Ventricular migration of shunt: Chhabra shunt complication

Authors

  • Arvind Malhotra Department of General Surgery, Govt. Medical College, Chandigarh
  • Mini Malhotra Consultant Pediatrician, Esi Hospital Ram Darbar, Industrial Area, Chandigarh

DOI:

https://doi.org/10.18203/2349-2902.isj20151109

Keywords:

Ventricular migration, Chhabra shunt, Complications of shunt, Ventricular peritoneal shunt

Abstract

We report a rare complication of Intraventricular migration of whole shunt and discuss the causes of this complication. A 9-month-old child presented in OPD with enlarging head and vomiting. The patient had undergone VP shunt twice before due to congenital hydrocephalus. Imaging was done which suggested of Intraventricular migration of complete shunt. The patient was posted for surgery and the shunt was removed from the lateral ventricle. Patient recovered well and has been followed up for 1 year till the writing of this report. After careful review of literature we found twenty reported cases of intra cranial migration of VP shunts. The probable causes of retrograde migration include technical issues like large burr hole and wide opening of Dura. An increasing number of reported cases are from Indian subcontinent and mostly the Chhabra shunt is implicated in this complication. The probable reasons for migration are: 1) Malnourished infant with thin cortical mantle, large ventricles having reduced pressure and raised intraabdominal pressure due to excess amount of CSF not absorbed in peritoneum. 2) Poor anchorage of shunt chamber along with indiscriminate pressing of cylindrical Chhabra shunt reservoir. To prevent it special care must be taken in neonates and infants in making smaller burr holes, smaller chamber area and stronger anchorage of shunt chamber to periosteum. Further instead of using the cylindrical Chhabra chambers which can easily migrate to ventricles, larger spherical chambers may be used.

References

Choudhury AR. Avoidable factors that contribute to the complications of ventriculoperitoneal shunt in childhood hydrocephalus. Childs Nerv Syst. 1990;6:346-9.

Naik V, Phalak M, Chandra PS. Total intracranial shunt migration. J Neurosci Rural Pract. 2013;4:95-6.

Ghritlaharey RK, Budhwani KS, Shrivastava DK, Gupta G, Kushwaha AS, Chanchlani R, et al. Trans-anal protrusion of ventriculo-peritoneal shunt catheter with silent bowel perforation: report of ten cases in children. Pediatr Surg Int. 2007;23:575-80.

Heim RC, Kaufman BA, Park TS. Complete migration of peritoneal shunt tubing to the scalp. Childs Nerv Syst. 1994;10:399-400.

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.

Mori K, Yamashita J, Handa H. “Missing tube” of peritoneal shunt: migration of the whole system into ventricle. Surg Neurol. 1975;4:57-9.

Villarejo F, Alvarez-Sastre C, Gimenez D, Gonzalez C. Migration of an entire one-piece shunt into the ventricle. Neurochirurgia (Stuttg). 1979;22:196-8.

Young HA, Robb PJ, Hardy DG. Complete migration of ventriculoperitoneal shunt into the ventricle: Report of two cases. Neurosurgery. 1983;12:469-71.

Garijo JA, Pecourt JC, de la Resurreccion M. Migration of ventriculo-peritoneal shunt into lateral ventricle of an adult. Surg Neurol. 1979;11:399-400.

Shimizu S, Mochizuki T, Nakayama K, Fujii K. Visual field defects due to a shunt valve migrating into the cranium. Acta Neurochir (Wien). 2002;144:1055-6.

Nadkarni TD, Menon RK, Dange NN, Desai KI, Goel A. Cranial migration of complete ventriculoperitoneal shunt assembly. J Clin Neurosci. 2007;14:92-4.

Sharma S, Gupta DK. Intraventricular migration of an entire vp shunt. Indian Pediatr. 2005;42:187-8.

Abou el Nasr HT. Modified method for prophylaxis against unishunt system complications with presentation of total intraventricular migration of unisystem ventriculoperitoneal shunt. Childs Nerv Syst. 1988;4:116-8.

Acharya R, Bhutani A, Saxena H, Madan VS. Complete migration of ventriculoperitoneal shunt into the ventricle. Neurol Sci. 2002;23:75-7.

Ahmed Ammar, Munear Nasser. Intraventricular migration of VP shunt. Neurosurg Rev. 1995;18(4):293-5.

Ali MN, Atif SM, Khan S. Intracranial migration of a ventriculoperitoneal shunt. J Coll Physicians Surg Pak. 2008;18:382-3.

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

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;3:1.

Eljamel MS, Sharif S, Pidgeon CN. Total intraventricular migration of unisystem ventriculo-peritoneal shunt. Acta Neurochir (Wien). 1995;136:217-8.

Gupta PK, Dev EJ, Lad SD. Total migration of a ventriculoperitoneal shunt into the ventricles. Br J Neurosurg. 1999;13:73-4.

Oluwole KE, Abiodun AA. Complete intraventricular migration of a ventriculo-peritoneal shunt-a case report and brief literature review. Afr J Neurol Sci. 2007;26:69-74.

Sharma RK, Bansal M, Agrawal M, Gupta A, Sinha VD. Complete intracranial migration of a ventriculoperitoneal shunt: rare complication of a common procedure. Neurol India. 2015 Jan-Feb;63(1):106-7.

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Published

2016-12-14