Abstract
Shunt failure requiring reintervention remains a common complication of hydrocephalus
treatment. Here, we report a novel cause of mechanical shunt obstruction in an adult
patient: position-dependent intermittent occlusion via an infusion port catheter.
A 51-year-old woman with a grade II oligodendroglioma presented in a delayed fashion
following surgery with a pseudomeningocele. She underwent ventriculoperitoneal shunt
placement due to communicating hydrocephalus, resolving her pseudomeningocele. Shortly
thereafter, she underwent placement of a subclavian infusion port at an outside institution.
Her pseudomeningocele returned. Imaging demonstrated close proximity of her port catheter
to the shunt catheter overlying the clavicle. Her shunt was tapped demonstrating a
patent ventricular catheter with normal pressure. She underwent shunt exploration
after her pseudomeningocele did not respond to valve adjustment. Intraoperative manometry
demonstrated head position-dependent distal catheter obstruction. Repeat manometry
following distal catheter revision demonstrated normal runoff independent of position.
Her pseudomeningocele was resolved on follow-up. To our knowledge, this is the only
reported case of intermittent, position-dependent distal catheter obstruction. Shunted
patients with concern for malfunction following subclavian infusion port placement
should be evaluated for possible dynamic obstruction of their distal catheter when
the two catheters are in close proximity along the clavicle.
Keywords
pseudomeningocele - ventriculoperitoneal shunt - shunt malfunction - mechanical obstruction
