Recurrent distal ventriculoperitoneal shunt migration in an obese patient with high-grade glioma: A case report

In neurosurgical practice, ventriculoperitoneal (VP) shunting is the predominant intervention for hydrocephalus. While shunt-related complications such as obstruction, infection, and mechanical failure are well recognized, distal catheter migration remains an uncommon but clinically significant problem. Migration may occur internally or externally and is influenced by patient-specific and technical factors.

A 63-year-old woman with a newly diagnosed World Health Organization grade IV astrocytoma presented with acute obstructive hydrocephalus requiring emergent VP shunt insertion. Two weeks later, she developed a painless abdominal swelling; imaging revealed distal catheter migration into the anterior abdominal wall. Revision surgery was performed with repositioning of the catheter into the peritoneal cavity. Within 1 month, the patient presented again with abdominal fullness and recurrent catheter migration. A second revision with shunt extension and secure fixation was required, involving dense intra-abdominal adhesions. Obesity, repeated revisions, and increased intra-abdominal pressure were considered major contributing factors.

This case highlights recurrent distal migration of a VP shunt in an obese patient with glioblastoma-related hydrocephalus. Although rare, distal catheter migration is an important cause of shunt malfunction. Awareness of predisposing factors such as obesity and adhesions, combined with careful intraoperative technique and secure distal catheter fixation, is crucial to reducing the likelihood of recurrence.