Migración de catéter distal a nivel del recto como complicación de derivación ventriculoperitoneal. Reporte de caso / Catheter Migration Through the Rectum as Ventricular Peritoneal Shunt Complication. Case Report

Resumen La hidrocefalia es una entidad nosológica común que en muchos casos tiene como tratamiento de elección la derivación ventricular hacia cualquier cavidad. Dentro de las complicaciones más frecuentes, tenemos las abdominales con formación de colecciones, así como irrupción a sistema intestinal con posterior migración del mismo con presentación de sintomatología a este nivel. Presentamos el caso de un paciente con nula sintomatología abdominal y migración del catéter distal hacia el recto.

Abstract Hydrocephalus is a common nosological entity, with ventricular shunting towards any cavity as the treatment of choice in many cases. Among the most frequent complications, we have the abdominal ones with the formation of collections, as well as irruption to the intestinal system with subsequent migration of the same with presentation of symptoms at this level. We present the case of a patient with no abdominal symptoms and migration of the distal catheter towards the rectum.

Clinical study of two-trocar laparoscopy-assisted ventriculoperitoneal shunt in the treatment of hydrocephalus / 上海交通大学学报（医学版）

Objective • To compare the clinical outcomes between two-trocar laparoscopy-assisted ventriculoperitoneal shunt (LAVPS) and conventional open ventriculoperitoneal shunt (OVPS), and explore the clinical practice and experience of the placement of distal catheter in two-trocar LAVPS. Methods • A total of 308 patients with hydrocephalus who underwent ventriculoperitoneal shunt (VPS) from January 2016 to December 2018 in the Department of Neurosurgery at Renji Hospital, Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. Among them, there were 90 patients in the LAVPS group (Group L), and the two-trocar method and the original suture loop method were adopted to place the distal catheter in the right hepato-diaphragmatic space. For the other 218 patients in the conventional OVPS group (Group O), the laparotomy approach was adopted to put the distal catheter into the left lower abdominal cavity through the midline incision. The operation time and complications of the distal catheter between the two groups were compared. Results • Compared with Group O, the mean operation time was significantly reduced in Group L (54 min vs 90 min, P=0.000), and the incidence of distal catheter complications was also significantly decreased (0 vs 9.6%, P=0.002). In Group L, only one case of visceral injury, one case of distal catheter migration and one case of proximal catheter obstruction occurred. The incidences of infection and obstruction of the distal catheters were 0 in Group L, significantly lower than those in Group O (0 vs 4.6%, P=0.039; 0 vs 5.0%, P=0.030). In Group O, 10 cases of distal catheter infection, 11 cases of obstruction, 4 cases of visceral injury and 2 cases of incisional hernia occurred. Conclusion • The modified two-trocar LAVPS, of which the distal catheter was guided by a suture loop method and placed in the right hepato-diaphragmatic space, is a safe, economical and simple surgical procedure that is more effective in treating hydrocephalus of various origins than conventional OVPS.

Upward Migration of a Peritoneal Catheter Following Ventriculoperitoneal Shunt

We present an unusual case of peritoneal catheter migration following a ventriculoperitoneal shunt operation. A 7-month-old infant, who had suffered from intraventricular hemorrhage at birth, was shunted for progressive hydrocephalus. The peritoneal catheter, connected to an 'ultra small, low pressure valve system' (Strata(R); PS Medical,Gola, CA, USA) at the subgaleal space, was placed into the peritoneal cavity about 30 cm in length. The patient returned to our hospital due to scalp swelling 21 days after the surgery. Simple X-ray images revealed total upward migration and coiling of the peritoneal catheter around the valve. Possible mechanisms leading to proximal upward migration of a peritoneal catheter are discussed.

Endovascular Intervention for Repositioning the Distal Catheter of Ventriculo-Atrial Shunt / 신경중재치료의학

Displacement of distal ventriculo-atrial (VA) shunt is not uncommon. However, misplacement of the distal catheter of VA shunt in the internal jugular vein is a possibility, especially when conducted without intraoperative monitoring. We describe a patient in whom a VA shunt was performed due to failure of ventriculo-peritoneal shunt and the distal catheter of the shunt was found to be misplaced in the left internal jugular vein. Endovascular intervention via femoral vein was used to retrieve the distal catheter.

