Endo Masamichi, Hanakita Shunya, Oya Soichi
Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
NMC Case Rep J. 2022 Apr 21;9:73-76. doi: 10.2176/jns-nmc.2021-0407. eCollection 2022.
There are various causes of ventriculoperitoneal shunt (VPS) failures. Patients who receive shunt placement during childhood need follow-up for decades as they grow, especially in the early periods of life. Herein, we report a rare case of mechanical shunt obstruction in a pediatric patient in whom a cramped burr hole and skull growth compressed the tube and obstructed cerebrospinal fluid flow. A 6-year-old girl presented to our hospital with nausea and headache. She was born preterm and developed intraventricular hemorrhage followed by VPS placement for hydrocephalus; thereafter, she had no need for shunt revision until this admission. After careful evaluation of the patency of the shunt system, the presence of tube stenosis was suspected at the site of the shunt tube penetrating the burr hole of the skull. During the operation to revise the shunt tube, a compressed tube was observed at the exit from the skull. After enlarging the narrowed burr hole and reconstructing the proximal catheter, her symptoms immediately improved. Previously, only one case of shunt malfunction due to tube compression from bone growth has been reported in a pediatric patient with osteopetrosis. To the best of our knowledge, such a condition has never been described in pediatric patients with no metabolic bone disease. Although it is rare, obstruction at the exit from the skull due to bone growth should be included in differential diagnoses for young patients during a long follow-up after VPS.
脑室腹腔分流术（VPS）失败有多种原因。儿童期接受分流管置入的患者在成长过程中需要数十年的随访，尤其是在生命早期。在此，我们报告一例儿科患者机械性分流管梗阻的罕见病例，该患者因狭窄的骨孔和颅骨生长压迫分流管，阻碍了脑脊液流动。一名6岁女孩因恶心和头痛就诊于我院。她早产，发生脑室内出血，随后因脑积水接受了VPS置入术；此后，直至此次入院前她都无需进行分流管翻修。在仔细评估分流系统的通畅性后，怀疑在分流管穿透颅骨骨孔的部位存在管腔狭窄。在进行分流管翻修手术时，在颅骨出口处观察到一根受压的分流管。扩大狭窄的骨孔并重建近端导管后，她的症状立即得到改善。此前，仅报道过1例患有骨质石化症的儿科患者因骨生长压迫分流管导致分流功能障碍。据我们所知，在无代谢性骨病的儿科患者中从未描述过这种情况。虽然罕见，但在VPS术后长期随访期间，对于年轻患者，因骨生长导致的颅骨出口处梗阻应列入鉴别诊断范围。
