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The wandering ventriculoperitoneal shunt and the scope of its salvage
Nitin Pant1, Sudhir Singh1, Gurmeet Singh1
1Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India.
Insights
Ventriculoperitoneal shunt salvage is a viable option for distal shunt migration in children when the shunt is functional and uninfected. Careful consideration of shunt length and extrusion type is crucial for successful salvage.
Area of Science:
- Pediatric Neurosurgery
- Medical Device Management
Background:
- Distal shunt migration is a complication of ventriculoperitoneal (VP) shunts in children.
- Traditional management involves shunt diversion or removal and replacement.
Purpose of the Study:
- To evaluate the feasibility and criteria for shunt salvage in pediatric distal shunt migration.
- To identify situations where shunt salvage should be considered or disregarded.
Main Methods:
- Retrospective study of pediatric patients with distal shunt migration between January 2013 and December 2019.
- Analysis of management strategies including shunt salvage, diversion, and replacement.
Main Results:
- Seventeen children were analyzed, with migration types including cutaneous extrusions, hollow viscus perforation, and hernias.
- Shunt salvage was successful in three cases; however, short residual shunt length precluded salvage in two others.
- Management varied from wound closure to laparotomy and repositioning.
Conclusions:
- Ventriculoperitoneal shunt salvage is possible in select cases of distal migration, particularly with functional, uninfected shunts.
- Small cutaneous extrusions may be managed with local flaps.
- Residual intraperitoneal shunt length is a critical factor in salvage decisions for pediatric patients.
Purpose:
Distal shunt tube migration following ventriculoperitoneal (VP) shunt placement in children is mostly managed by an initial shunt diversion/removal and subsequent replacement. Lately, shunt salvage is being used as an alternative in certain conditions. We have focused on the situations where one can consider or disregard shunt salvage in such cases.
Method:
A retrospective study of children treated for distal shunt migration following VP shunt placement between January 2013 and December 2019.
Result:
Seventeen children were managed for over 7 years. These included cutaneous extrusions (n = 4), hollow viscus perforation (n = 6), inguinal hernias (n = 5), and umbilical extrusion (n = 2). The surgical treatment varied from a cutaneous wound closure (with a tube in situ), temporary external shunt diversion, and laparotomy with shunt reposition into the peritoneal cavity. Shunt salvage was possible in three cases, whereas in 2 cases even though shunt salvage was possible, it was not feasible due to a short residual shunt length.
Conclusion:
VP shunt salvage is possible in certain cases of distal shunt migration with a functional uninfected shunt. Small cutaneous extrusions can be covered by a local skin flap. Also, one should consider the residual intraperitoneal shunt length before its salvage in small children.
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