Child's Nervous System

, Volume 35, Issue 4, pp 713–717 | Cite as

Atlanto-axial rotatory fixation complicating ventriculo-peritoneal shunt surgery: a case report and literature review

  • Costanza ZattraEmail author
  • Marco Paolo Schiariti
  • Emanuele La Corte
  • Morgan Broggi
  • Francesco Acerbi
  • Paolo Ferroli
Case Report



Atlanto-axial rotatory fixation (AARF) is a rare complication of ventriculo-peritoneal shunt (VPS) surgery.

Case presentation

The authors present a unique case of AARF developing early after VP shunting, with persistent torticollis, a “cock-robin” head position, and a thick fibrous band along the catheter path. Due to refractoriness to conservative treatments, AARF, which can be an early-onset complication of VPS surgery, was resolved by removing the distal catheter along with the fibrous band encasing it.


Surgical removal of the fibrous band might be enough to solve such complication with no need of further surgical fusion procedures.


Pediatrics Atlanto-axial rotatory fixation Hydrocephalus Ventriculo-peritoneal shunt 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from the patient and his parents.


  1. 1.
    Hashimoto M, Yokota A, Urasaki E, Tsujigami S, Shimono M (2004) A case of abdominal CSF pseudocyst associated with silicone allergy. Childs Nerv Syst 20(10):761–764Google Scholar
  2. 2.
    Heary R, Reid P, Carmel P (2011) Atlantoaxial rotatory fixation after ventriculoperitoneal shunting. Neuropediatrics 42:197–199CrossRefGoogle Scholar
  3. 3.
    Hussain NS, Wang PP, James C, Carson BS, Avellino AM (2005) Distal ventriculoperitoneal shunt failure caused by silicone allergy. J Neurosurg 102(3):536–539CrossRefGoogle Scholar
  4. 4.
    Ishii K, Toyama Y, Nakamura M, Chiba K, Matsumoto M (2012) Management of chronic atlantoaxial rotatory fixation. Spine (Phila Pa 1976) 37:E278–E285CrossRefGoogle Scholar
  5. 5.
    Pang D, Li V (2004) Atlantoaxial rotatory fixation: part 1—biomechanics of normal rotation at the atlantoaxial joint in children. Neurosurgery 55:614–625CrossRefGoogle Scholar
  6. 6.
    Pang D, Li V (2005) Atlantoaxial rotatory fixation: part 2—new diagnostic paradigm and a new classification based on motion analysis using computed tomographic imaging. Neurosurgery 57:941–953CrossRefGoogle Scholar
  7. 7.
    Pang D, Li V (2005) Atlantoaxial rotatory fixation: part 3—a prospective study of the clinical manifestation, diagnosis, management, and outcome of children with atlantoaxial rotatory fixation. Neurosurgery 57:954–972CrossRefGoogle Scholar
  8. 8.
    Singh G, Kaif M, Ojha BK, Chandra A, Cronk K, Nakaji P (2011) Torticollis as a late complication of ventriculoperitoneal shunt surgery. J Clin Neurosci 18(6):865–866CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
  2. 2.Department of Health SciencesUniversity of MilanMilanItaly

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