Distal ventriculoperitoneal shunt catheter tightly coiled around the valve in the absence of a subgaleal cerebrospinal fluid collection: illustrative case

Goichiro Tamura; Kerry A Vaughan; Sara Breitbart; Helen M Branson; George M Ibrahim

doi:10.3171/CASE21115

Distal ventriculoperitoneal shunt catheter tightly coiled around the valve in the absence of a subgaleal cerebrospinal fluid collection: illustrative case

J Neurosurg Case Lessons. 2021 May 17;1(20):CASE21115. doi: 10.3171/CASE21115.

Authors

Goichiro Tamura¹, Kerry A Vaughan¹, Sara Breitbart¹, Helen M Branson², George M Ibrahim¹

Affiliations

¹ Division of Neurosurgery, Department of Surgery; and.
² Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.

Abstract

Background: Among the known complications of ventriculoperitoneal (VP) shunts, subcutaneous or subgaleal migration of distal catheters is rare. Prior case reports have proposed several risk factors, including inadequate fixation of the shunt device, presence of a large subgaleal space filled with cerebrospinal fluid (CSF), and repetitive flexion/extension movement of the head producing a "windlass effect." Tight coiling of a distal catheter around the valve without a large subgaleal space has not been reported.

Observations: The patient was born prematurely and underwent VP shunt placement for posthemorrhagic ventricular dilatation at 3 months of age with reassuring postoperative imaging. At approximately 3 years of age, shunt radiography and head computed tomography unexpectedly showed excess tubing coiled extracranially around the shunt valve. The patient did not exhibit any clinical symptoms of shunt malfunction and underwent an uneventful revision of the VP shunt system. No CSF-filled subgaleal space was observed intraoperatively.

Lessons: Distal catheter migration can occur without the clear presence of a subgaleal CSF collection and symptoms of acute hydrocephalus. Appropriate fixation of the shunt system using nonabsorbable stitches is recommended to prevent catheter migration caused by the windlass effect.

Keywords: CSF = cerebrospinal fluid; CT = computed tomography; MRI = magnetic resonance imaging; VP = ventriculoperitoneal; catheter migration; cerebrospinal fluid collection; complication; subcutaneous space; subgaleal space; ventriculoperitoneal shunt.

Publication types

Case Reports