scholarly journals Dynamic Occlusion of Distal Ventriculoperitoneal Shunt Catheter after Infusion Port Placement: A New Shunt Malfunction

2021 ◽  
Vol 82 (02) ◽  
pp. e17-e20
Author(s):  
Lacey M. Carter ◽  
Camille K. Milton ◽  
Kyle P. O'Connor ◽  
Arpan R. Chakraborty ◽  
Tressie M. Stephens ◽  
...  
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Normal Pressure ◽  
Ventricular Catheter ◽  
Communicating Hydrocephalus ◽  
Port Catheter ◽  
Port Placement ◽  
Distal Catheter ◽  
Shunt Catheter ◽  
Catheter Obstruction ◽  
Close Proximity

AbstractShunt failure requiring reintervention remains a common complication of hydrocephalus treatment. Here, we report a novel cause of mechanical shunt obstruction in an adult patient: position-dependent intermittent occlusion via an infusion port catheter. A 51-year-old woman with a grade II oligodendroglioma presented in a delayed fashion following surgery with a pseudomeningocele. She underwent ventriculoperitoneal shunt placement due to communicating hydrocephalus, resolving her pseudomeningocele. Shortly thereafter, she underwent placement of a subclavian infusion port at an outside institution. Her pseudomeningocele returned. Imaging demonstrated close proximity of her port catheter to the shunt catheter overlying the clavicle. Her shunt was tapped demonstrating a patent ventricular catheter with normal pressure. She underwent shunt exploration after her pseudomeningocele did not respond to valve adjustment. Intraoperative manometry demonstrated head position-dependent distal catheter obstruction. Repeat manometry following distal catheter revision demonstrated normal runoff independent of position. Her pseudomeningocele was resolved on follow-up. To our knowledge, this is the only reported case of intermittent, position-dependent distal catheter obstruction. Shunted patients with concern for malfunction following subclavian infusion port placement should be evaluated for possible dynamic obstruction of their distal catheter when the two catheters are in close proximity along the clavicle.

scholarly journals Subgaleal Migration of the Distal Catheter of a Ventriculoperitoneal Shunt

2009 ◽  
Vol 52 (2) ◽  
pp. 77-79 ◽  
Author(s):  
Fatih Serhat Erol ◽  
Bekir Akgun
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Ventricular Catheter ◽  
Peritoneal Catheter ◽  
Shunt Valve ◽  
Distal Catheter ◽  
X Ray ◽  
Proximal Migration ◽  
Shunt Dysfunction ◽  
Valve Placement ◽  
The Brain

Proximal migration of the distal end of a ventriculoperitoneal shunt has been observed much more rarely than other numerous shunt-related complications. Subgaleal migration of the peritoneal end is one of the samples. In the preset report we have discussed a case of subgaleal migration of the peritoneal end detected as a result of the examinations performed for shunt dysfunction. There was ventricular dilatation on CT scan of the brain. X-ray examinations confirmed proper ventricular catheter and shunt valve placement but a complete migration of distal (peritoneal) catheter into the subgaleal space. Then the patient’s shunt was revised. When our case and the literature were examined, we observed that this complication was frequently encountered during the first postoperative months, in the pediatric ages and in patients with advanced hydrocephalus. Besides, we have detected that the peritoneal catheters had tendency to migration into the subgaleal tissues similar to pre-insertion forms of the preoperatively original packages.

Bucket and straw technique to facilitate passage of a ventriculoperitoneal shunt through the distal tunneling sheath

2014 ◽  
Vol 14 (6) ◽  
pp. 662-664 ◽  
Author(s):  
Angela E. Downes ◽  
William A. Vandergrift ◽  
Joshua M. Beckman ◽  
Devon Truong ◽  
Gerald F. Tuite
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Simple Technique ◽  
Suction Pressure ◽  
Special Equipment ◽  
Distal Catheter ◽  
Shunt Catheter ◽  
Shunt Tubing

Placement of a ventriculoperitoneal shunt (VPS) is a procedure comprising many small steps. Difficulties and delays can arise when passing the distal shunt tubing down the distal tunneling sheath during surgery. The authors of this report describe a simple technique for quickly passing the distal catheter of a VPS through the tunneler sheath, whereby the sheath is used as a fluid tube to allow the distal catheter to be drawn through the fluid tube under suction pressure. The plastic sheath that surrounds the shunt tunneler device is used as a fluid tube, or “straw,” with the proximal aperture submerged into a bucket of sterile irrigation liquid containing the distal catheter. Suction pressure is placed against the distal aperture of the tunneler, and the shunt catheter is quickly drawn through the sheath. No special equipment is required. In time trials, the bucket and straw technique took an average of 0.43 seconds, whereas traditional passage methods took 32.3 seconds. The “bucket and straw” method for passing distal shunt tubing through the tunneler sheath is a technique that increases surgical efficiency and reduces manual contact with shunt hardware.

