The wandering ventriculoperitoneal shunt and the scope of its salvage.

Abstract

PURPOSE:

Distal shunt tube migration following ventriculoperitoneal (VP) shunt placement in children is mostly managed by an initial shunt diversion/removal and subsequent replacement. Lately, shunt salvage is being used as an alternative in certain conditions. We have focused on the situations where one can consider or disregard shunt salvage in such cases.

METHOD:

A retrospective study of children treated for distal shunt migration following VP shunt placement between January 2013 and December 2019.

RESULT:

Seventeen children were managed for over 7 years. These included cutaneous extrusions (n = 4), hollow viscus perforation (n = 6), inguinal hernias (n = 5), and umbilical extrusion (n = 2). The surgical treatment varied from a cutaneous wound closure (with a tube in situ), temporary external shunt diversion, and laparotomy with shunt reposition into the peritoneal cavity. Shunt salvage was possible in three cases, whereas in 2 cases even though shunt salvage was possible, it was not feasible due to a short residual shunt length.

CONCLUSION:

VP shunt salvage is possible in certain cases of distal shunt migration with a functional uninfected shunt. Small cutaneous extrusions can be covered by a local skin flap. Also, one should consider the residual intraperitoneal shunt length before its salvage in small children.

• Authors: Nitin Pant, Sudhir Singh, Gurmeet Singh, Akhilesh Kumar, Rahul Kumar Rai, Jiledar Rawat, Ashish Wakhlu
• Journal: Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery (Childs Nerv Syst) Vol. 37 Issue 8 Pg. 2613-2618 (08 2021) ISSN: 1433-0350 [Electronic] Germany
• PMID: 33963923 (Publication Type: Journal Article)
• Copyright: © 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Topics

• Child
• Humans
• Hydrocephalus (diagnostic imaging, surgery)
• Peritoneal Cavity
• Retrospective Studies
• Salvage Therapy
• Ventriculoperitoneal Shunt (adverse effects)