Intraventricular migration of a Rickham reservoir: endoscopic retrieval

An unusual case of the intraventricular migration of a Rickham reservoir in a child and its subsequent removal by endoscopy is described. A newborn boy presenting with hydrocephalus secondary to intraventricular haemorrhage, had a Rickham reservoir inserted through a frontal burr hole, made adjacent to the anterior fontanel. Later, serial CT scans of the brain over a 3-year period revealed progressive migration of the Rickham reservoir into the lateral ventricle and then into the third ventricle. As the ventricles were also enlarged, they were explored endoscopically and the Rickham reservoir was removed.

Intracranial migration of a Rickham reservoir is rare. It is suggested that the placement of a small burr hole, away from the fontanels and growing sutures and the use of anchoring sutures to hold the reservoir to the periosteum are important steps in avoiding this unusual complication.