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CC BY-NC-ND 4.0 · J Neurol Surg Rep 2021; 82(02): e17-e20
DOI: 10.1055/s-0041-1726274
Case Report

Dynamic Occlusion of Distal Ventriculoperitoneal Shunt Catheter after Infusion Port Placement: A New Shunt Malfunction

Lacey M. Carter
1   Department of Neurosurgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
,
Camille K. Milton 
1   Department of Neurosurgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
,
Kyle P. O'Connor
1   Department of Neurosurgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
,
Arpan R. Chakraborty 
1   Department of Neurosurgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
,
Tressie M. Stephens
1   Department of Neurosurgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
,
Chad A. Glenn
1   Department of Neurosurgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
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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

Disclosures

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. There are no competing interests with regard to this project. No portion of this work has been presented or published at a prior date.




Publication History

Received: 10 June 2020

Accepted: 17 November 2020

Article published online:
14 June 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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