Efficacy of Laparoscopy Guided Ventriculo-Peritoneal Shunt : Analysis of Data in 102 Consecutive Patients / 대한뇌혈관외과학회지

OBJECTIVE: This study compare outcomes in patients with laparoscopic guided ventriculo-peritoneal shunt placement with the nonlaparoscopic approach (conventional mini-laparotomy technique) in patients with hydrocephalus. METHODS: The study enrolled 102 adult patients who had undergone surgery between August 2005 and May 2008 for the treatment of hydrocephalus at our department. Seventy-six patients (38 men and 38 women) received laparoscopy-assisted distal catheter placement, and 26 patients (14 men and 12 women) received shunt surgery by a conventional mini-laparotomy approach. The median follow-up period of the non-laparoscopic group was 26 months (14-33 months) and laparoscopic group was 12 months (1-30 months). We analyzed age, sex, cause of hydrocephalus, type of shunt valve, operation time, shunt infection rate, and shunt distal catheter malfunction during follow-up. RESULTS: There was no statistically significant difference in age, sex, cause of hydrocephalus, or type of shunt valve. Shunt infections were observed in 10 cases (13.2%) in the laparoscopic group and in 4 cases (15.4%) in the mini-laparotomy group, which was not statistically significant. Distal shunt malfunction rates were significantly lower in the laparoscopic group (1.3%) compared to the mini-laparotomy group (11.5%, P<0.05). The mean operation time was also shorter in the laparoscopic group (108 min, 45-190 min) than of the mini-laparotomy group (146 min, 75-255 min, P<0.005). CONCLUSION: Laparoscopic guided placement of the VP shunt in hydrocephalus patients reduces shunt distal catheter malfunction and operation time.

Upward Migration of Distal Ventriculoperitoneal Shunt Catheter into the Heart : Case Report

Ventriculoperitoneal (VP) shunt is commonly and effectively used to treat hydrocephalus. Intracardiac migration of the shunt catheter is a rare complication. A 68-year-old woman underwent ventriculoperitoneal shunting for hydrocephalus secondary to subarachnoid hemorrhage due to anterior communicating artery aneurysm rupture. Two weeks after the shunt surgery, she had suffered from the abdominal pain. Plain chest x-rays, computed tomography, and echocardiography revealed the distal catheter which was in the right ventricle of the heart. We tried to remove the catheter through the internal jugular vein by fluoroscopic guidance. But, the distal catheter was kinked and knotted; therefore, we failed to withdraw the catheter. After then, we punctured the right femoral vein and pulled down the multi-knotted shunt catheter to the femoral vein using the snare catheter. Finally, we removed the knotted distal catheter via the femoral vein and a new distal catheter was placed into the peritoneal cavity. We report a case in which the distal catheter of the VP shunt migrated into the heart via the internal jugular vein. We emphasize the importance of careful and proper placement of the distal catheter during the tunneling procedure to prevent life-threatening complications.

A Parkinsonism as a Component of Sylvian Aqueduct Syndrome: Effect of Floating Cranioplasty and Distal Catheter Elongation

The sylvian aqueduct syndrome is a global rostral midbrain dysfunction induced by a transtentorial pressure gradient through the aquaeductus. Several months after ventriculoperitoneal shunt, a patient with hydrocephalus began experiencing a constellation of midbrain dysfunction symptoms, including bradykinesia, medial longitudinal fasciculus syndrome, third nerve palsy, and mutism. These were indicative of cerebral aqueduct syndrome. In addition, the patient showed posture-dependent underdrainage or overdrainage. All symptoms were resolved after distal catheter elongation and floating cranioplasty. We present a case of reversible parkinsonism, which developed in a patient with shunted hydrocephalus and aqueductal stenosis, and discuss the diagnosis and treatment of the sylvian aqueduct syndrome. We also review the literature to address problems of drainage and potential treatment modalities.