Shunt exposure as a ventriculoperitoneal shunt complication: A case series

Wihasto Suryaningtyas; I G M Aswin R Ranuh; Muhammad Arifin Parenrengi

doi:10.1016/j.ijscr.2021.01.084

Shunt exposure as a ventriculoperitoneal shunt complication: A case series

Int J Surg Case Rep. 2021 Feb:79:484-491. doi: 10.1016/j.ijscr.2021.01.084. Epub 2021 Jan 27.

Authors

Wihasto Suryaningtyas¹, I G M Aswin R Ranuh², Muhammad Arifin Parenrengi³

Affiliations

¹ Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr Soetomo Academic Medical Center Hospital, Indonesia.
² Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr Soetomo Academic Medical Center Hospital, Indonesia. Electronic address: aswinranuh@rocketmail.com.
³ Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr Soetomo Academic Medical Center Hospital, Indonesia. Electronic address: arifin_ns@yahoo.com.

Abstract

Introduction: Shunting is a technique in neurosurgery for treating hydrocephalus. Shunting is an effective choice for both cases of obstructive or communicative hydrocephalus. However, in some rare cases, complications, such as exposed shunt, can occur. In this case series, the author discusses 6 cases of hydrocephalus patients with exposed shunts. The risk factors, diagnosis, and management of exposed VP shunt will be discussed further in this case series report.

Methods: This study was an analysis of all cases treated in a period of 1 year from January to December 2018 with an inclusion criterion of history of exposed shunt of any age group. This study is a single-centre retrospective report of the clinical presentation and radiology examination before and after treatment. Clinical and radiology evaluation were performed in immediate post procedural period. A detailed clinical examination was performed to look for exposed shunt complication.

Results: In this series of studies 6 patients with hydrocephalus who had shunts were reported. All patients were pediatric patients. Six patients had exposed shunt on the scalp or abdomen. Radiological examinations including CT scan, chest X-ray or babygram were performed to evaluate the location of the shunt. The data reported was from January to December 2018 and there were 301 VP shunt installment cases. Management included surgical revisions and treatments to prevent further complications.

Conclusion: Shunting is still a routine therapy in the field of neurosurgery, although other modalities such as endoscopic third ventriculostomy (ETV) have started to be performed more frequently. Complications such as exposed shunt are rare in the treatment of pediatrics with hydrocephalus. We presented that exposed shunt is a rare complication (2.3% incidence rate) which might be caused by certain risk factors, such as age of patient when the shunting was performed, and nutritional status. Early diagnosis and treatment are important to prevent further complications, especially infections. Subpericranial technique for shunt tunneling might be useful in preventing exposure of shunts with associated morbidity factors.

Keywords: Case report; Exposed shunt; Hydrocephalus; Ventriculoperitoneal shunt.