Recurrent subgaleal migration of the peritoneal catheter of ventriculoperitoneal shunt: A case report and literature review

Abstract

Introduction: Complications from ventriculoperitoneal shunt (VPS) are common, but the migration of the distal or peritoneal catheter to the subgaleal space is rare. Many theories are trying to explain them, with no consensus. Besides, no well-documented method that helps in solving this problem. The literature was reviewed to look for multiple factors that may have a role. Case description: A ten months boy with Myelomeningocele post-repair, hydrocephalus post shunt insertion who had a shunt malfunction, and underwent VPS revision with changing the location from occipital to frontal on the same side. Afterward, he developed two recurrent migration of the distal catheter to subgaleal space even though it was done conventionally. Suspected theory and the method used to solve this rare complication was explained. Conclusion: The migration of the peritoneal catheter to subgaleal space is a rare complication that needs to be taken into consideration during the assessment for distal shunt malfunction. The dead space should be closed, and the catheter needs to be anchored to avoid migration, especially in a redo case. In the study case, Windless motion due to the excessive head movement with the presence of the dead space from the previous shunt is most likely cause, as it didn't recur after we solve those factors.