scholarly journals Evidence for increased intraabdominal pressure as a cause of recurrent migration of the distal catheter of a ventriculoperitoneal shunt: illustrative case

2021 ◽  
Vol 1 (3) ◽  
Author(s):  
Christopher Lee ◽  
Lucinda Chiu ◽  
Pawan Mathew ◽  
Gabrielle Luiselli ◽  
Charles Ogagan ◽  
...  
Keyword(s):  
Rare Complication ◽  
Surgical Techniques ◽  
Intraabdominal Pressure ◽  
Illustrative Case ◽  
Distal Catheter ◽  
Vp Shunt ◽  
Catheter Migration ◽  
Bowel Distention ◽  
Increased Risk ◽  
Subcutaneous Space

BACKGROUNDPlacement 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.OBSERVATIONSThe 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.LESSONSIn 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.

scholarly journals Distal ventriculoperitoneal shunt catheter tightly coiled around the valve in the absence of a subgaleal cerebrospinal fluid collection: illustrative case

2021 ◽  
Vol 1 (20) ◽  
Author(s):  
Goichiro Tamura ◽  
Kerry A. Vaughan ◽  
Sara Breitbart ◽  
Helen M. Branson ◽  
George M. Ibrahim
Keyword(s):  
Cerebrospinal Fluid ◽  
Case Reports ◽  
Fluid Collection ◽  
Illustrative Case ◽  
Shunt System ◽  
Distal Catheter ◽  
Vp Shunt ◽  
Catheter Migration ◽  
Flexion Extension ◽  
Subgaleal Space

BACKGROUND Among the known complications of ventriculoperitoneal (VP) shunts, subcutaneous or subgaleal migration of distal catheters is rare. Prior case reports have proposed several risk factors, including inadequate fixation of the shunt device, presence of a large subgaleal space filled with cerebrospinal fluid (CSF), and repetitive flexion/extension movement of the head producing a “windlass effect.” Tight coiling of a distal catheter around the valve without a large subgaleal space has not been reported. OBSERVATIONS The patient was born prematurely and underwent VP shunt placement for posthemorrhagic ventricular dilatation at 3 months of age with reassuring postoperative imaging. At approximately 3 years of age, shunt radiography and head computed tomography unexpectedly showed excess tubing coiled extracranially around the shunt valve. The patient did not exhibit any clinical symptoms of shunt malfunction and underwent an uneventful revision of the VP shunt system. No CSF-filled subgaleal space was observed intraoperatively. LESSONS Distal catheter migration can occur without the clear presence of a subgaleal CSF collection and symptoms of acute hydrocephalus. Appropriate fixation of the shunt system using nonabsorbable stitches is recommended to prevent catheter migration caused by the windlass effect.

scholarly journals Sinking skin flap syndrome in a patient with bone resorption after cranioplasty and ventriculoperitoneal shunt placement: illustrative case

2021 ◽  
Vol 2 (11) ◽  
Author(s):  
Camryn R. Rohringer ◽  
Taryn J. Rohringer ◽  
Sumit Jhas ◽  
Mehdi Shahideh
Keyword(s):  
Bone Resorption ◽  
Decompressive Craniectomy ◽  
Rare Complication ◽  
Skin Flap ◽  
Mass Effect ◽  
Neurological Status ◽  
Bone Flap ◽  
Illustrative Case ◽  
Vp Shunt

