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LETTER TO THE EDITOR
Year : 2011  |  Volume : 6  |  Issue : 1  |  Page : 88-89
 

Total migration of a ventriculo-peritoneal shunt catheter into the ventricles


Department of Neurosurgery, Datta Meghe Institute of Medical Sciences, Sawangi, Meghe, Wardha, Maharashtra, India

Date of Web Publication2-Sep-2011

Correspondence Address:
Amit Agarwal
Department of Neurosurgery, Datta Meghe Institute of Medical Sciences, Sawangi, Meghe, Wardha - 442 004, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1817-1745.84421

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How to cite this article:
Agarwal A, Kakani A. Total migration of a ventriculo-peritoneal shunt catheter into the ventricles. J Pediatr Neurosci 2011;6:88-9

How to cite this URL:
Agarwal A, Kakani A. Total migration of a ventriculo-peritoneal shunt catheter into the ventricles. J Pediatr Neurosci [serial online] 2011 [cited 2019 Apr 22];6:88-9. Available from: http://www.pediatricneurosciences.com/text.asp?2011/6/1/88/84421


Dear sir,

Complete proximal migration of an entire ventriculo-peritoneal shunt into the ventricles is a rare complication. [1],[2],[3] A 10-month-old male child underwent right ventriculo-peritoneal shunt for congenital hydrocephalus at the age of 6 months. He was doing apparently well after surgery until the mother noticed an increase in the size of the head about 1 month back. Computed tomography (CT) scan showed the coiling of the shunt in the ventricular system and persistence of ventriculomegaly [Figure 1]. X-ray skull lateral view showed complete migration of the shunt system into the ventricles [Figure 2]. The shunt revision was performed and the child is doing well. Cephalad migration requires a potential space (subgaleal or ventricular) and no resistance to movement of the tubing, and mechanism of upward migration of the entire length of distal shunt catheter probably involves patient motion that creates a "windlass" effect. [2],[4] Several other mechanisms contributing to the migration of the shunt tubing have been proposed and these include negative sucking intraventricular pressure, positive pushing intra-abdominal pressure, tortuous subcutaneous track and neck movements. [1] Further, a large dural hole around the ventricular catheter may predispose to periventricular CSF collection and easy proximal migration of the valve system. [4],[5] It has been suggested that this complication can be prevented by securing the shunt near the site of motion. [2]
Figure 1: Skiagram showing the entire ventriculo-peritoneal shunt that migrated into the ventricles

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Figure 2: Plain radiograph of skull (lateral view) showing complete migration of the shunt system into the ventricles

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   References Top

1.Eljamel MS, Sharif S, Pidgeon CN. Total intraventricular migration of unisystem ventriculo-peritoneal shunt. Acta Neurochir (Wien) 1995;136:217-8.  Back to cited text no. 1
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2.Heim RC, Kaufman BA, Park TS. Complete migration of peritoneal shunt tubing to the scalp. Childs Nerv Syst 1994;10:399-400.  Back to cited text no. 2
[PUBMED]    
3.Sharma S, Gupta DK. Intraventricular migration of an entire vp shunt. Indian Pediatr 2005;42:187-8.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Kim KJ, Wang KC, Cho BK. Proximal migration and subcutaneous coiling of a peritoneal catheter: Report of two cases. Childs Nerv Syst 1995;11:428-31.  Back to cited text no. 4
[PUBMED]    
5.Chauhan H, Jain R, Rath G, Prabhakar H. Upward migration and subcutaneous coiling of the ventriculo-peritoneal shunt catheter: A case report. Internet J Neurosurg 2006:3.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]


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