Pediatric Neurosurgery
Original Paper
Evidence for a Patent Fibrous Tract in Fractured, Outgrown, or Disconnected Ventriculoperitoneal ShuntsClyde B.L. · Leland Albright A.Department of Neurological Surgery, Children’s Hospital of Pittsburgh, Pa., USA
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Article / Publication Details
Received: January 23, 1995
Accepted: May 12, 1995
Published online: March 06, 2008
Issue release date: 1995
Number of Print Pages: 6
Number of Figures: 0
Number of Tables: 0
ISSN: 1016-2291 (Print)
eISSN: 1423-0305 (Online)
For additional information: https://www.karger.com/PNE
Abstract
As cerebrospinal fluid (CSF) shunts function for several years, outgrowth and disconnection of the distal catheter are seen more frequently. Though a shunt revision is clearly indicated if patients are symptomatic, asymptomatic patients with a disconnection or who have outgrown the distal catheter may no longer require CSF diversion. This follows an assumption that the shunt is no longer functioning and, in an asymptomatic patient, no longer required. However, patent fibrous tracts have been postulated which may allow passage of CSF through disconnected or outgrown distal catheters. We have recently treated 2 patients with ventriculoperitoneal (VP) shunts with evidence of a persistent fibrous tract. A 13-year-old boy was asymptomatic for 2 years after radiographs revealed an outgrown distal VP shunt catheter, after which he acutely deteriorated and died from massive hydrocephalus, although the entire shunt was patent. Another 14-year-old boy who was profoundly retarded presented with subtle changes in his daily activity. Shunt radiographs revealed two disconnections and a broken valve, but a shunt tap revealed a normal opening pressure (OP). A radionuclide shuntogram revealed rapid passage of isotope through fibrous sheaths at the disconnections, and into the peritoneum. A shunt revision was performed and the patient returned to his previous level of health. Patients with outgrown or disconnected distal catheters may be asymptomatic and/or have normal OP, and must not be assumed to have arrested hydrocephalus. A ventricular pressure measurement and radionuclide shuntogram should be performed to rule out a patent persistent fibrous tract.
© 1995 S. Karger AG, Basel
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Article / Publication Details
Received: January 23, 1995
Accepted: May 12, 1995
Published online: March 06, 2008
Issue release date: 1995
Number of Print Pages: 6
Number of Figures: 0
Number of Tables: 0
ISSN: 1016-2291 (Print)
eISSN: 1423-0305 (Online)
For additional information: https://www.karger.com/PNE
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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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