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Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
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American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
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Cranial Migration of Ventriculo Peritoneal Shunt: An Unusual Complication

Neeraj Salhotra*, Samit Binewale, Bashar Al Tunbi, Livingston C, Faraz Qayyum Khan, Ahmed Tolba

Department of Neurosurgery, Khoula Hospital, Muscat, Oman

Abstract: Ventriculoperitoneal shunt insertion is a common neurosurgical procedure performed by the surgeons. Complications are numerous but total cranial migration of the shunt is a rare thing to happen. We herewith one case of ours who underwent ventriculoperitoneal shunt for hydrocephalus encountered this complication and was managed accordingly.

Keywords: shunt complications

Received February 10, 2020; Revised March 19, 2020; Accepted April 01, 2020

Citation: Neeraj Salhotra, Samit Binewale, Bashar Al Tunbi, Livingston C, Faraz Qayyum Khan, Ahmed Tolba, Cranial Migration of Ventriculo Peritoneal Shunt: An Unusual Complication. American Journal of Medical Case Reports, 8 (6). 140-142. January 2020. doi:10.12691/ajmcr-8-6-1

1. Material and Methods

A 2 month old child was admitted here with multiple congenital anomalies in our hospital. Patient was on colostomy for anorectaal malformation. Patient was having large head. CT brain had revealed dandy walker malformation with hydrocephalus. Patient underwent cystoperitoneal shunt for same and post operative period was uneventful. Postoperative CT was also satisfactory and baby was discharged home. However patient was readmitted with increasing head circumference.

2. Results

Baby underwent a repeat ct brain and to our surprise the whole shunt was seen cranially displaced in the posterior fossa in the dandy walker cyst. After through explanation to the family the patient underwent rexploration and endoscopic removal of the migrated shunt in the posterior fossa was done through old burr hole. New shunt was placed in position well anchored to soft tissues at both ends. Post operative scan was satisfactory. Patient was followed up in OPD and is doing well with shunt holding well till date.

3. Discussion

In 2009 Tarun Agarwal etal mentioned about the unusual compliatations of the ventriculoperitoneal shunts. [1] In 2016 Lyon K etal mentioned about migration of a shunt into pulmonary vasculature. [2] In 2015 Oktay K etal mentioned about spontaneous extrusion of the shunt cathter through lumbar region. [3] In 2018 Badri M reported the trans oral migration of VP shunt. [4] In 2012 Ozturk mentioned about their case of trans anal migration of the shunt. [5] In 2008 Ali MN mentioned about their case of a child with trans cranial migration of the shunt [6].

Figure 1. Postoperative CT brain of patient

Figure 2. CT showing cranial migration of shunt

Figure 3. CT showing new shunt placement after endoscopic removal of migrated shunt

4. Conclusion

We attribute factors such as outsized burr hole, wide dural opening, and poor anchoring of the straight connector of shunt chamber to periosteum because of poor tissue preservation (redo operation). Repeated flushing of the shunt chamber by cranial direction pressing on it by the mother might be a contributing factor for loosening of anchor sutures and cranial migration. Patients undergoing VP shunt procedure must be under regular follow-up for early recognition of this potential complication. Cranial migration of VP shunt is usually not a fatal complication.

References

[1]   | Tarun Agarwal, Sanjay Pandey, Ashutosh Niranjan, Veenu Jain, Shashank Mishra, and Vishal Agarwal. Unusual complication of ventriculoperitoneal shunt surgery. J Pediatr Neurosci. 2009 Jul-Dec; 4(2): 122-123.
[2]   | Lyon K, Ban VS¹, Bedros N, Aoun SG, El Ahmadieh TY, White J. Migration of a Ventriculoperitoneal Shunt into the Pulmonary Vasculature: Case Report, Review of the Literature, and Surgical Pearls. World Neurosurg. 2016 Aug; 92: 585. e5-585.e11.
[3]   | Oktay K, Erkoc YS, Ethemoglu KB, Olguner SK, Sarac ME. Spontaneous Extrusion of Ventriculoperitoneal Shunt Catheter through the Right Lumbar Region: A Case Report and Review of the Literature. Pediatr Neurosurg. 2015; 50(6): 336-8.
[4]   | Badri M, Gader G, Belkahla G, Kallel J, Zammel I. Transoral migration of the inferior end of a ventriculoperitoneal shunt: A case report with literature review. Neurochirurgie. 2018 Jun; 64(3): 203-205.
[5]   | Ozturk H, Is M, Ozturk H, Kucuk A, Dosoglu M. Transanal protrusion of a ventriculoperitoneal shunt catheter. J Coll Physicians Surg Pak. 2012 Nov; 22(11): 733-4.
[6]   | Ali MN, Atif SM, Khan S. Intracranial migration of a ventriculoperitoneal shunt. J Coll Physicians Surg Pak. 2008 Jun; 18(6): 382-3.