Lindsay Rumberger, MD, James Killeffer, MD, Dana Taylor, MD. University of Tennessee Medical Center
Ventriculoperitoneal (VP) shunting has been the mainstay of treatment for hydrocephalus for several decades. Although relatively uncommon, migration of the distal portion of the shunt out of the peritoneum into the subcutaneous tissue has been described in numerous reports. Such migration results in the need to surgically replace the catheter into the peritoneum since the subcutaneous pocket cannot accommodate adequate cerebrospinal fluid absorption. We report a novel technique to prevent migration of the distal portion of the catheter within the peritoneum in a patient in whom the catheter had repeatedly migrated out of the peritoneum post-operatively.
A 65-year-old woman presented with a several month history of normal pressure hydrocephalous that was responsive to a high-volume lumbar tap. She underwent uneventful placement of a VP shunt through an open mini laparotomy. After a month she developed recurrent symptoms and it was determined that her catheter had migrated into a subcutaneous position. After being revised several times, the distal portion of the catheter continued to migrate into a subcutaneous position.
In conjunction with a laparoscopically trained general surgeon, the patient’s fourth revision was undertaken laparoscopically. By weaving the distal portion of the catheter through a macroporous polyester mesh and tacking it to the anterior abdominal wall, the distal portion of the catheter was secured to the abdominal wall preventing it from migrating into a subcutaneous position. After a year of follow up, the patient continues to do well and has not experienced further episodes of shunt migration.
Catheter migration is a well-known complication of VP shunting. By using this simple technique in high risk patients to secure the shunt to the abdominal wall with mesh using a laparoscopic approach, patient morbidity can be greatly improved.