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Shunt tube calcification as a late complication of ventriculoperitoneal shunting.

Salim AD, Elzain MA, Mohamed HA, Ibrahim Zayan BE - Asian J Neurosurg (2015 Jul-Sep)

Bottom Line: The patient was then operated with removal of the old peritoneal catheter and replacing it with a new one.The second patient was 17-year-old boy originally was a case of posterior fossa pilocytic astrocytoma associated with obstructive hydrocephalus, he was operated with both shunting for the hydrocephalus and tumor removal, 6 years later he presented with shunt exposure.Disturbed calcium and phosphate metabolisms may be involved in this condition.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, National Center of Neurological Sciences, Khartoum, Sudan.

ABSTRACT
Shunt calcification is a rare complication of ventriculoperitoneal shunting that occurs years later after the initial operation this condition is rarely reported in literature. Two patients with shunt calcifications were described. The first patient was 17-year-old lady who had congenital hydrocephalus and shunted in the early infancy, she was presented recently complaining of itching of the skin along the shunt track and limitation of neck movement. The patient was then operated with removal of the old peritoneal catheter and replacing it with a new one. The second patient was 17-year-old boy originally was a case of posterior fossa pilocytic astrocytoma associated with obstructive hydrocephalus, he was operated with both shunting for the hydrocephalus and tumor removal, 6 years later he presented with shunt exposure. Calcification of the shunt tube was discovered intraoperatively upon shunt removal. Shunt calcification has been observed mainly in barium-impregnated catheters. Introducing plain silicone-coated shunt tubing may reduce the rate of this condition. The usual complaints of the patients suffering from this condition are pain in the neck and chest wall along the shunt pathway and limitation of the neck movement due to shunt tube tethering, but features of shunt dysfunction and skin irritation above the shunt may be present. In this review, plain X-ray and operative findings showed that the most extensive calcification is present in the neck, where the catheters were subject to heavy mechanical stress. Disturbed calcium and phosphate metabolisms may be involved in this condition. Shunt calcification is a rare condition that occurs due to material aging presenting with features of shunt tethering, dysfunction or overlying skin irritation. Plain X-ray is needed to detect calcification while shunt removal, replacement or endoscopic third ventriculostomy may carry solution for this condition.

No MeSH data available.


Related in: MedlinePlus

Plain X-ray of the first patient showing calcification around the shunt tube in the neck
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Figure 2: Plain X-ray of the first patient showing calcification around the shunt tube in the neck

Mentions: Her CT scan of the brain [Figure 1] showed slightly dilated left lateral ventricle. The ventricular catheter was well placed inside the ventricle, but there were calcifications scattered in the cerebral matter. Her serum calcium was (11.1 mg/dL) and her serum phosphate was (4.3 mg/dL). Shunt view X-ray [Figure 2], showed some calcification around the shunt tube. Shunt revision was decided in fear of shunt penetration as the patient was continuously scratching the skin overlying the shunt track. A new abdominal catheter was inserted and was then fixed to the valve-ventricular catheter complex. Following the procedure, the patient was relieved from itching, pain and neck movement limitation [Figure 3].


Shunt tube calcification as a late complication of ventriculoperitoneal shunting.

Salim AD, Elzain MA, Mohamed HA, Ibrahim Zayan BE - Asian J Neurosurg (2015 Jul-Sep)

Plain X-ray of the first patient showing calcification around the shunt tube in the neck
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553745&req=5

Figure 2: Plain X-ray of the first patient showing calcification around the shunt tube in the neck
Mentions: Her CT scan of the brain [Figure 1] showed slightly dilated left lateral ventricle. The ventricular catheter was well placed inside the ventricle, but there were calcifications scattered in the cerebral matter. Her serum calcium was (11.1 mg/dL) and her serum phosphate was (4.3 mg/dL). Shunt view X-ray [Figure 2], showed some calcification around the shunt tube. Shunt revision was decided in fear of shunt penetration as the patient was continuously scratching the skin overlying the shunt track. A new abdominal catheter was inserted and was then fixed to the valve-ventricular catheter complex. Following the procedure, the patient was relieved from itching, pain and neck movement limitation [Figure 3].

Bottom Line: The patient was then operated with removal of the old peritoneal catheter and replacing it with a new one.The second patient was 17-year-old boy originally was a case of posterior fossa pilocytic astrocytoma associated with obstructive hydrocephalus, he was operated with both shunting for the hydrocephalus and tumor removal, 6 years later he presented with shunt exposure.Disturbed calcium and phosphate metabolisms may be involved in this condition.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, National Center of Neurological Sciences, Khartoum, Sudan.

ABSTRACT
Shunt calcification is a rare complication of ventriculoperitoneal shunting that occurs years later after the initial operation this condition is rarely reported in literature. Two patients with shunt calcifications were described. The first patient was 17-year-old lady who had congenital hydrocephalus and shunted in the early infancy, she was presented recently complaining of itching of the skin along the shunt track and limitation of neck movement. The patient was then operated with removal of the old peritoneal catheter and replacing it with a new one. The second patient was 17-year-old boy originally was a case of posterior fossa pilocytic astrocytoma associated with obstructive hydrocephalus, he was operated with both shunting for the hydrocephalus and tumor removal, 6 years later he presented with shunt exposure. Calcification of the shunt tube was discovered intraoperatively upon shunt removal. Shunt calcification has been observed mainly in barium-impregnated catheters. Introducing plain silicone-coated shunt tubing may reduce the rate of this condition. The usual complaints of the patients suffering from this condition are pain in the neck and chest wall along the shunt pathway and limitation of the neck movement due to shunt tube tethering, but features of shunt dysfunction and skin irritation above the shunt may be present. In this review, plain X-ray and operative findings showed that the most extensive calcification is present in the neck, where the catheters were subject to heavy mechanical stress. Disturbed calcium and phosphate metabolisms may be involved in this condition. Shunt calcification is a rare condition that occurs due to material aging presenting with features of shunt tethering, dysfunction or overlying skin irritation. Plain X-ray is needed to detect calcification while shunt removal, replacement or endoscopic third ventriculostomy may carry solution for this condition.

No MeSH data available.


Related in: MedlinePlus