BACKGROUND Sinking skin flap syndrome (SSFS) is an uncommon complication that can follow decompressive craniectomy. Even less common is the development of SSFS following bone resorption after cranioplasty with exacerbation by a ventriculoperitoneal (VP) shunt. OBSERVATIONS A 56-year-old male sustained a severe traumatic brain injury and subsequently underwent an emergent decompressive craniectomy. After craniectomy, a cranioplasty was performed, and a VP shunt was placed. The patient returned to the emergency department 5 years later with left-sided hemiplegia and seizures. His clinical presentation was attributed to complete bone flap resorption (BFR) complicated by SSFS likely exacerbated by his VP shunt and the resultant mass effect on the underlying brain parenchyma. The patient underwent surgical intervention via synthetic bone flap replacement. Within 6 days, he recovered to his baseline neurological status. LESSONS SSFS after complete BFR is a rare complication following cranioplasty. To the authors’ knowledge, having a VP shunt in situ to exacerbate the clinical picture has yet to be reported in the literature. In addition to presenting the case, the authors also describe an effective treatment strategy of decompressing the brain and elevating the scalp flap while addressing the redundant tissue, then using a synthetic mesh to reconstruct the calvarial defect while keeping the shunt in situ.

scholarly journals Endovascular retrieval of a broken distal ventriculoatrial shunt catheter within the heart: illustrative case

2021 ◽  
Vol 2 (21) ◽  
Author(s):  
Jordan Xu ◽  
Gira Morchi ◽  
Suresh N. Magge
Keyword(s):  
Case Report ◽  
Right Ventricular ◽  
Multidisciplinary Approach ◽  
Rare Complication ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Illustrative Case ◽  
Ventriculoatrial Shunt ◽  
Distal Catheter ◽  
The Right

BACKGROUND Displacement of a distal catheter of a ventriculoatrial (VA) shunt is a rare complication and can lead to a challenging extraction requiring endovascular retrieval of the distal catheter. OBSERVATIONS The authors describe a patient in whom the distal catheter of the VA shunt had become displaced and traveled through the tricuspid valve into the right ventricular outflow tract. LESSONS In this case report, the authors present a multidisciplinary approach to retrieving a displaced distal catheter from a VA shunt.

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.

scholarly journals Mechanisms and Major Sites of Distal Catheter Migration in Ventriculoperitoneal Shunting Maneuvers: A Review Article

2018 ◽  
Vol 4 (2) ◽  
pp. 141-155
Author(s):  
Ismatullah Soufiany ◽  
Khalil Ahmad Hijrat ◽  
Spina Soufiany ◽  
Lukui Chen
Keyword(s):  
Peritoneal Cavity ◽  
Intrathoracic Pressure ◽  
The Body ◽  
Intraabdominal Pressure ◽  
Jugular Veins ◽  
Distal Catheter ◽  
Iatrogenic Perforation ◽  
Catheter Migration ◽  
Ventriculoperitoneal Shunting ◽  
The Many

A ventriculoperitoneal shunt (VPS) is a medical device used to deflect cerebrospinal fluid from cerebral ventricles to the peritoneal cavity. Since 1908, ventriculoperitoneal shunts have been considered the best option in hydrocephalus management. Manifestation related to VPS may arise anywhere whilst tunneling the VPS from the ventricle to the peritoneal cavity, but complications associated with the distal catheter are especially common and a leading cause of revision surgeries. Among the many complications associated with peritoneal shunts, migration of the catheter into other parts of the body is still common. Scrotal migration mainly takes place in children aged 4 days to 5 years. Patent processus vaginalis, formation of an inguinal hernia, and increased intraabdominal pressure are leading risk factors associated with migration of the peritoneal catheter into the scrotum. Thoracic migration of peritoneal catheters predominantly occurs in adult patients. Important mechanisms in thoracic migration include (1) iatrogenic perforation of the external or internal jugular veins by the surgeon during tunneling and (2) gradual destruction of the venous structures by the catheter due to routine extension and flexion of the neck. After entering the vessel, negative intrathoracic pressure combined with positive intraabdominal pressure aids migration into the thoracic cavity. Sharp tips or shunt types contribute to intraabdominal migration and perforation.

scholarly journals Rare complication of ventriculoperitoneal shunt: Ectopic distal catheter in a Grynfeltt hernia – case report

