Advertisement

Late Complications of Shunts

  • Paolo Frassanito
  • Simone Peraio
  • Concezio Di Rocco
Living reference work entry

Latest version View entry history

Abstract

Extra-thecal shunting of the cerebrospinal fluid (CSF) remains the primary treatment option for pediatric hydrocephalus, despite the rate of failure in children is higher than adults, with significant medical and social burden.

Although the majority of shunt revisions occur during the first 6 months after shunt placement and may be accordingly classified as early failures, the risk of shunt malfunction persists through the entire life of the patient.

In cases of late complications, clinical onset and symptomatology vary according to the functionality of the shunting device. In fact, we may further distinguish late complications due to the failure of the shunt and a second category of complications occurring despite a correctly working shunt. The former group includes all the complications related to the nature of the shunting device as a foreign body, further classified as infectious or mechanical.

The latter group includes complications related to the function of the shunting device and the subsequent chronic drainage of CSF, affecting either the CSF receiving site, for example, ascites and hydrocele for VP shunt and cor pulmonale and nephritis for VA shunt, or the intracranial compartment, namely, the acquired craniocerebral disproportion (ACCD) and the slit ventricle syndrome (SVS).

Keywords

Acquired craniocerebral disproportion Complications Hydrocephalus Slit ventricle syndrome Endoscopic third ventriculostomy Shunt infection Ventriculo atrial shunt Ventriculo peritoneal shunt 

