Huliyappa Harsha A, Jaiswal Manish, Singh Sunil K, Ojha Balakrishna, Chandra Anil, Chhitij Srivastava
Department of Neurosurgery, JSS Medical College and University, Mysore, Karnataka, India.
Department of Neurosurgery, King George's Medical University, Lucknow, Uttar Pradesh, India.
J Pediatr Neurosci. 2017 Jan-Mar;12(1):93-95. doi: 10.4103/1817-1745.205654.
Distal migration of shunt is a very common occurrence. Proximal migration of shunt is rare and possible pathophysiological mechanisms to explain this unusual complication is rarely attempted. A 5-month-old child shunted for posttraumatic hydrocephalus presented 1.5 years later with raised intracranial pressure and seizures. Imaging showed subdural hygroma, partial intracranial migration of shunt/chamber. On endoscopy, choroid plexus was adherent to shunt tip and some pericranial tissue was found in the anchoring suture (intraventricularly displaced). Shunt was retrieved endoscopically and diversion established by endoscopic third ventriculostomy with symptoms free follow-up. Host-related and surgical factors have been postulated. Tug-of-war effect on the anchoring suture and collapsing cortex are the possible mechanisms that explain proximal migration in our case. Three-point fixation of the chamber to pericranium, small burr hole with a smaller durotomy, can prevent shunt migration. Proximal shunt migrations should be dealt with endoscopy so as to avoid complications.
分流管向远端移位是非常常见的情况。分流管向近端移位很少见，且很少有人尝试解释这种不寻常并发症的可能病理生理机制。一名因创伤后脑积水而接受分流术的5个月大儿童，1.5年后出现颅内压升高和癫痫发作。影像学检查显示硬膜下积液，分流管/脑室腔部分颅内移位。在内镜检查中，脉络丛附着于分流管尖端，在固定缝线处发现一些颅周组织（移位至脑室内）。通过内镜取出分流管，并通过内镜下第三脑室造瘘术建立分流，随访期间症状消失。已推测出与宿主相关和手术相关的因素。在我们的病例中，对固定缝线的拔河效应和萎缩的皮质是解释近端移位的可能机制。将脑室腔三点固定于颅骨膜，采用小骨孔和较小的硬脑膜切开术，可防止分流管移位。近端分流管移位应通过内镜处理，以避免并发症。