Prevention of ventricular catheter obstruction and slit ventricle syndrome by the prophylactic use of the Integra antisiphon device in shunt therapy for pediatric hypertensive hydrocephalus: a 25-year follow-up study

2010 ◽  
Vol 5 (1) ◽  
pp. 4-16 ◽  
Author(s):  
Rolf W. Gruber ◽  
Bernd Roehrig
Keyword(s):  
High Rate ◽  
Ventricular Catheter ◽  
Shunt System ◽  
Distal Catheter ◽  
Slit Ventricle Syndrome ◽  
Follow Up Study ◽  
Catheter Obstruction ◽  
Slit Ventricle ◽  
Antisiphon Device

Object This 25-year follow-up study was performed on 120 children with hypertensive hydrocephalus to evaluate the influence of the early prophylactic implantation of the Integra antisiphon device (ASD, Integra Neurosciences Ltd.) on the rate of proximal shunt obstructions and the frequency of symptomatic slit ventricle syndrome (SVS). The adaptability of the ASD to growth, proper positioning of the ASD as a necessity for its successful performance, and the 3 phases of SVS development are discussed. Method Since 1978, the ASD has consistently been implanted either at the time of primary shunt insertion (66 neonates, mean follow-up 11 years) or during revisions of preexisting shunts (54 children, mean follow-up 11.8 years). The complication rate among the 54 children before ASD implantation (mean follow-up 8.3 years) was compared with that among all 120 patients once an ASD had been inserted. Shunt complications were documented as ventricular catheter, distal catheter, and infectious complications. Results The study revealed a significant long-term reduction in ventricular catheter obstructions and hospitalizations due to intermittent intracranial hypertension symptoms (symptomatic SVS) after both primary and secondary ASD implantation. Data in the study suggest that the high rate of ventricular catheter obstruction in pediatric shunt therapy is caused by hydrostatic suction induced by differential-pressure valve shunts during mobilization of the patient and that the development of a SVS can be traced back to this constant suction, which causes chronic CSF overdrainage and ventricular noncompliance. Recurrent ventricular catheter obstruction and SVS can be prevented by prophylactic supplementation of every shunt system with an ASD. Conclusions To inhibit chronic hydrostatic suction, to prevent overdrainage and proximal shunt obstruction, and to avoid SVS and thus improve the patient's quality of life, the prophylactic implantation of an ASD in every pediatric hydrocephalus shunt is recommended.

scholarly journals Ventriculoperitoneal Shunt assisted by Neuroendoscopy

2018 ◽  
Vol 22 (3) ◽  
pp. 100-103
Author(s):  
Flávio Ramalho Romero
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Intraventricular Hemorrhage ◽  
Shunt Revision ◽  
Ventricular Catheter ◽  
Communicating Hydrocephalus ◽  
Common Cause ◽  
Vp Shunt ◽  
Endoscopic View ◽  
Catheter Location

Object. We present our experience in ventriculoperitoneal shunt assisted by neuroendoscopy. Methods. Thirty-six patients with new communicating hydrocephalus were selected to VP shunt placement assisted by neuroendoscopy. Postoperative computerized tomography (CT) was performed in the first day in all patients and ventricular catheter location was analysed. A follow up of 12 months was performed and results showed. Results. Mean patient age at implantation was 57 ± 13.59 years (range, 16-77). There was a slight preponderance of males (22 patients, 61%). The most common cause for shunt surgery was hemorrhage (20 patients, 55%), including  subarachnoid hemorrhage (14 patients, 39%), and intracerebral hemorrhage (ICH) or intraventricular hemorrhage (IVH) (5 patients, 16%). Posttraumatic hydrocephalus followed as a secondary cause (11 patients 31.5%). During the period covered by thestudy, 8 valves were revised, thereby meeting the criteria for shunt failure endpoint. The most common cause for shunt revision was underdrainage in 5 patients, followed by infection in 2 patients, and overdrainage in 1 patient. None of them had proximal obstruction and in all cases, the ventricular catheter was well located. Conclusions. Endoscopic view can be used to place the ventricular catheter in a good position inside the ventricular system. 

