Skip to main content Skip to main navigation menu Skip to site footer

Shunt fracture as ventriculoperitoneal shunt complication in pediatric: a case series

  • Fachriy Balafif ,
  • Muhammad Arifin Parenrengi ,
  • Wihasto Suryaningtyas ,


Abstract

Link of Video Abstract: https://youtu.be/7m2n6og9EUI

Background: Shunt fracture is a ventriculoperitoneal (VP) complication requiring shunt revision. The author discusses the experience of treating 5 cases of hydrocephalus patients with shunt fracture, including a clinical manifestation, nutritional status, and age of VP shunt insertion as a risk factor of shunt fracture will be discussed further in this case series report.

Case Presentation: This study analyzed all cases treated in 6 years from 2016 to 2021, with an inclusion criterion of all pediatric patients with shunt fractures. This study is a retrospective report of the clinical manifestations and diagnoses assessed for pre-procedural and post-procedural conditions. Eight hundred fifty-two patients with hydrocephalus with VP shunt insertion and 5 patients with shunt fracture were reported. Headache, lump in the shunt line, vomiting, and seizure were the main complaints of all patients. Four of the five patients had poor nutritional status (<50th and <3rd percentile). One patient had a shunt removal, two had a shunt revision, and two had a laparoscopic shunt extraction and VP shunt insertion. All patients had improved clinical outcomes.

Conclusion: Knowing the process of shunt fracture is essential as a modality to determine the subsequent management. A comprehensive clinical and radiological examination is mandatory to rule out a shunt fracture. Monitoring patients with VP shunt is an important thing that must be done to prevent further complications.

Keywords: hydrocephalus VP Shunt shunt complication shunt fracture

References

  1. Estey CM. Congenital Hydrocephalus. Vet Clin North Am Small Anim Pract. 2016;46(2):217–229.
  2. Symss NP, Oi S. Theories of cerebrospinal fluid dynamics and hydrocephalus: historical trend. J Neurosurg Pediatr. 2013;11(2):170–177.
  3. Kahle KT, Kulkarni A V, Limbrick DD, Warf BC. Hydrocephalus in children. The Lancet. 2016;387(10020):788–799.
  4. McAllister II JP. Pathophysiology of congenital and neonatal hydrocephalus. Semin Fetal Neonatal Med. 2012;17(5):285–294.
  5. Dewan MC, Rattani A, Mekary R, Glancz LJ, Yunusa I, Baticulon RE, et al. Global hydrocephalus epidemiology and incidence: systematic review and meta-analysis. Journal of Neurosurgery. 2019;130(4):1065–1079.
  6. Beuriat PA, Puget S, Cinalli G, Blauwblomme T, Beccaria K, Zerah M, et al. Hydrocephalus treatment in children: long-term outcome in 975 consecutive patients. J Neurosurg Pediatr. 2017;20(1):10–18.
  7. Hanak BW, Bonow RH, Harris CA, Browd SR. Cerebrospinal Fluid Shunting Complications in Children. Pediatr Neurosurg. 2017;52(6):381–400.
  8. Giordano M. Complications of CSF shunting in hydrocephalus. Child’s Nervous System. 2015;31(7):1207–1207.
  9. Hamdan AR. Ventriculoperitoneal shunt complications: a local study at Qena University Hospital: a retrospective study. Egyptian Journal of Neurosurgery. 2018;33(1):1-8.
  10. Siddiqui MA, Hardy AK, Mercier PA, Farmakis SG. Association between ventricular shunt catheter calcifications and the development of shunt fracture. Pediatr Radiol. 2019 Dec 16;49(13):1773–1780.
  11. Isaacs AM, Bezchlibnyk YB, Yong H, Koshy D, Urbaneja G, Hader WJ, et al. Endoscopic third ventriculostomy for treatment of adult hydrocephalus: long-term follow-up of 163 patients. Neurosurg Focus. 2016;41(3):E3.
  12. Langmoen IA, Lundar T, Vatne K, Hovind KH. Occurrence and management of fractured peripheral catheters in CSF shunts. Childs Nerv Syst. 1992;8(4):222–225.
  13. 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;33(3):475–481.
  14. Suryaningtyas W, Ranuh IGMAR, Parenrengi MA. Shunt exposure as a ventriculoperitoneal shunt complication: A case series. Int J Surg Case Rep. 2021;79:484-491.
  15. Jain G, Mukerji G, Dixit A, Manshani N, Yadav YR. The impact of nutritional status on the outcome of Indian patients undergoing neurosurgical shunt surgery. British Journal of Nutrition. 2007;98(5):944–949.
  16. Blakeney WG, D’Amato C. Ventriculoperitoneal Shunt Fracture Following Application of Halo-Gravity Traction: A Case Report. J Pediatr Orthop. 2015;35(6):e52-e54.
  17. Lee L, Low S, Low D, Ng LP, Nolan C, Seow WT. Late pediatric ventriculoperitoneal shunt failures: a Singapore tertiary institution’s experience. Neurosurg Focus. 2016;41(5):E7.
  18. Paff M, Alexandru-Abrams D, Muhonen M, Loudon W. Ventriculoperitoneal shunt complications: A review. Interdisciplinary Neurosurgery. 2018;13:66–70.
  19. Reddy GK, Bollam P, Caldito G. Long-term outcomes of ventriculoperitoneal shunt surgery in patients with hydrocephalus. World Neurosurg. 2014;81(2):404–10.
  20. Gutierrez-Murgas Y, Snowden JN. Ventricular shunt infections: immunopathogenesis and clinical management. J Neuroimmunol. 2014;276(1–2):1–8.
  21. Arifin MT, Purnomo F, Muttaqin Z, Bakhtiar Y, Andar E, Priambada D, et al. Cerebrospinal fluid contents and risk of shunt exposure in hydrocephalus. Bali Medical Journal. 2019;8(3):661-663.
  22. Wardhana DPW, Maliawan S. Operative nuances of endoscopic third ventriculostomy for pediatric obstructive hydrocephalus. Bali Medical Journal. 2018;7(2):351-355.
  23. Rampengan SH, Rosmaningtyas CAA. A patient with large ostium primum atrial septal defect who underwent open heart surgical closure with pericardial patch: a case report. Bali Medical Journal. 2023;12(2):1934-1939.

How to Cite

Balafif, F., Parenrengi, M. A., & Suryaningtyas, W. (2023). Shunt fracture as ventriculoperitoneal shunt complication in pediatric: a case series. Bali Medical Journal, 12(2), 2160–2164. https://doi.org/10.15562/bmj.v12i2.4524
ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver
Download Citation
Endnote/Zotero/Mendeley (RIS) BibTeX

HTML
7

Total
6

Share

Search Panel

Fachriy Balafif
Google Scholar
Pubmed
BMJ Journal

Muhammad Arifin Parenrengi
Google Scholar
Pubmed
BMJ Journal

Wihasto Suryaningtyas
Google Scholar
Pubmed
BMJ Journal