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Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Blindness following ventriculoperitoneal shunt block in a child with spinal dysraphism: case report
1Neurosurgical Unit, Department of Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.
Insights
Shunt malfunction in children with myelomeningocele can cause serious symptoms like vision loss, mimicking meningitis. Prompt shunt revision is crucial to prevent permanent vision loss in these patients.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Ophthalmology
Background:
- Hydrocephalus is a common complication following myelomeningocele repair.
- Ventriculoperitoneal shunts are frequently used to manage hydrocephalus in this population.
- Spinal dysraphism presents unique challenges in shunt management and complication diagnosis.
Observation:
- A six-year-old boy with a history of myelomeningocele repair and ventriculoperitoneal shunt insertion presented with headache, visual loss, and convulsions.
- Initial treatment for presumed meningitis was ineffective.
- Brain imaging revealed ventricular enlargement, and the shunt was found to be broken and blocked.
Findings:
- Revision of the malfunctioning ventriculoperitoneal shunt led to rapid clinical improvement.
- Despite shunt revision, the patient's visual loss was irreversible.
- The clinical presentation of shunt malfunction mimicked meningitis, leading to delayed diagnosis and treatment.
Implications:
- Shunt malfunction is a critical cause of visual loss in pediatric patients with spinal dysraphism.
- Timely diagnosis and surgical intervention (shunt revision) are essential to prevent irreversible complications.
- Awareness of shunt malfunction symptoms is vital for clinicians managing patients with hydrocephalus and myelomeningocele.
Abstract:
A six-year-old boy presented with a week history of increasing headache, visual loss and convulsions. He had repair of myelomeningocele early in life and later had insertion of a ventriculoperitoneal shunt for hydrocephalus after the repair. He was treated for meningitis at the referring hospital without improvement. Computed tomography scan of the brain showed ventricular enlargement. The shunt was found to be broken and blocked and was revised. This was followed by rapid improvement but vision was never regained. Shunt malfunction in patients with spinal dysraphism can lead to visual loss but the features may mimic those of meningitis, and delayed referral and treatment. Early shunt revision should prevent this complication.