Brunozzi Denise, LoPresti Melissa A, McGrath Jennifer L, Alden Tord D
1Department of Neurological Surgery, University of Illinois Chicago, Chicago, Illinois.
2Department of Neurosurgery, Division of Neurological Surgery, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
J Neurosurg Case Lessons. 2023 Nov 27;6(22). doi: 10.3171/CASE23310.
Ventriculoperitoneal shunting (VPS) is a standard procedure for the treatment of hydrocephalus, and the management of its complications is common in the practice of pediatric neurosurgery. Shunt exposure, though a rare complication, can occur because of thin, fragile skin, a young patient age, protuberant hardware, poor scalp perfusion, and a multitude of other patient factors.
The authors report a complex case of VPS erosion through the scalp in a young female with Pfeiffer syndrome treated with external ventricular drainage, empirical antibiotics, and reinternalization with countersinking of replaced shunt hardware into the calvarium to prevent internal skin pressure points, reduce wound tension, and allow wound healing.
Recessing the shunt hardware, or countersinking the implant, into the calvarium is a simple technique often used in functional neurosurgical implantation surgeries, providing a safe surgical strategy to optimize wound healing in select cases in which the skin flap is unfavorable.
脑室腹腔分流术（VPS）是治疗脑积水的标准手术，其并发症的处理在小儿神经外科实践中很常见。分流装置外露虽是一种罕见的并发症，但由于皮肤薄且脆弱、患者年龄小、硬件突出、头皮灌注不良以及众多其他患者因素，仍可能发生。
作者报告了一例患有 Pfeiffer 综合征的年轻女性患者，其 VPS 分流装置经头皮侵蚀，治疗方法包括进行外部脑室引流、经验性使用抗生素，以及将更换后的分流硬件埋入骨内重新植入，以防止头皮内部压力点形成、减轻伤口张力并促进伤口愈合。
将分流硬件埋入骨内，即把植入物埋入骨内，是功能神经外科植入手术中常用的一种简单技术，为在皮瓣情况不佳的特定病例中优化伤口愈合提供了一种安全的手术策略。