2021 ◽  
Vol 12 ◽  
pp. 525
Author(s):  
Melissa Esposito Gomes Rigueiral ◽  
Fernanda Lopes Rocha Cobucci ◽  
Pedro Henrique Simm Pires de Aguiar ◽  
Raphael Vinicius Gonzaga Vieira ◽  
Cesar Cozar Pacheco ◽  
...  
Keyword(s):  
Case Report ◽  
Rare Case ◽  
Rare Complication ◽  
Abdominal Cavity ◽  
Case Description ◽  
Rare Presentation ◽  
Distal Catheter ◽  
Ventriculoperitoneal Shunts ◽  
Catheter Migration ◽  
Underlying Mechanisms

Background: Ventriculoperitoneal shunts (VPSs) insertion is the most common used intervention in cases of hydrocephalus. The main postoperative complications are infections and catheter obstructions. Although the literature has well-documented cases describing migration of the distal catheter, this rare presentation can become more confusing when occurring in conjunction with some unusual preexistent morbidity in the patient, as a Grynfeltt hernia. Case Description: This study reports a rare case of a VPS postoperative migration, in which the distal catheter exits the abdominal cavity through a Grynfeltt hernia. This condition was not discovered until the catheter fistulated through the overlying skin. The Grynfeltt hernia is the most uncommon among the lumbar ones and it’s asymptomatic in the majority of the cases, being hardly diagnosed. Conclusion: The unusualness of the reported case deserves furthermore discussion to properly evaluate these underlying mechanisms of catheter migration.

scholarly journals Case report: isolated lower lip lesion following cavernoma resection in prone position

2019 ◽  
Vol 34 (1) ◽  
Author(s):  
Mir Ibrahim Sajid ◽  
Noor Malik ◽  
Rashid Jooma
Keyword(s):  
Cervical Spine ◽  
Prone Position ◽  
Vision Loss ◽  
Rare Complication ◽  
Lower Lip ◽  
Anatomical Structures ◽  
Long Duration ◽  
Increased Risk ◽  
Duration Of Surgery ◽  
Spine Mri

Abstract Background Surgery in a prone position is necessary when access to posterior anatomical structures is needed. A procedure in this position is associated with complications such as injuries to the eyes, peripheral nerves, and pressure points and swelling of the tongue. We report a rare complication of isolated lower lip swelling following neck dissection in the prone position. Case presentation A 25-year-old male patient presented to the clinic with complaint of neck pain for the past 2 months. A cervical spine MRI was done which showed the presence of a cavernoma. C2 laminectomy was performed for resection of the tumor in prone position with the head fixed on a three-point Mayfield clamp. Postoperatively, isolated swelling of the lower lip was observed. The patient was managed conservatively. Conclusion Cervical spine surgeries done in prone positions carry an increased risk of postoperative vision loss and swellings including those of the oropharynx and in the periorbital region. Possible risk factors for such conditions include anemia, hypotension, long duration of surgery, and significant intraoperative hydration.

scholarly journals Mobile spine chordoma: results of 166 patients from the AOSpine Knowledge Forum Tumor database

2016 ◽  
Vol 24 (4) ◽  
pp. 644-651 ◽  
Author(s):  
Ziya L. Gokaslan ◽  
Patricia L. Zadnik ◽  
Daniel M. Sciubba ◽  
Niccole Germscheid ◽  
C. Rory Goodwin ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Survival Data ◽  
Large Scale ◽  
Surgical Techniques ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Increased Risk ◽  
Significant Difference ◽  
Mobile Spine

