A Very Unusual Carotid Shunt Migration

Introduction. Ventriculoperitoneal shunts are often placed as treatment for refractory idiopathic intracranial hypertension. Dislodgement and migration of the distal portion of the shunt are more common in obese patients and can be difficult to detect. We report the case of a woman with two separate episodes of shunt migration into her abdominal wall.Case Presentation. We report a case of a 37-year-old female with history of obesity eventually diagnosed with idiopathic intracranial hypertension (IIH) as the cause. She failed outpatient therapy and, through neurosurgery, had a VP shunt placed for symptom control. She had subsequent development of worsened symptoms that were found to be due to shunt migration. This happened not once but twice to the same patient.Conclusion. Shunt dislodgement, migration, and subsequent failure are common in obese patients who have shunts placed for IIH. The medical provider should maintain a high index of suspicion for shunt malfunction in these patients, particularly because clinical evaluation may be challenging due to habitus.

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Diverse Clinical Applications of Percutaneous Lumboperitoneal Shunts

Neurosurgery ◽

10.1227/00006123-198101000-00008 ◽

1981 ◽

Vol 8 (1) ◽

pp. 39-42 ◽

Cited By ~ 36

Author(s):

H. E. James ◽

P. A. Tibbs

Keyword(s):

Cerebrospinal Fluid ◽

Wound Dehiscence ◽

Pseudotumor Cerebri ◽

Shunt Infection ◽

Communicating Hydrocephalus ◽

Lumbar Region ◽

Csf Fistula ◽

Shunt Removal ◽

Shunt Migration ◽

Shunt Obstruction

Abstract A population of 28 patients underwent the percutaneous placement of a shunt in the lumbar region with a single tube, the other end of which was placed in the peritoneal cavity by laparotomy. The clinical indications for the procedure were: communicating hydrocephalus (16 patients), pseudotumor cerebri (3 patients), cranial cerebrospinal fluid fistula (4 patients), and a bulging postcraniotomy site (2 patients). An additional 3 patients were treated by lumbar subcutaneousperitoneal shunt for a cerebrospinal fluid (CSF)-subcutaneous fistula after the removal of a leptomyelolipoma. The mean time of follow-up was 18.8 ± 7.8 months. All patients with pseudotumor cerebri and subcutaneous lumbar CSF fistula and all but 1 of the patients with a cranial CSF fistula improved without further therapy. Twelve of the 16 patients with communicating hydrocephalus improved and did not require other shunt procedures. There was one shunt infection, one wound dehiscence that led to shunt removal, and one shunt migration into the spinal canal. Shunt obstruction that led to revision of the shunt occurred on three occasions in 2 patients. The shunt functioned in only 1 of 4 infants under 4 months of age.

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