References

  1. Acharya R, Ramachandran CS, Singh S (2001) Laparoscopic management of abdominal complications in ventriculoperitoneal shunt surgery. J Laparoendosc Adv Surg Tech A 11:167–170CrossRefPubMedGoogle Scholar
  2. Adeloye A (1973) Spontaneous extrusion of the abdominal tube through the umbilicus complicating peritoneal shunt for hydrocephalus. Case report. J Neurosurg 38:758–760CrossRefPubMedGoogle Scholar
  3. Akhaddar A (2015) In: Complications of CSF shunting in hydrocephalus: prevention, identification, and management. Springer ChamGoogle Scholar
  4. Attenello FJ, Garces-Ambrossi GL, Zaidi HA, Sciubba DM, Jallo GI (2010) Hospital costs associated with shunt infections in patients receiving antibiotic-impregnated shunt catheters versus standard shunt catheters. Neurosurgery 66:284–289; discussion 289CrossRefPubMedGoogle Scholar
  5. Baird C, O’Connor D, Pittman T (1999) Late shunt infections. Pediatr Neurosurg 31:269–273CrossRefPubMedGoogle Scholar
  6. Baskin JJ, Manwaring KH, Rekate HL (1998) Ventricular shunt removal: the ultimate treatment of the slit ventricle syndrome. J Neurosurg 88:478–484CrossRefPubMedGoogle Scholar
  7. Bateman GA (2013) Hypertensive slit ventricle syndrome: pseudotumor cerebri with a malfunctioning shunt? J Neurosurg 119:1503–1510CrossRefPubMedGoogle Scholar
  8. Becker DP, Nulsen FE (1968) Control of hydrocephalus by valve-regulated venous shunt: avoidance of complications in prolonged shunt maintenance. J Neurosurg 28:215–226CrossRefPubMedGoogle Scholar
  9. Bezerra S, Frigeri TM, Severo CM, Santana JC, Graeff-Teixeira C (2011) Cerebrospinal fluid eosinophilia associated with intraventricular shunts. Clin Neurol Neurosurg 113:345–349CrossRefPubMedGoogle Scholar
  10. Boch AL, Hermelin E, Sainte-Rose C, Sgouros S (1998) Mechanical dysfunction of ventriculoperitoneal shunts caused by calcification of the silicone rubber catheter. J Neurosurg 88:975–982CrossRefPubMedGoogle Scholar
  11. Carvalhal Ribas E, Beer-Furlan A, Campos Pinto F (2014) Ventriculoatrial shunt catheter displacement by a central venous catheter: a rare complication. J Neurosurg Sci 58:125–126PubMedGoogle Scholar
  12. Choux M, Genitori L, Lang D, Lena G (1992) Shunt implantation: reducing the incidence of shunt infection. J Neurosurg 77:875–880CrossRefPubMedGoogle Scholar
  13. Del Bigio MR (2002) Neuropathological findings in a child with slit ventricle syndrome. Pediatr Neurosurg 37:148–151CrossRefPubMedGoogle Scholar
  14. Di Rocco C (1994) Is the slit ventricle syndrome always a slit ventricle syndrome? Childs Nerv Syst 10:49–58CrossRefPubMedGoogle Scholar
  15. Di Rocco C, Frassanito P (2015) In: Complications of CSF shunting in hydrocephalus. Prevention, identification and management. Springer, New YorkGoogle Scholar
  16. Di Rocco C, Tamburrini G (2003) Shunt dependency in shunted arachnoid cyst: a reason to avoid shunting. Pediatr Neurosurg 38:164CrossRefPubMedGoogle Scholar
  17. Di Rocco C, Velardi F (2003) Acquired Chiari type I malformation managed by supratentorial cranial enlargement. Childs Nerv Syst 19:800–807CrossRefPubMedGoogle Scholar
  18. Di Rocco C, Pettorossi VE, Caldarelli M, Mancinelli R, Velardi F (1978) Communicating hydrocephalus induced by mechanically increased amplitude of the intraventricular cerebrospinal fluid pressure: experimental studies. Exp Neurol 59:40–52CrossRefPubMedGoogle Scholar
  19. Di Rocco C, Marchese E, Velardi F (1994) A survey of the first complication of newly implanted CSF shunt devices for the treatment of nontumoral hydrocephalus. Cooperative survey of the 1991–1992 Education Committee of the ISPN. Childs Nerv Syst 10:321–327CrossRefPubMedGoogle Scholar
  20. Di Rocco C, Conforti G, Caldarelli M (2014) The current minor perception of V-S complication. World Neurosurg 81:285–287CrossRefPubMedGoogle Scholar
  21. Dietzel J et al (2012) Beta-trace protein in ascites and pleural effusions: limits of CSF leakage detection. J Neurotrauma 29:1817–1820CrossRefPubMedGoogle Scholar
