Ventriculoperitoneal Shunt Disconnection [Neurosurgery Wiki]

This page is read only. You can view the source, but not change it. Ask your administrator if you think this is wrong.
====== Ventriculoperitoneal Shunt Disconnection ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1ZcXDdiuMGSeBPAOpQfqj9GHTF9fE3j8jd1BLKx9WCeZ8eUgEp/?limit=15&utm_campaign=pubmed-2&fc=20250606010332}}

{{ ::ventriculoperitoneal_shunt_disconnection_ct.png?300|}}
----


**Ventriculoperitoneal (VP) shunt disconnection** is a mechanical failure of the shunt system characterized by physical separation of one or more components, such as the ventricular catheter, valve, or peritoneal catheter. This interruption in CSF flow can lead to increased intracranial pressure and clinical deterioration.

===== Clinical Features =====

Symptoms typically reflect shunt malfunction and raised intracranial pressure:

  * Headache
  * Nausea or vomiting
  * Lethargy or altered level of consciousness
  * Papilledema
  * Ventricular enlargement on imaging
  * Swelling or palpable gap along the shunt tract
  * Pediatric patients may present with rapid head growth

===== Diagnosis =====

  * **Shunt series X-ray**:
    * Cervical, thoracic, and abdominal views.
    * May show discontinuity or disconnection of tubing.
  * **CT scan of the brain**:
    * Assesses for hydrocephalus or ventricular dilation.
  * **Radionuclide shuntogram or contrast study**:
    * Evaluates CSF flow through the shunt.
  * **Shunt tap (valve puncture)**:
    * Measures proximal pressure and patency.

===== Common Disconnection Sites =====

^ Site                          ^ Risk Factors                                       ^
| Valve-catheter junction       | Poor fixation, surgical technique                  |
| Proximal connector (ventricle) | Growth in pediatric patients, repeated revisions  |
| Distal connector (peritoneum) | Traction, abdominal adhesions, fibrosis            |

===== Management =====

  * Urgent surgical revision.
  * Replace or reconnect affected components.
  * Consider complete shunt replacement if the system is old or damaged.
  * Obtain CSF cultures if infection is suspected.

===== Prevention =====

  * Secure fixation of all components during initial surgery.
  * Minimize tension on connectors.
  * Regular follow-up, especially in growing children.

----


Mechanical [[shunt failure]] from [[shunt disconnection]] or [[shunt fracture]] is a significant cause of [[shunt failure]]
((Erol FS, Ozturk S, Akgun B, Kaplan M. [[Ventriculoperitoneal shunt malfunction]] caused by fractures and disconnections over 10 years of follow-up. Childs Nerv Syst. 2017 Mar;33(3):475-481. doi: 10.1007/s00381-017-3342-0. Epub 2017 Jan 17. PMID: 28097382.)).

[[Shunt catheter]] disconnection has been well described in the literature as a cause of [[shunt malfunction]]. 

The distal component among the [[valve]] and the [[peritoneal catheter]] is the most probable site of disconnection
((Ghritlaharey RK, Budhwani KS, Shrivastava DK, Gupta G, Kushwaha AS, et al. (2007) Trans-anal protrusion of ventriculo-peritoneal shunt catheter with silent bowel perforation: report of ten cases in children. Pediatr Surg Int 23(6): 575-580.)).

===== Risk factors ===== 

[[Ventriculoperitoneal shunt disconnection risk factors]].

===== Diagnosis =====

Suspect with [[Undershunting]].

see [[Shunt evaluation]].

===== Prevention =====

[[Ventriculoperitoneal shunt disconnection prevention]].

===== Complications =====
Shunt catheters that migrate peritoneally bring the possibility of visceral injury, predominantly perforation of the bowel. These disconnected or fractured shunts can be revised by substituting or reconnecting the components, or by replacing the whole shunt system. In the modern era, the laparoscopic retrieval of migrated shunt catheters can be done safely, either as an emergency or an elective process 
((Vinchon M, Baroncini M, Laurent T, Patrick D (2006) Bowel perforation caused by peritoneal shunts catheters: diagnosis and treatment. Neurosurgery 58(1): 76-82.)).

===== Case reports =====

A 5-year-old boy with a right-sided ventriculoperitoneal shunt presented with a 3-month history of progressively enlarging subperiosteal fluid collection in the scalp, which started in the right parietal region and had spread and extended across the midline to occupy both parietal regions. There were no changes in symptoms or signs from those observed 3 months previously. A CT scan confirmed the collection of fluid under the scalp over both parietal regions. The peritoneal catheter was found to be disconnected from the distal end of the functioning valve, which drained cerebrospinal fluid into the subperiosteal space. Distention of the parietal subperiosteal space led to stretching and tearing of the emissary veins. This resulted in the formation of a hydrohematocele. The spread of fluid to the opposite parietal region may be due to a disorganized and loose attachment of the periosteum to the widely separated sagittal suture
((Choudhury AR. Cephalhydrohematocele due to catheter valve disconnection
following ventriculoperitoneal shunting. Childs Nerv Syst. 1988 Dec;4(6):376-7.
PubMed PMID: 3245948.)).
----
An 8-year-old boy with a right VP shunt was referred because of progressive loss of consciousness in the morning. A CT scan of the head established moderate [[hydrocephalus]]. A shunt series presented a [[disconnection]] of the distal tube of the [[shunt]] as the distal part was free in the abdominal cavity. The patient experienced a complete shunt revision. The abdominal incision was revived and the tube removed from the abdominal cavity gently. The patient was discharged 72 h later
((Haddadi K, Qazvini HRG, Sahebi M (2017) Ventriculoperitoneal Shunt Disconnection Associated with Loss of Consciousness in a Child Patient: A Case Report and Review of Intra-Abdominal Complications of Vp Shunts. J Neurol Stroke 7(3): 00237. DOI: 10.15406/jnsk.2017.07.00237)).

===== References =====