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Inguinal herniation with glial implants: possible complication of ventriculoperitoneal shunting
J F Magee1, N E Barker, G K Blair
1Department of Anatomic Pathology, University of British Columbia Vancouver, British Columbia's Children's Hospital, Vancouver, Canada.
Insights
Ventriculoperitoneal shunts for hydrocephalus can cause inguinal hernias. In rare cases, glial tissue may be found within these hernias, potentially linked to shunt placement near the hernia sac.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Pathology
Background:
- Hydrocephalus is commonly treated with valve-regulated ventriculoperitoneal (VP) shunts.
- VP shunt insertion is associated with inguinal hernias and hydroceles.
Observation:
- A review of 304 pediatric VP shunt placements identified 31 patients requiring herniorrhaphy.
- Two cases presented with glial differentiation within the hernia sac, confirmed by GFAP and S100 staining.
Findings:
- Inguinal herniation is a frequent complication following VP shunt insertion.
- Glial tissue within inguinal hernias is a rare complication, observed when the shunt tip is near the hernia sac.
Implications:
- This highlights a potential, albeit uncommon, risk associated with VP shunt placement.
- Understanding this complication may inform surgical techniques and patient monitoring.
Abstract:
The standard treatment of hydrocephalus is the insertion of a valve-regulated ventriculoperitoneal (VP) shunt, which may result in the development or clinical worsening of an inguinal hernia or hydrocele. A review of the British Columbia's Children's Hospital experience with VP shunt insertion (1983-1994) identified 304 patients who underwent VP shunt placement, 31 of whom subsequently required herniorrhaphy, 5 suffering recurrences. Two cases exhibited areas of glial differentiation (diffusely scattered in one sac from a bilateral repair, focally present in the second unilateral hernia repair) displaying cytoplasmic staining with glial fibrillary acidic protein and S100. At time of surgical repair of case 1 (bilateral hernia repair), the tip of the VP shunt was detected within the hernia sac exhibiting glial differentiation; no glial tissue was identified in the sac from the other side. We conclude that inguinal herniation is a common complication of VP shunt insertion, and the identification of glial tissue within such an inguinal hernia is a rarer complication, possibly occurring when the shunt tip lies in close proximity to the hernial mesothelial tissue.