OBJECT A chordoma is an indolent primary spinal tumor that has devastating effects on the patient's life. These lesions are chemoresistant, resistant to conventional radiotherapy, and moderately sensitive to proton therapy; however, en bloc resection remains the preferred treatment for optimizing patient outcomes. While multiple small and largely retrospective studies have investigated the outcomes following en bloc resection of chordomas in the sacrum, there have been few large-scale studies on patients with chordomas of the mobile spine. The goal of this study was to review the outcomes of surgically treated patients with mobile spine chordomas at multiple international centers with respect to local recurrence and survival. This multiinstitutional retrospective study collected data between 1988 and 2012 about prognosis-predicting factors, including various clinical characteristics and surgical techniques for mobile spine chordoma. Tumors were classified according to the Enneking principles and analyzed in 2 treatment cohorts: Enneking-appropriate (EA) and Enneking-inappropriate (EI) cohorts. Patients were categorized as EA when the final pathological assessment of the margin matched the Enneking recommendation; otherwise, they were categorized as EI. METHODS Descriptive statistics were used to summarize the data (Student t-test, chi-square, and Fisher exact tests). Recurrence and survival data were analyzed using Kaplan-Meier survival curves, log-rank tests, and multivariate Cox proportional hazard modeling. RESULTS A total of 166 patients (55 female and 111 male patients) with mobile spine chordoma were included. The median patient follow-up was 2.6 years (range 1 day to 22.5 years). Fifty-eight (41%) patients were EA and 84 (59%) patients were EI. The type of biopsy (p < 0.001), spinal location (p = 0.018), and if the patient received adjuvant therapy (p < 0.001) were significantly different between the 2 cohorts. Overall, 58 (35%) patients developed local recurrence and 57 (34%) patients died. Median survival was 7.0 years postoperative: 8.4 years postoperative for EA patients and 6.4 years postoperative for EI patients (p = 0.023). The multivariate analysis showed that the EI cohort was significantly associated with an increased risk of local recurrence in comparison with the EA cohort (HR 7.02; 95% CI 2.96–16.6; p < 0.001), although no significant difference in survival was observed. CONCLUSIONS EA resection plays a major role in decreasing the risk for local recurrence in patients with chordoma of the mobile spine.

Repair of Protruding Bilateral Cleft Lip and Palate With Staged Premaxilla Setback Osteotomy, Cheiloplasty, and Palatoplasty in Trisomy 17p Patient: A Review of Syndromic Clinical Characteristic

2021 ◽  
pp. 105566562110698
Author(s):  
Kristaninta Bangun ◽  
Jessica Halim ◽  
Vika Tania
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Surgical Techniques ◽  
Chromosome 17 ◽  
Long Term Effects ◽  
Surgical Strategies ◽  
Increased Risk ◽  
The Cost

Chromosome 17 duplication is correlated with an increased risk of developmental delay, birth defects, and intellectual disability. Here, we reported a female patient with trisomy 17 on the whole short arm with bilateral complete cleft lip and palate (BCLP). This study will review the surgical strategies to reconstruct the protruding premaxillary segment, cleft lip, and palate in trisomy 17p patient. The patient had heterozygous pathogenic duplication of chromosomal region chr17:526-18777088 on almost the entire short arm of chromosome 17. Beside the commonly found features of trisomy 17p, the patient also presented with BCLP with a prominent premaxillary portion. Premaxillary setback surgery was first performed concomitantly with cheiloplasty. The ostectomy was performed posterior to the vomero-premaxillary suture (VPS). The premaxilla was firmly adhered to the lateral segment and the viability of philtral flap was not compromised. Two-flap palatoplasty with modified intravelar veloplasty (IVV) was performed 4 months after. Successful positioning of the premaxilla segment, satisfactory lip aesthetics, and vital palatal flap was obtained from premaxillary setback, primary cheiloplasty, and subsequent palatoplasty in our trisomy 17p patient presenting with BLCP. Postoperative premaxillary stability and patency of the philtral and palatal flap were achieved. Longer follow-up is needed to evaluate the long-term effects of our surgical techniques on inhibition of midfacial growth. However, the benefits that the patient received from the surgery in improving feeding capacity and facial appearance early in life outweigh the cost of possible maxillary retrusion.

Sign in / Sign up

Export Citation Format

Share Document