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Updated: May 28, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Atlantoaxial rotatory fixation after ventriculoperitoneal shunting
R F Heary1, P Reid, P W Carmel
1UMDNJ – New Jersey Medical School, Neurological Institute of New Jersey, Newark, New Jersey 07103, USA.
Insights
Atlantoaxial rotatory fixation (AARF) is a rare complication following ventriculoperitoneal (VP) shunting in children. This case report details the first instance of AARF after a VP shunt revision, emphasizing delayed diagnosis and successful non-operative management.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Orthopedic Surgery
Background:
- Ventriculoperitoneal (VP) shunting is a standard neurosurgical intervention for pediatric hydrocephalus.
- Atlantoaxial rotatory fixation (AARF) is a recognized condition within the pediatric population.
- The potential association between VP shunting and AARF has not been previously documented.
Observation:
- A 10-year-old boy with congenital hydrocephalus and a temporal arachnoid cyst underwent revision of his VP and cystoperitoneal shunts.
- Postoperative neck pain was initially attributed to the surgical procedure.
- Delayed presentation with a "cock-robin" head position prompted further investigation.
Findings:
- Radiographic and CT imaging confirmed AARF in the C1-C2 vertebral complex.
- The patient was successfully treated with halo traction, analgesics, sedation, and muscle relaxants.
- Anatomic re-alignment was achieved, followed by immobilization in a halo-vest for 3 months.
Implications:
- This case highlights AARF as a potential, albeit rare, complication following VP shunt procedures.
- Early recognition of AARF is crucial, as symptoms can be masked by postoperative pain or positioning.
- Non-operative management, including halo traction, can be effective for treating post-VP shunt AARF in pediatric patients.
Abstract:
Ventriculoperitoneal (VP) shunting is a common neurosurgical procedure in the pediatric population. Atlantoaxial rotatory fixation (AARF) is not uncommon in this same group. We present the first reported case of AARF following a VP shunt procedure. A 10-year-old boy, with hydrocephalus and a left temporal arachnoid cyst since birth, underwent a revision of his VP and cystoperitoneal shunts. A second operation was performed 2 days later to optimize catheter placement. Postoperative neck pain was attributed to tunneling of the subcutaneous catheter. 2 months after surgery, the child had minimal neck discomfort but maintained his head in a "cock-robin" position. Plain radiographs and computed tomographic (CT) images confirmed AARF. The child was admitted and placed in halo traction. After 3 days of traction, analgesics, sedation, and muscle relaxants, anatomic re-alignment of the C1-C2 vertebral complex was confirmed on CT scan. Following 3 months of immobilization in a halo-vest apparatus, the halo was removed. At 8-year follow-up, the clinical examination is normal and repeat imaging studies remain normal. Due to surgical positioning, and postoperative signs attributed to normal postoperative pain, an AARF was not initially recognized. This case represents the first time that AARF has been reported following a VP shunt procedure.
