Krishna Chaitanya Joshi1, Kiran Khanapure2, Aniruddh Tekkatte Jagannatha3, Ravi Gopal Varma4. 1. M. S. Ramaiah Medical College, New BEL Road, Bangalore, 560055, India. krishnacjoshi@yahoo.com. 2. M. S. Ramaiah Medical College, New BEL Road, Bangalore, 560055, India. kkhanapure@gmail.com. 3. M. S. Ramaiah Medical College, New BEL Road, Bangalore, 560055, India. anirudhbmc@yahoo.co.in. 4. M. S. Ramaiah Medical College, New BEL Road, Bangalore, 560055, India. rg.varma@hotmail.com.
Abstract
PURPOSE: Ventriculoperitoneal (VP) shunt is one of the most commonly performed procedures by a neurosurgeon. It is occasionally fraught with the most bizarre complications. Understanding the pathophysiology of these complications can help us make the procedure safe and more effective. METHODS: The authors report a case of 8-year-old boy, previously operated for lumbar myelomeningocele and hydrocephalus with an intra diploic migration of shunt tube and shunt dysfunction, and discuss the pathophysiology, diagnosis, and surgical strategy. RESULTS: After diagnosis of shunt malfunction, shunt revision was done with placement of new system and removal of the old apparatus. Patient had a remarkable recovery after the surgery. CONCLUSION: Intradiploic migration is an extremely rare cause of shunt malfunction and has never been reported in literature before. Possible mechanism is that prolonged pressure on the valve due to recumbent head position in a paraplegic child might have led to new bone formation and subsequent intradiploic migration of the valve. Careful planning the position of shunt valve in relation to head position, especially in children who are recumbent due to paraplegia might avoid this untoward complication.
PURPOSE: Ventriculoperitoneal (VP) shunt is one of the most commonly performed procedures by a neurosurgeon. It is occasionally fraught with the most bizarre complications. Understanding the pathophysiology of these complications can help us make the procedure safe and more effective. METHODS: The authors report a case of 8-year-old boy, previously operated for lumbar myelomeningocele and hydrocephalus with an intra diploic migration of shunt tube and shunt dysfunction, and discuss the pathophysiology, diagnosis, and surgical strategy. RESULTS: After diagnosis of shunt malfunction, shunt revision was done with placement of new system and removal of the old apparatus. Patient had a remarkable recovery after the surgery. CONCLUSION: Intradiploic migration is an extremely rare cause of shunt malfunction and has never been reported in literature before. Possible mechanism is that prolonged pressure on the valve due to recumbent head position in a paraplegic child might have led to new bone formation and subsequent intradiploic migration of the valve. Careful planning the position of shunt valve in relation to head position, especially in children who are recumbent due to paraplegia might avoid this untoward complication.