scholarly journals The role of shuntography in diagnosis of mechanic complications after implantation of ventriculoperitoneal shunts in patients with idiopathic normal pressure hydrocephalus: a retrospective clinical evaluation

2021 ◽  
Author(s):  
Rot Sergej ◽  
Goelz Leonie ◽  
Arndt Holger ◽  
Gutowski Pawel ◽  
Meier Ullrich ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Clinical Information ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Ventricular Catheter ◽  
Symptomatic Therapy ◽  
Mechanical Obstruction ◽  
Revision Operation ◽  
Distal Catheter ◽  
Mechanical Complications

Abstract Background Mechanical obstruction of ventriculoperitoneal shunt (VPS) during the first year after shunt implantation is a common complication and is widely described in the literature. In this paper, we evaluated the suitability of the shuntography for the diagnosis of mechanical complications of the VPS in patients with idiopathic normal pressure hydrocephalus (iNPH). Methods We retrospectively identified 49 patients with pathologic shuntography over of a period of 20 years in our hospital. The percentage of procedure-associated complications was determined. Results Ninety-eight percent (n = 48) of the patients who underwent shuntography showed clinical and radiographic signs of underdrainage prior to examination. Shuntography revealed mechanical complications of the VP shunt in 37% (n = 18) as a cause of clinical deterioration and following revision operation. During shuntography, mechanical obstruction was discovered in 78% (n = 14) and disconnection of shunt components in 22% (n = 4). In the obstruction group, in 50% (n = 7) the closure was detected in the ventricular catheter, in 29% (n = 4) in the distal catheter of the VPS, and in 21% (n = 3) in both sides of the VPS. In the case of an inconspicuous shuntography (63%, n = 31), the patients received symptomatic therapy (32%, n = 10) or re-adjustment of the valve setting (68%, n = 21). Fifty-seven percent of the patients who underwent surgical treatment improved clinically by at least one point according to the Kiefer score. Conclusion Shuntography can produce valuable clinical information uncovering mechanic complications after implantation VPS in patients with idiopathic normal-pressure hydrocephalus. Patients with mechanical complications of their VPS needed revision surgery and showed clinical benefit after treatment.

Increased risk of distal ventriculoperitoneal shunt obstruction associated with slit valves or distal slits in the peritoneal catheter

1997 ◽  
Vol 87 (5) ◽  
pp. 682-686 ◽  
Author(s):  
Jeffrey W. Cozzens ◽  
James P. Chandler
Keyword(s):  
Shunt Revision ◽  
Ventricular Catheter ◽  
Peritoneal Catheter ◽  
Distal Catheter ◽  
Content Type ◽  
Vp Shunt ◽  
Increased Risk ◽  
Catheter Obstruction ◽  
Shunt Obstruction ◽  
Fine Print

✓ The authors describe a relationship between the presence of distal shunt catheter side-wall slits and distal catheter obstruction in a single-surgeon series of ventriculoperitoneal (VP) shunt revisions. Between 1985 and 1996, 168 operations for VP shunt revision were performed by the senior author (J.W.C.) in 71 patients. Indications for shunt revision included obstruction in 140 operations; overdrainage or underdrainage requiring a change of valve in 17 operations; inadequate length of distal shunt tubing resulting in the distal end no longer reaching the peritoneum in five operations; the ventricular catheter in the wrong ventricle or space, requiring repositioning in five operations; and a disconnected or broken shunt in one operation. Of the 140 instances of shunt obstruction, the blockage occurred at the ventricular end in 108 instances (77.1%), the peritoneal end in 17 (12.1%), the ventricular and the peritoneal end in 14 (10%), and in the valve mechanism (not including distal slit valves) in one (0.8%). Thus, the peritoneal end was obstructed in 31 (22.1%) of 140 cases of shunt malfunction. In every case in which the peritoneal end was obstructed, some form of distal slit was found: either a distal slit valve in an otherwise closed catheter or slits in the side of an open catheter. No instances were found of distal peritoneal catheter obstruction when the peritoneal catheter was a simple open-ended tube with no accompanying side slits (0 of 55). It is concluded that side slits in the distal peritoneal catheters of VP shunts are associated with a greater incidence of distal shunt obstruction.

