (VPS) are the primary treatment for hydrocephalus and are associated with a high risk of complications, specifically in patients who are obese or have abdominal adhesions or shunt revisions. The present study describes the use of a novel type of peritoneal catheter peritoneocentesis trocar insertion with the assistance of a one-port laparoscope. A total of 36 patients with hydrocephalus underwent this novel type of peritoneocentesis trocar-assisted VPS. The distal shunt catheter was placed into the right subdiaphragmatic space and the catheter was traversed through a single hole drilled through the liver falciform ligament. The duration of the laparoscopic surgery ranged from 6–18 min (mean 10.4±1.6 min). No shunt-related infections or catheter malfunctions or injuries to the intra-abdominal organs occurred. The total abdominal incision length was 1.0 cm (0.5+0.5 cm). No laparoscopy-related complications were observed during follow-up assessments. The novel approach used in the current study is very easy to perform, and this method may significantly reduce the risk of malfunction complications. The presented method also has the advantages of reduced trauma and a simpler surgery. The current study indicated that this simple, minimally invasive procedure was beneficial for patients with hydrocephalus, specifically in cases of patients with obesity, peritoneal adhesions or shunt revisions.
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Affiliation(s)
- Guangming Wang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yongxin Luan
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yanwu Han
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Shuanglin Fu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Castle-Kirszbaum MD, Tee JW, Chan P, Hunn MK. Obesity in Neurosurgery: A Narrative Review of the Literature. World Neurosurg 2017. [DOI: 10.1016/j.wneu.2017.06.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bolster F, Fardanesh R, Morgan T, Katz DS, Daly B. Cross-sectional imaging of thoracic and abdominal complications of cerebrospinal fluid shunt catheters. Emerg Radiol 2015; 23:117-25. [PMID: 26610766 DOI: 10.1007/s10140-015-1368-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
Abstract
This study aims to review the imaging findings of distal (thoracic and abdominal) complications related to ventriculo-peritoneal (VP), ventriculo-pleural (VPL), and ventriculo-atrial (VA) cerebrospinal fluid (CSF) shunt catheter placement. Institution review board-approved single-center study of patients with thoracic and abdominal CSF catheter-related complications on cross-sectional imaging examinations over a 14-year period was performed. Clinical presentation, patient demographics, prior medical history, and subsequent surgical treatment were recorded. The presence or absence of CSF catheter-related infection and/or acute hydrocephalus on cross-sectional imaging was also recorded. There were 81 distal CSF catheter-related complications identified on 47 thoracic or abdominal imaging examinations in 30 patients (age 5-80 years, mean 39.3 years), most often on CT (CT = 42, MRI = 1, US = 4). Complications included 38 intraperitoneal and 11 extraperitoneal fluid collections. Extraperitoneal collections included nine abdominal wall subcutaneous (SC) pseudocysts associated with shunt migration and obesity, an intrapleural pseudocyst, and a breast pseudocyst. There were also two large VPL-related pleural effusions, a fractured catheter in the SC tissues, and a large VA shunt thrombus within the right atrium. Ten patients (33.3 %) had culture-positive infection from CSF or shunt catheter samples. Ten patients (33.3 %) had features of temporally related acute or worsening hydrocephalus on neuroimaging. In four of these patients, the detection of thoracic and abdominal complications on CT preceded and predicted the findings of acute hydrocephalus on cranial imaging. Thoracic and abdominal complications of CSF shunts, as can be identified on CT, include shunt infection and/or obstruction, may be both multiple and recurrent, and may be predictive of concurrent acute intracranial problems.
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Affiliation(s)
- Ferdia Bolster
- Department of Radiology, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD, 21201, USA.
| | - Reza Fardanesh
- Department of Radiology, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD, 21201, USA
| | - Tara Morgan
- Department of Radiology, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD, 21201, USA
| | - Douglas S Katz
- Department of Radiology, Winthrop-University Hospital, Mineola, NY, 11501, USA
| | - Barry Daly
- Department of Radiology, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD, 21201, USA
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Abode-Iyamah KO, Khanna R, Rasmussen ZD, Flouty O, Dahdaleh NS, Greenlee J, Howard MA. Risk factors associated with distal catheter migration following ventriculoperitoneal shunt placement. J Clin Neurosci 2015; 25:46-9. [PMID: 26549674 DOI: 10.1016/j.jocn.2015.07.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 07/18/2015] [Indexed: 11/19/2022]
Abstract
Ventriculoperitoneal (VP) shunt placement is used to treat hydrocephalus. Shunt migration following VP shunt placement has been reported. The risk factors related to this complication have not been previously evaluated to our knowledge. In this retrospective cohort study, we aimed to determine risk factors leading to distal catheter migration and review the literature on the current methods of management and prevention. Adult patients undergoing VP shunt placement from June 2011 to December 2013 at a single institution were identified using electronic health records. The records were reviewed for demographic and procedural information, and subsequent treatment characteristics. The parameters of patients with distal shunt migration were compared to those undergoing new VP shunt placement for the same time period. We identified 137 patients undergoing 157 new VP shunt procedures with an average age of 57.7 ± standard deviation of 18.4 years old. There were 16 distal shunt migrations. Body mass index >30 kg/m(2) and number of previous shunt procedures were found to be independent risk factors for distal catheter migration. Obesity and number of previous shunt procedures were factors for distal catheter migration. Providers and patients should be aware of these possible risk factors prior to VP shunt placement.
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Affiliation(s)
- Kingsley O Abode-Iyamah
- Department of Neurosurgery, Carver College of Medicine, The University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA.
| | - Ryan Khanna
- Department of Neurosurgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | | | - Oliver Flouty
- Department of Neurosurgery, Carver College of Medicine, The University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Nader S Dahdaleh
- Department of Neurosurgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Jeremy Greenlee
- Department of Neurosurgery, Carver College of Medicine, The University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Matthew A Howard
- Department of Neurosurgery, Carver College of Medicine, The University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
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Maknojia A, Caron JL. Proximal subcutaneous migration of the distal end of a ventriculoperitoneal shunt presenting with recurrent cerebrospinal fluid galactorrhea. J Neurosurg 2013; 120:164-6. [PMID: 23870017 DOI: 10.3171/2013.6.jns121768] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report an unusual case of recurrent proximal migration of the distal end of a ventriculoperitoneal shunt catheter presenting as CSF galactorrhea. The authors review the pertinent literature and discuss the possible causes as well as techniques to prevent a similar occurrence.
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Affiliation(s)
- Asif Maknojia
- Department of Neurosurgery, School of Medicine, University of Texas Health Science Center at San Antonio, Texas
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