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Ventriculoperitoneal Shunt Malfunction in a Pediatric Patient Due to Compression by Skull Growth: A Case Report
Masamichi Endo1, Shunya Hanakita1, Soichi Oya1
1Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
Insights
A rare case of pediatric ventriculoperitoneal shunt (VPS) failure due to skull bone growth compressing the shunt tube is presented. This highlights the importance of considering bone growth as a cause of VPS obstruction in long-term pediatric follow-up.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Medical Device Engineering
Background:
- Ventriculoperitoneal shunts (VPS) are crucial for managing pediatric hydrocephalus.
- Long-term follow-up is essential for pediatric patients with VPS due to growth and potential complications.
- Shunt failures can stem from various mechanical and non-mechanical issues.
Observation:
- A 6-year-old girl with a history of preterm birth, intraventricular hemorrhage, and VPS placement presented with nausea and headache.
- Evaluation revealed suspected shunt tube stenosis at the burr hole site.
- Surgical revision identified significant compression of the shunt tube exiting the skull.
Findings:
- Mechanical obstruction of the VPS was caused by the cramped burr hole and subsequent skull bone growth.
- Enlarging the burr hole and reconstructing the catheter resolved the obstruction and improved symptoms.
- This represents a rare instance of VPS malfunction due to bone compression in a pediatric patient without metabolic bone disease.
Implications:
- Skull bone growth should be considered a potential cause of VPS obstruction in pediatric patients, even without metabolic bone disease.
- This case expands the differential diagnosis for shunt malfunction in long-term pediatric VPS management.
- Careful surgical technique and consideration of anatomical changes during growth are vital for successful shunt outcomes.
Abstract:
There are various causes of ventriculoperitoneal shunt (VPS) failures. Patients who receive shunt placement during childhood need follow-up for decades as they grow, especially in the early periods of life. Herein, we report a rare case of mechanical shunt obstruction in a pediatric patient in whom a cramped burr hole and skull growth compressed the tube and obstructed cerebrospinal fluid flow. A 6-year-old girl presented to our hospital with nausea and headache. She was born preterm and developed intraventricular hemorrhage followed by VPS placement for hydrocephalus; thereafter, she had no need for shunt revision until this admission. After careful evaluation of the patency of the shunt system, the presence of tube stenosis was suspected at the site of the shunt tube penetrating the burr hole of the skull. During the operation to revise the shunt tube, a compressed tube was observed at the exit from the skull. After enlarging the narrowed burr hole and reconstructing the proximal catheter, her symptoms immediately improved. Previously, only one case of shunt malfunction due to tube compression from bone growth has been reported in a pediatric patient with osteopetrosis. To the best of our knowledge, such a condition has never been described in pediatric patients with no metabolic bone disease. Although it is rare, obstruction at the exit from the skull due to bone growth should be included in differential diagnoses for young patients during a long follow-up after VPS.