Preventing Distal Catheter Obstruction in Laparoscopic Ventriculoperitoneal Shunt Placement in Adults: The “Falciform Technique”

2015 ◽  
Vol 25 (8) ◽  
pp. 642-645 ◽  
Author(s):  
Shane M. Svoboda ◽  
Habeeba Park ◽  
Neal Naff ◽  
Zeena Dorai ◽  
Michael A. Williams ◽  
...  
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Distal Catheter ◽  
Shunt Placement ◽  
Catheter Obstruction

INTRA-ABDOMINAL VASCULAR INJURY DURING TROCAR-ASSISTED VENTRICULOPERITONEAL SHUNTING

Neurosurgery ◽  
2008 ◽  
Vol 63 (3) ◽  
pp. E613-E613 ◽  
Author(s):  
Deepa Danan ◽  
Christopher J. Winfree ◽  
Guy M. McKhann
Keyword(s):  
Vascular Injury ◽  
Normal Pressure Hydrocephalus ◽  
Ventriculoperitoneal Shunt ◽  
Normal Pressure ◽  
Emergency Laparotomy ◽  
Distal Catheter ◽  
Ventriculoperitoneal Shunting ◽  
Shunt Procedure ◽  
Programmable Valve ◽  
Surgical History

ABSTRACT OBJECTIVE Laparoscopic trocar injury is a relatively well-described complication of cholecystectomies and gynecological procedures. However, this type of injury has not been reported in association with adult neurological surgery. To increase awareness of this very serious risk, we report a case of intra-abdominal vascular injury during a shunt procedure involved with a common neurosurgical procedure. CLINICAL PRESENTATION A 76-year-old man with no previous abdominal surgical history presented with probable normal pressure hydrocephalus. INTERVENTION After an appropriate preoperative workup confirming probable normal pressure hydrocephalus, the patient consented to placement of a ventriculoperitoneal shunt with a programmable valve. During placement of the distal catheter using an abdominal trocar, the aorta was punctured inadvertently, necessitating emergency laparotomy for vascular repair. CONCLUSION An abdominal trocar should be used with caution in ventriculoperitoneal shunt surgery. Even with meticulous technique, vascular injury can occur with any trocar-based abdominal procedure. The neurosurgeon who uses this technique must be prepared to initiate emergent vascular access and repair, with a vascular surgery team available should such an injury occur. Alternatively, open placement of peritoneal catheters avoids blind peritoneal instrumentation and is an effective method for minimizing potentially catastrophic vascular injuries.

scholarly journals Migration of Ventriculoperitoneal Shunt Catheter into the Scrotum: A Case Report and Literature Review

2020 ◽  
Vol 2 (2(May-August)) ◽  
pp. e282020
Author(s):  
Antônio Gilson Prates Junior ◽  
Fernando Augusto Medeiros Carrera Macedo ◽  
Emmanuel De Oliveira Vasconcelos e Sá ◽  
Ana Luisa Ribeiro Pinto
Keyword(s):  
Case Report ◽  
Ventriculoperitoneal Shunt ◽  
Distal Catheter ◽  
Catheter Migration ◽  
Shunt Catheter ◽  
End Of Treatment ◽  
Scrotal Swelling ◽  
Shunt Dysfunction ◽  
The Right

Introduction: The ventriculoperitoneal shunt is the most widely used surgical procedure for the treatment of hydrocephalus. It is associated with numerous mechanical complications, including distal catheter migration. Case report: We present a case in which the peritoneal catheter migrated into the scrotum. The patient was admitted with asymmetric scrotal swelling and, during hospitalization, developed shunt dysfunction and infection. The shunt was withdrawn and treatment was initiated for infection. At the end of treatment, a new shunt was implanted and bilateral hernioplasty was performed by the pediatric surgery team. At follow-up, there was adequate head circumference growth and no testicular abnormalities. Discussion: The procesus vaginalis is formed from the evagination of the peritoneum through the inguinal canal, leading to the descent of the testis during the embryonic period. The patency of this structure is the predisposing anatomical condition for the occurrence of inguinal hernia and for the migration of the shunt catheter into the scrotum. This condition is present in up to 80% of newborns and 60% of 1-year-old infants. The migration of the catheter commonly occurs until 12 months after surgery, typically on the right side. Conclusion: The presence of scrotal swelling in a patient with ventriculoperitoneal shunt should warrant the investigation of catheter migration. 

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