1. Microscopic removal of deep seated retained ventricular catheter in a child with recurrent VP shunt infection Dr M Taha, Department of Neurosurgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
Case:
We present a case of one year-old child who had VP shunt inserted soon after birth for congenital hydrocephalus. The child had several shunt revision (3 in total) for obstructions and infections performed in another hospital. All infections were caused by one bacterium (Staph. Epidermis). She was admitted to our hospital with fever, vomiting, and drowsiness. CT head showed multi-loculated hydrocephalus. 2 ventricular catheters were found on belong to her right frontal VP shunt and one isolated and located deep in the brain parenchyma between the right sylvian fissure and the right thalamus . The reservoir was tap and showed CSF infection with the same bacteria. She had first an emergency surgery for removal of her shunt and insertion of EVD, and then we decided to remove her deep seated ventricular catheter to prevent further recurrence of her infection. The second surgery was performed microscopically with navigation (Stealth) (figure below). All adhesions around the catheter were released carefully under the microscope to prevent any bleeding when the tube is pulled out. After the clearance of her CSF infection a new shunt was inserted. During her 18 months follow up she had no more shunt infection.
Discussion: Surgical removal of retained ventricular catheter following recurrent or persistent shunt infection is usually simple and can be performed through the pre-existent burr hole if possible or endoscopically if away from the brain surface. In case of deep-seated catheter away from the ventricle we advise a microscopic removal through a small craniotomy with navigation to ensure a precise localization. The site of the craniotomy should be away from eloquent areas to preserve neurological function. We also recommend that all adhesions are release under microscopic vision before pulling out the tube to prevent any hemorrhage in the deep tissue of the brain. Conclusion; This case emphasizes the need for removal of all retained shunt catheters to prevent recurrent shunt infections. In cases where catheters are outside the ventricles or endoscopy is not feasible; microscopic removal with navigation should be performed. References: 1-Pindrik J1, Jallo GI, Ahn ES. Complications and subsequent removal of retained shunt hardware after endoscopic third ventriculostomy: case series, J Neurosurg Pediatr Jun;11(6): Vajramani GV1, Jones G, Bayston R, Gray WP. Persistent and intractable ventriculitis due to retained ventricular catheters, Br J Neurosurg Dec;19(6):
Presented at the World Federation of Neurosurgical Societies, Istanbul ,Turkey, 2017.