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Cephalhydrohematocele due to catheter valve disconnection following ventriculoperitoneal shunting
1Riyadh Armed Forces Hospital, Kingdom of Saudi Arabia.
Insights
A dislodged ventriculoperitoneal shunt caused a scalp fluid collection in a child. This cerebrospinal fluid leakage led to a hydrohematocele due to torn emissary veins.
Area of Science:
- Pediatric Neurosurgery
- Medical Device Complications
- Hydrocephalus Management
Background:
- Ventriculoperitoneal shunts are used to treat hydrocephalus.
- Shunt malfunction can lead to complications.
- Subperiosteal fluid collections are a rare shunt complication.
Observation:
- A 5-year-old boy presented with a 3-month history of a progressively enlarging scalp fluid collection.
- The collection initially involved the right parietal region and spread across the midline.
- CT scan confirmed fluid accumulation in the subperiosteal space over both parietal regions.
Findings:
- The peritoneal catheter was disconnected from the functioning valve, causing cerebrospinal fluid to drain into the subperiosteal space.
- Distention of the subperiosteal space led to stretching and tearing of emissary veins, forming a hydrohematocele.
- Fluid spread to the contralateral side may be due to lax periosteal attachment over the sagittal suture.
Implications:
- This case highlights a rare complication of ventriculoperitoneal shunt malfunction.
- Prompt diagnosis and management are crucial to prevent further complications.
- Understanding shunt anatomy and potential failure modes is essential for pediatric neurosurgeons.
Abstract:
A 5-year-old boy with a right-sided ventriculoperitoneal shunt presented with a 3-month history of progressively enlarging subperiosteal fluid collection in the scalp, which started in the right parietal region and had spread and extended across the midline to occupy both parietal regions. There were no changes in symptoms or signs from those observed 3 months previously. A CT scan confirmed the collection of fluid under the scalp over both parietal regions. The peritoneal catheter was found to be disconnected from the distal end of the functioning valve, which drained cerebrospinal fluid into the subperiosteal space. Distention of the parietal subperiosteal space led to stretching and tearing of the emissary veins. This resulted in the formation of a hydrohematocele. The spread of fluid to the opposite parietal region may be due to a disorganized and loose attachment of the periosteum to the widely separated sagittal suture.