  22. Drake LA et al (1997) Oral terbinafine in the treatment of toenail onychomycosis: North American multicenter trial. J Am Acad Dermatol 37:740–745CrossRefPubMedGoogle Scholar
  23. Echizenya K et al (1987) Mineralization and biodegradation of CSF shunting systems. J Neurosurg 67:584–591CrossRefPubMedGoogle Scholar
  24. Elisevich K, Mattar AG, Cheeseman F (1994) Biodegradation of distal shunt catheters. Pediatr Neurosurg 21:71–76CrossRefPubMedGoogle Scholar
  25. Epstein FJ, Fleischer AS, Hochwald GM, Ransohoff J (1974) Subtemporal craniectomy for recurrent shunt obstruction secondary to small ventricles. J Neurosurg 41:29–31CrossRefPubMedGoogle Scholar
  26. Epstein F, Lapras C, Wisoff JH (1988) ‘Slit-ventricle syndrome’: etiology and treatment. Pediatr Neurosci 14:5–10CrossRefPubMedGoogle Scholar
  27. Faulhauer K, Schmitz P (1978) Overdrainage phenomena in shunt treated hydrocephalus. Acta Neurochir 45:89–101CrossRefPubMedGoogle Scholar
  28. Fewel ME, Garton HJ (2004) Migration of distal ventriculoperitoneal shunt catheter into the heart. Case report and review of the literature. J Neurosurg 100:206–211PubMedGoogle Scholar
  29. Galarza M, Martìnez P (2015) In: Complications of CSF shunting in hydrocephalus: prevention, identification, and management. SpringerGoogle Scholar
  30. Gruber RW, Roehrig B (2010) Prevention of ventricular catheter obstruction and slit ventricle syndrome by the prophylactic use of the Integra antisiphon device in shunt therapy for pediatric hypertensive hydrocephalus: a 25-year follow-up study. J Neurosurg Pediatr 5:4–16CrossRefPubMedGoogle Scholar
  31. Heggers JP et al (1983) Biocompatibility of silicone implants. Ann Plast Surg 11:38–45CrossRefPubMedGoogle Scholar
  32. Henningfeld J et al (2016) Pleural effusion in a child with a ventriculoperitoneal shunt and congenital heart disease. Springerplus 5:90CrossRefPubMedPubMedCentralGoogle Scholar
  33. Hinojosa J (2015) In: Complications of CSF shunting in hydrocephalus: prevention, identification, and management. Springer, LondonGoogle Scholar
  34. Jang M, Yoon SH (2013) Hypothesis for intracranial hypertension in slit ventricle syndrome: new concept of capillary absorption laziness in the hydrocephalic patients with long-term shunts. Med Hypotheses 81:199–201CrossRefPubMedGoogle Scholar
  35. Jimenez DF, Keating R, Goodrich JT (1994) Silicone allergy in ventriculoperitoneal shunts. Childs Nerv Syst 10:59–63CrossRefPubMedGoogle Scholar
  36. Kang JK, Jeun SS, Chung DS, Lee IW, Sung WH (1996) Unusual proximal migration of ventriculoperitoneal shunt into the heart. Childs Nerv Syst 12:176–179CrossRefPubMedGoogle Scholar
  37. Kestle J et al (2000) Long-term follow-up data from the Shunt Design Trial. Pediatr Neurosurg 33:230–236CrossRefPubMedGoogle Scholar
  38. Kinney EL et al (1979) Recurrent pulmonary emboli secondary to right atrial thrombus around a permanent pacing catheter: a case report and review of the literature. Pacing Clin Electrophysiol 2:196–202CrossRefPubMedGoogle Scholar
  39. Kluge S et al (2010) Pulmonary hypertension after ventriculoatrial shunt implantation. J Neurosurg 113:1279–1283CrossRefPubMedGoogle Scholar
  40. Knickmeyer RC et al (2008) A structural MRI study of human brain development from birth to 2 years. J Neurosci 28:12176–12182CrossRefPubMedPubMedCentralGoogle Scholar
  41. Lazareff JA, Kelly J, Saito M (1998) Herniation of cerebellar tonsils following supratentorial shunt placement. Childs Nerv Syst 14:394–397CrossRefPubMedGoogle Scholar
  42. Lo WB, Ramirez R, Rodrigues D, Solanki GA (2013) Ventriculoperitoneal shunt disconnection associated with spontaneous knot formation in the peritoneal catheter. BMJ Case Rep 2013.  https://doi.org/10.1136/bcr-2013-009590
  43. Major O et al (1994) Slit-ventricle syndrome in shunt operated children. Acta Neurochir 127:69–72CrossRefPubMedGoogle Scholar
