Ventriculoperitoneal shunt disconnection

Ventriculoperitoneal shunt disconnection

Mechanical shunt failure from shunt disconnection or fracture is a significant cause of shunt failure 1).

Shunt catheter disconnection has been well described in the literature as a cause of shunt malfunction.

The distal component among the valve and the peritoneal catheter is the most probable site of disconnection 2).

Ventriculoperitoneal shunt disconnection risk factors.

Suspect with Undershunting.

see Shunt evaluation.

Ventriculoperitoneal shunt disconnection prevention.

Shunt catheters that migrate peritoneally bring the possibility of visceral injury, predominantly perforation of the bowel. These disconnected or fractured shunts can be revised by substituting or reconnecting the components, or by replacing the whole shunt system. In the modern era, the laparoscopic retrieval of migrated shunt catheters can be done safely, either as an emergency or an elective process 3).

A 5-year-old boy with a right-sided ventriculoperitoneal shunt presented with a 3-month history of progressively enlarging subperiosteal fluid collection in the scalp, which started in the right parietal region and had spread and extended across the midline to occupy both parietal regions. There were no changes in symptoms or signs from those observed 3 months previously. A CT scan confirmed the collection of fluid under the scalp over both parietal regions. The peritoneal catheter was found to be disconnected from the distal end of the functioning valve, which drained cerebrospinal fluid into the subperiosteal space. Distention of the parietal subperiosteal space led to stretching and tearing of the emissary veins. This resulted in the formation of a hydrohematocele. The spread of fluid to the opposite parietal region may be due to a disorganized and loose attachment of the periosteum to the widely separated sagittal suture 4).


An 8-year-old boy with a right VP shunt was referred because of progressive loss of consciousness in the morning. A CT scan of the head established moderate hydrocephalus. A shunt series presented a disconnection of the distal tube of the shunt as the distal part was free in the abdominal cavity. The patient experienced a complete shunt revision. The abdominal incision was revived and the tube removed from the abdominal cavity gently. The patient was discharged 72 h later 5).


1)

Erol FS, Ozturk S, Akgun B, Kaplan M. Ventriculoperitoneal shunt malfunction caused by fractures and disconnections over 10 years of follow-up. Childs Nerv Syst. 2017 Mar;33(3):475-481. doi: 10.1007/s00381-017-3342-0. Epub 2017 Jan 17. PMID: 28097382.
2)

Ghritlaharey RK, Budhwani KS, Shrivastava DK, Gupta G, Kushwaha AS, et al. (2007) Trans-anal protrusion of ventriculo-peritoneal shunt catheter with silent bowel perforation: report of ten cases in children. Pediatr Surg Int 23(6): 575-580.
3)

Vinchon M, Baroncini M, Laurent T, Patrick D (2006) Bowel perforation caused by peritoneal shunts catheters: diagnosis and treatment. Neurosurgery 58(1): 76-82.
4)

Choudhury AR. Cephalhydrohematocele due to catheter valve disconnection following ventriculoperitoneal shunting. Childs Nerv Syst. 1988 Dec;4(6):376-7. PubMed PMID: 3245948.
5)

Haddadi K, Qazvini HRG, Sahebi M (2017) Ventriculoperitoneal Shunt Disconnection Associated with Loss of Consciousness in a Child Patient: A Case Report and Review of Intra-Abdominal Complications of Vp Shunts. J Neurol Stroke 7(3): 00237. DOI: 10.15406/jnsk.2017.07.00237

Lumbar puncture for idiopathic normal pressure hydrocephalus diagnosis

Lumbar puncture for idiopathic normal pressure hydrocephalus diagnosis

see Opening pressure.

see Lumbar infusion test.

Cerebrospinal fluid tap test (CSF-TT), are often used in practice to provide further predictive value in detecting suitable patients for shunting.

Intracranial Elastance Index.

