• Ahmed A M Ezzat, Mohamed A R Soliman, Amr A Hasanain, Mohamed A Thabit, Hesham Elshitany, Haitham Kandel, Sameh H Abdel-Bari, Ahmed M F Ghoul, Ahmed Abdullah, Mohamed F M Alsawy, Ammar A Ghaleb, Ahmed Al Menabbawy, Ahmed A Marei, Bassante Abd El Razik, Schroeder Henry W S HWS Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany., Sascha Marx, Ahmed Zohdi, and Ehab El Refaee.
• Department of Neurosurgery, Cairo University, Cairo, Egypt.
• World Neurosurg. 2018 Nov 1; 119: e131-e137.

BackgroundVentriculoperitoneal (VP) shunting is the most commonly performed procedure in the treatment of hydrocephalus. VP shunt migration can occur at different sites. The aim of the study was to present different sites of abnormal distal shunt location, pathophysiology, and the management in each situation.MethodsBetween 2014 and 2017, all patients with hydrocephalus in the Department of Neurosurgery, Cairo University, were gathered prospectively. All pediatric patients below the age of 12 years with shunt migration of the distal end of the VP shunt were identified.ResultsOf 1092 patients operated on by the VP shunt between 2014 and 2017, 15 presented with shunt dysfunction because of distal shunt migration (6 anal, 3 scrotal, 1 colon, 1 peroral, 1 upper lumbar extrusion, 1 paraspinal, 1 penile, and 1 umbilical). Especially upper lumbar extrusion and paraspinal shunt location are extremely rare. All the 15 patients were treated successfully with VP shunts and prospectively followed until they presented with complications on different occasions.ConclusionsPeritoneal complications are among the most common causes of VP failure. We present a rare complication where the shunt migrates outside the peritoneal cavity elsewhere with ambiguous pathogenesis. Special considerations have to be appointed during the shunt revision surgeries of these cases.Copyright © 2018 Elsevier Inc. All rights reserved.

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