• John K Houten, Shiela Smith, and Amit Y Schwartz.
• Division of Neurosurgery, Maimonides Medical Center, Brooklyn, New York, USA; Department of Neurosurgery, Hofstra Northwell School of Medicine, Hempstead, New York, USA. Electronic address: jkhmd@yahoo.com.
• World Neurosurg. 2017 Aug 1; 104: 1046.e13-1046.e14.

BackgroundVentriculoperitoneal (VP) shunting is a common neurosurgical procedure to treat hydrocephalus that diverts cerebrospinal fluid from the cerebral ventricles to the peritoneal cavity for reabsorption. The distal catheter may potentially migrate through any potential or iatrogenic opening in the peritoneal cavity. Increasingly successfully management of childhood hydrocephalus and adult-onset conditions leading to hydrocephalus, such as subarachnoid hemorrhage, is leading many adult female patients harboring VP shunts needing to undergo hysterectomy. Hysterectomy creates a potential defect though which a VP shunt catheter may migrate. It is not known whether the hysterectomy cuff closure technique may affect the likelihood of distal catheter migration though the repair site.Case DescriptionWe report the case of a 38-year-old woman with a VP shunt who underwent laparoscopic hysterectomy via an open vaginal cuff technique who subsequently presented with vaginal cerebrospinal fluid leakage secondary to migration of the distal shunt catheter through the hysterectomy cuff.ConclusionsVaginal migration of the distal VP shunt catheter is a possible complication of hysterectomy. The authors postulate that an open cuff hysterectomy closure technique may increase the risk of catheter migration, an issue that may be better understood with further investigation.Copyright © 2017 Elsevier Inc. All rights reserved.

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