Spinal meningioma epidemiology

Spinal meningioma epidemiology

Because spinal meningiomas are infrequently encountered in any one center, a large portion of the literature relating to spinal meningiomas consists of case reports or case series 1)


In The Surveillance, Epidemiology and End Results, the age-adjusted incidence rate was 0.37 cases per 1,000,000 person-years between 2004 and 2016. Spinal meningiomas represented 4.25% of all meningiomas. A total of 4204 patients with spinal meningiomas were included in the study. Most of the patients were white and diagnosed at 60-69 years of age, and the female:male ratio was 4:1. Most of the tumors were benign and less than 3 cm in size. The most common pathological type was psammomatous meningioma. Surgery was the first choice of treatment for patients with spinal meningiomas. Male and pediatric patients were more vulnerable to borderline or malignant spinal meningiomas. Survival analysis showed that married, female, and younger patients with benign meningiomas had better overall survival than their counterparts 2).


Approximately 1000 spinal meningiomas were diagnosed in the United States per year, and the incidence was relatively stable. Advanced age, female sex, Asian Pacific Islander and Caucasian race, and Hispanic ethnicity were all associated with an increased incidence of spinal meningioma. The study of represents the most comprehensive evaluation of population-based descriptive epidemiology of spinal meningiomas in the United States to date 3).


Spinal meningiomas represent a significant fraction of all primary intradural spinal tumors and of all meningiomas. The results of a study of Westwick and Shamji established the association of lesion incidence and survival with sex, with a less frequent incidence in but greater mortality among males 4).

Meningiomas arising from the coverings of the spinal cord are one of the two most common intradural extramedullary spinal tumors, representing 25-30% of all such tumor5)

Amongst the intraspinal location, meningiomas account for 25% to 46% of primary spinal neoplasms, while the incidence of spinal meningiomas is 7.5% to 12.7% of all meningiomas

They have a peak incidence in the fifth and sixth decades. Interestingly, and unlike intracranial meningiomas, in the adult population, females are approximately ten times more commonly affected than males. In children, there does not appear to be a sex predilection.

There is an increased incidence of spinal meningiomas in patients with neurofibromatosis type 2 (NF2), and in fact in the paediatric population, meningiomas uncommonly occur outside of the setting of NF2.


Except in cases of neurofibromatosis, it is very rare for tumors of different pathological types to exist concurrently at the same spinal level, with only 9 cases reported to date, in which spinal meningioma was found with spinal schwannoma in 7 cases and with spinal neurofibroma in 2 cases 6).


2)

Cao Y, Jiang Y, Liu C, Jin R, Jin Z, Hong X, Zhao L, Zhao G, Wang Y. Epidemiology and survival of patients with spinal meningiomas: A SEER analysis. Eur J Surg Oncol. 2021 Jan 22:S0748-7983(21)00039-1. doi: 10.1016/j.ejso.2021.01.012. Epub ahead of print. PMID: 33546961.
3)

Kshettry VR, Hsieh JK, Ostrom QT, Kruchko C, Benzel EC, Barnholtz-Sloan JS. Descriptive Epidemiology of Spinal Meningiomas in the United States. Spine (Phila Pa 1976). 2015 Aug 1;40(15):E886-9. doi: 10.1097/BRS.0000000000000974. PMID: 25996535.
4)

Westwick HJ, Shamji MF. Effects of sex on the incidence and prognosis of spinal meningiomas: a Surveillance, Epidemiology, and End Results study. J Neurosurg Spine. 2015 Sep;23(3):368-73. doi: 10.3171/2014.12.SPINE14974. Epub 2015 May 29. PMID: 26023898.
5)

Osborn AG. Diagnostic neuroradiology. Mosby Inc. (1994) ISBN:0801674867.
6)

Zhan Z, Yan X, Nie W, Ding Y, Xu W, Huang H. Neurofibroma and Meningioma within a Single Dumbbell-Shaped Tumor at the Same Cervical Level without Neurofibromatosis: a Case Report and Literature Review. World Neurosurg. 2019 Jun 26. pii: S1878-8750(19)31788-7. doi: 10.1016/j.wneu.2019.06.142. [Epub ahead of print] PubMed PMID: 31254713.
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