Ventricular peritoneal shunt malfunction after operative correction of scoliosis: report of three cases |
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| Authors: | Lawrence P. Lai Michael R. Egnor Wesley V. Carrion Susan S. Haralabatos Michael T. Wingate |
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| Affiliation: | 1. Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, 90 Bergen St., Suite 3200, Newark, NJ 07103, USA;2. Department of Neurosurgery, Stony Brook University, 24 Research Way, Suite 200, Stony Brook, NY 11794, USA;3. Department of Orthopedic Surgery, Stony Brook University, 4 Technology Dr., Suite 11 and 12, East Setauket, NY 11733, USA;1. Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong;2. Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong;3. School of Aerospace, Tsinghua University, China;1. Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA;2. Department of Neurological Surgery, University of California Los Angeles, Los Angeles, California, USA;3. Department of Neurological Surgery, George Washington University, Washington, D.C., USA;1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People''s Republic of China;2. China National Clinical Research Center for Neurological Diseases, Beijing, People''s Republic of China;3. Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, People''s Republic of China;4. Beijing Key Laboratory of Brian Tumor, Beijing, People''s Republic of China;5. Department of Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, People''s Republic of China;6. China National Clinical Research Center for Neurological Diseases, NCRC-ND, Center of Brain Tumor, Beijing, People''s Republic of China;7. Institute for Brain Disorders, Beijing Key Laboratory of Brain Tumor, Beijing, People''s Republic of China;1. Division of Pulmonology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland;2. Department of Rheumatology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland;3. Department of Rheumatology, University Hospital Basel, Spitalstrasse 21, 4056, Basel, Switzerland;1. Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany;2. Department of Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany;3. Department of Plastic and Hand Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany;4. Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany;5. Department of Paediatrics, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany;6. Department of Trauma and Orthopedic Surgery, Paracelcus Medical University, Nürnberg, Germany |
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| Abstract: | Background contextTwo of the most common disease processes associated with hydrocephalus in children are spina bifida and intraventricular hemorrhage of prematurity, both of which are known to be also associated with spinal deformity in later childhood. The occurrence of shunt malfunction after mechanical injury or stress to the hardware has been well documented. Newer techniques in the treatment of neuromuscular scoliosis, including anterior release with segmental fixation, have resulted in more powerful corrections of these large spinal deformities. A new potential cause of shunt malfunction is the aggressive correction of scoliosis.PurposeTo report patients with neuromuscular curves averaging 100° who were subsequently recognized to have perioperative shunt malfunction.Study designThree case studies from a university hospital setting were included.Patient sampleAll three children were young adolescents and had-long term shunts. Two of the children had spina bifida and a third had cerebral palsy. All children underwent anterior release of their scoliosis with posterior segmental instrumentation, with unit rods and sublaminar wires. All had significant correction of their scoliosis.Outcome measuresMalfunctioning of the ventriculoperitoneal shunts were recorded.MethodsChart reviews of three cases were analyzed.ResultsTwo children had shunt malfunctions within a month of their surgery, and one child had intraoperative recognition and externalization of the shunt.ConclusionsOlder children undergoing repair of neuromuscular scoliosis are often preadolescents or adolescents who have the same indwelling shunt systems originally implanted in early infancy. The shunt may be brittle and calcified, and the peritoneal catheter may be short. The correction of scoliosis often results in an almost instantaneous growth of a few inches. Because of the potential difficulty in recognizing shunt malfunction in the perioperative period, consideration should be given for elective revision of the peritoneal catheter in children at risk. |
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| Keywords: | Ventriculoperitoneal shunt Scoliosis Surgery Cerebral palsy Spina bifida Malfunction |
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