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Approaches to ventriculoperitoneal shunt scalp erosion: countersinking into the calvarium. Illustrative case
Denise Brunozzi1, Melissa A LoPresti2,3, Jennifer L McGrath4
11Department of Neurological Surgery, University of Illinois Chicago, Chicago, Illinois.
Insights
Ventriculoperitoneal shunting (VPS) complications like scalp erosion can be managed by countersinking hardware. This technique prevents pressure points and aids wound healing in challenging pediatric neurosurgery cases.
Area of Science:
- Neurosurgery
- Pediatric Surgery
Background:
- Ventriculoperitoneal shunting (VPS) is a standard treatment for hydrocephalus.
- Shunt exposure is a rare but serious complication, particularly in pediatric patients with factors like thin skin or prominent hardware.
Purpose of the Study:
- To describe a surgical technique for managing VPS erosion through the scalp.
- To present a case of successful management in a pediatric patient with Pfeiffer syndrome.
Main Methods:
- The case involved external ventricular drainage and empirical antibiotics.
- Reinternalization of shunt hardware was performed with countersinking into the calvarium.
- This technique aimed to prevent internal skin pressure and reduce wound tension.
Main Results:
- Countersinking the shunt hardware into the calvarium facilitated wound healing.
- The technique effectively addressed unfavorable skin flap conditions.
Conclusions:
- Recessing shunt hardware (countersinking) is a simple and safe strategy for optimizing wound healing in complex VPS cases.
- This method is particularly beneficial when dealing with challenging scalp conditions in pediatric neurosurgery.
Background:
Ventriculoperitoneal shunting (VPS) is a standard procedure for the treatment of hydrocephalus, and the management of its complications is common in the practice of pediatric neurosurgery. Shunt exposure, though a rare complication, can occur because of thin, fragile skin, a young patient age, protuberant hardware, poor scalp perfusion, and a multitude of other patient factors.
Observations:
The authors report a complex case of VPS erosion through the scalp in a young female with Pfeiffer syndrome treated with external ventricular drainage, empirical antibiotics, and reinternalization with countersinking of replaced shunt hardware into the calvarium to prevent internal skin pressure points, reduce wound tension, and allow wound healing.
Lessons:
Recessing the shunt hardware, or countersinking the implant, into the calvarium is a simple technique often used in functional neurosurgical implantation surgeries, providing a safe surgical strategy to optimize wound healing in select cases in which the skin flap is unfavorable.