  44. Martínez-Lage JF et al (2000) Ventriculopleural shunting with new technology valves. Childs Nerv Syst 16:867–871CrossRefPubMedGoogle Scholar
  45. Martinez-Lage JF et al (2006) Shunt-related craniocerebral disproportion: treatment with cranial vault expanding procedures. Neurosurg Rev 29:229–235CrossRefPubMedGoogle Scholar
  46. Massimi L, Di Rocco C (2015) In: Complications of CSF shunting in hydrocephalus: prevention, identification, and management. Springer, DordrechtGoogle Scholar
  47. Massimi L, Paternoster G, Fasano T, Di Rocco C (2009) On the changing epidemiology of hydrocephalus. Childs Nerv Syst 25:795–800CrossRefPubMedGoogle Scholar
  48. Mastroianni C, Chauvet D, Ressencourt O, Kirsch M (2013) Late ventriculo-atrial shunt migration leading to pericardial cerebrospinal fluid effusion and cardiac tamponade. Interact Cardiovasc Thorac Surg 16:391–393CrossRefPubMedGoogle Scholar
  49. McGirt MJ et al (2003) Risk factors for pediatric ventriculoperitoneal shunt infection and predictors of infectious pathogens. Clin Infect Dis 36:858–862CrossRefPubMedGoogle Scholar
  50. Mobley LW, Doran SE, Hellbusch LC (2005) Abdominal pseudocyst: predisposing factors and treatment algorithm. Pediatr Neurosurg 41:77–83CrossRefPubMedGoogle Scholar
  51. Morell RC, Bell WO, Hertz GE, D’Souza V (1994) Migration of a ventriculoperitoneal shunt into the pulmonary artery. J Neurosurg Anesthesiol 6:132–134CrossRefPubMedGoogle Scholar
  52. Mori T et al (1993) Management of a broken atrial catheter migrated into the heart: a rare complication of ventriculoatrial shunt–case report. Neurol Med Chir 33:713–715CrossRefGoogle Scholar
  53. Nagata Y et al (2016) The “steppingstone” phenomenon: a new endoscopic finding in slit-ventricle syndrome. Childs Nerv Syst 32:2265–2268CrossRefPubMedGoogle Scholar
  54. Nagulic M, Djordjevic M, Samardzic M (1996) Peritoneo-vulvar catheter extrusion after shunt operation. Childs Nerv Syst 12:222–223CrossRefPubMedGoogle Scholar
  55. Natelson SE, Molnar W (1972) Malfunction of ventriculoatrial shunts caused by the circulatory dynamics of coughing. J Neurosurg 36:283–286CrossRefPubMedGoogle Scholar
  56. Nguyen HS, Turner M, Butty SD, Cohen-Gadol AA (2010) Migration of a distal shunt catheter into the heart and pulmonary artery: report of a case and review of the literature. Childs Nerv Syst 26:1113–1116CrossRefPubMedGoogle Scholar
  57. Oi S, Matsumoto S (1986) Morphological findings of postshunt slit-ventricle in experimental canine hydrocephalus. Aspects of causative factors of isolated ventricles and slit-ventricle syndrome. Childs Nerv Syst 2:179–184CrossRefPubMedGoogle Scholar
  58. Oktem IS et al (1998) Migration of abdominal catheter of ventriculoperitoneal shunt into the scrotum. Acta Neurochir 140:167–170CrossRefPubMedGoogle Scholar
  59. Olson S (2004) The problematic slit ventricle syndrome. A review of the literature and proposed algorithm for treatment. Pediatr Neurosurg 40:264–269CrossRefPubMedGoogle Scholar
  60. Osuagwu FC, Lazareff JA, Rahman S, Bash S (2006) Chiari I anatomy after ventriculoperitoneal shunting: posterior fossa volumetric evaluation with MRI. Childs Nerv Syst 22:1451–1456CrossRefPubMedGoogle Scholar
  61. Pang D, Altschuler E (1994) Low-pressure hydrocephalic state and viscoelastic alterations in the brain. Neurosurgery 35:643–655; discussion 655–646CrossRefPubMedGoogle Scholar
  62. Portnoy HD, Croissant PD (1973) Two unusual complications of a ventriculoperitoneal shunt. Case report. J Neurosurg 39:775–776CrossRefPubMedGoogle Scholar
  63. Portnoy HD, Schulte RR, Fox JL, Croissant PD, Tripp L (1973) Anti-siphon and reversible occlusion valves for shunting in hydrocephalus and preventing post-shunt subdural hematomas. J Neurosurg 38:729–738CrossRefPubMedGoogle Scholar
  64. Ramani PS (1974) Extrusion of abdominal catheter of ventriculoperitoneal shunt into the scrotum. Case report. J Neurosurg 40:772–773CrossRefPubMedGoogle Scholar
