On-Off Malfunctıon In A Pedıatrıc Shunt: A Case Report

Abstract

3 years-old-boy with a history of ventriculo-peritoneal shunt placement was admitted to our neurosurgery department with headache, vomiting and sunset eye phenomena. Direct X-ray examination of the shunt system was completely normal. The palpation of the shunt dome resulted the unfilling of pumping device. Computerised tomography (CT) of the head revealed ventricular enlargement and periventricular oedema. The patient was hospitalised for shunt revision. The symptoms were spontaneously disappeared within 48 hours. The pumping device returned to normal refilling. Follow up CT showed small ventricular size and shape. This case indicates that the symptomatic intermittent occlusion of the proximal shunt catheter can be seen in the paediatric age group and the obstruction may continue for a certain period and spontaneously return to normal function with correlated clinical response.

Keywords

• Ventriculo-peritoneal Shunt
• Shunt Malfunction
• On-off Shunt Occlusion
• Pediatric Patient
• Hydrocephalus

References

1. Blount, J.P., Campbell, J.A., Haines, S.J., 1993. Complications in ventricular cerebrospinal fluid shunting. Neurosurg. Clin. N. Am. 4, 633-656.
2. Kast, J., Duong, D., Nowzari, F., Chadduck, W.M., Schiff, S.J., 1994. Time-related patterns of ventricular shunt failure. Child. Nerv. Syst. 10, 524-528.
3. Little, J.R., Rhoton, A.L., Mellinger, J.F., 1972. Comparison of ventriculoperitoneal and ventriculoatrial shunts for hydrocephalus in children. Mayo Clin. Proc. 47, 396-401.
4. Rekate, H.L., 1993. Classification of slit-ventricle syndromes using intracranial pressure monitoring. Pediatr. Neurosurg. 19, 15-20.
5. Sainte-Rose, C., 1993. Shunt obstruction: a preventable complication? Pediatr. Neurosurg. 19, 156-164.
6. Sainte-Rose, C., Piatt, J.H., Renier, D., Pierre-Khan, A., Hirsch, J.F., Hoffman, H.J., Humphreys, R.P., Hendrick, E.B., 1991.Mechanical complication in shunts. Pediatr. Neurosurg. 17, 2-9.
7. Takahashi, Y., Ohkura, A., Hirohata, M., Tokutomi, T., Shigemori, M., 1998. Ultrastructure of obstructive tissue in malfunctioning ventricular catheters without infection. Neurol. Med-Chir (Tokyo). 38, 399-404.
8. Walker, M.L., Fried, A., Petronio, J., 1993. Diagnosis and treatment of slit ventricle syndrome. Neurosurg. Clin. N. Am. 4, 707-714.