  65. Reddy GK, Bollam P, Caldito G, Guthikonda B, Nanda A (2012) Ventriculoperitoneal shunt surgery outcome in adult transition patients with pediatric-onset hydrocephalus. Neurosurgery 70:380–388; discussion 388–389CrossRefPubMedGoogle Scholar
  66. Rekate HL (1993) Classification of slit-ventricle syndromes using intracranial pressure monitoring. Pediatr Neurosurg 19:15–20CrossRefPubMedGoogle Scholar
  67. Roth J et al (2011) Modified bilateral subtemporal decompression for resistant slit ventricle syndrome. Childs Nerv Syst 27:101–110CrossRefPubMedGoogle Scholar
  68. Sainte-Rose C et al (1991) Mechanical complications in shunts. Pediatr Neurosurg 17:2–9CrossRefPubMedGoogle Scholar
  69. Salomão JF, Leibinger RD (1999) Abdominal pseudocysts complicating CSF shunting in infants and children. Report of 18 cases. Pediatr Neurosurg 31:274–278CrossRefPubMedGoogle Scholar
  70. Sandler AL, Goodrich JT, Daniels LB 3rd, Biswas A, Abbott R (2013) Craniocerebral disproportion: a topical review and proposal toward a new definition, diagnosis, and treatment protocol. Childs Nerv Syst 29:1997–2010CrossRefPubMedGoogle Scholar
  71. Schreffler RT, Schreffler AJ, Wittler RR (2002) Treatment of cerebrospinal fluid shunt infections: a decision analysis. Pediatr Infect Dis J 21:632–636CrossRefPubMedGoogle Scholar
  72. Tamburrini G, Massimi L, Caldarelli M, Di Rocco C (2008) Antibiotic impregnated external ventricular drainage and third ventriculostomy in the management of hydrocephalus associated with posterior cranial fossa tumours. Acta Neurochir 150:1049–1055; discussion 1055–1046CrossRefPubMedGoogle Scholar
  73. Tsitouras V, Sgouros S (2015) In: Complications of CSF shunting in hydrocephalus: prevention, identification, and management. Springer, HeidelbergGoogle Scholar
  74. Ulus A et al (2012) CSF hydrothorax: neither migration of peritoneal catheter into the chest nor ascites. Case report and review of the literature. Childs Nerv Syst 28:1843–1848CrossRefPubMedGoogle Scholar
  75. Vella J et al (1995) Glomerulonephritis after ventriculo-atrial shunt. QJM 88:911–918PubMedGoogle Scholar
  76. Vinchon M, Lemaitre MP, Vallée L, Dhellemmes P (2002) Late shunt infection: incidence, pathogenesis, and therapeutic implications. Neuropediatrics 33:169–173CrossRefPubMedGoogle Scholar
  77. Weinzweig J et al (2008) Cranial vault expansion in the management of postshunt craniosynostosis and slit ventricle syndrome. Plast Reconstr Surg 122:1171–1180CrossRefPubMedGoogle Scholar
  78. Yamamoto S, Ohno K, Aoyagi M, Ichinose S, Hirakawa K (2002) Calcific deposits on degraded shunt catheters: long-term follow-up of V-P shunts and late complications in three cases. Childs Nerv Syst 18:19–25CrossRefPubMedGoogle Scholar
  79. Yilmaz MB, Egemen E, Tonge M, Kaymaz M (2013) Transoral protrusion of a peritoneal catheter due to gastric perforation 10 years after a ventriculoperitoneal shunting: case report and review of the literature. Turk Neurosurg 23:285–288PubMedGoogle Scholar
  80. Yukinaka M et al (1998) Cerebrospinal ascites developed 3 years after ventriculoperitoneal shunting in a hydrocephalic patient. Intern Med 37:638–641CrossRefPubMedGoogle Scholar
  81. Zierdt CH (1983) Evidence for transient Staphylococcus epidermidis bacteremia in patients and in healthy humans. J Clin Microbiol 17:628–630PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Paolo Frassanito
    • 1
  • Simone Peraio
    • 1
  • Concezio Di Rocco
    • 2
  1. 1.Pediatric NeurosurgeryFondazione Policlinico Universitario A. Gemelli, Catholic University Medical SchoolRomeItaly
  2. 2.Department of NeurosurgeryInternational Neuroscience InstituteHannoverGermany

Section editors and affiliations

  • Concezio Di Rocco
    • 1
  • Gianpiero Tamburrini
    • 2
  1. 1.Director of Pediatric NeurosurgeryInternational Neuroscience InstituteHannoverGermany
  2. 2.Pediatric Neurosurgery, Institute of NeurosurgeryCatholic University Medical SchoolRomeItaly

Personalised recommendations