Case Report: A Rare Case of Fourth Ventricle to Spinal Subarachnoid Space Shunt Migration: Surgical Pearl and Literature Review

Abstract

Background: In the event of syringomyelia communicating with the fourth ventricle, a fourth ventricle to cervical subarachnoid space shunting could be proposed. Case Report: In this review article, we describe the case of a 40-year-old woman who had a previously implanted fourth ventricle to spinal subarachnoid space shunt for the treatment of syringomyelia in the context of Chiari syndrome. The catheter migrated intradurally to the lumbosacral space, but in the absence of neurological repercussions, we decided to leave it in place. Conclusions: To the best of our knowledge, this is the first case described in the literature review of a catheter migration in the subarachnoid space from occipitocervical to lumbosacral level.

Keywords: Chiari syndrome; catheter migration; cranio-cervical junction; fourth ventricle to spinal subarachnoid space shunt; syringomyelia; trapped fourth ventricle; trapped fourth ventricle with syrinx.

Figure 1

Lumbar x-rays: anteroposterior (A) and lateral views (B), MRI sagittal view, respectively, T1 (C), and T2 (D) sequences. The presence of the catheter was hard to identify even for experienced radiologists, as its intensity on T1-weighted and T2-weighted images was similar to that of the cauda equina nerve roots. (E) Lumbar CT scanner sagittal view showing the initially placed fourth ventricle to cervical subarachnoid space shunt located at L2-S1 level measuring around 15 cm in length and 2.5 mm in diameter. (F,G) Three-dimensional (3D) reconstructions. There is no local compression of neurological elements.

Figure 2

(A) Lateral x-ray showing the ventriculoperitoneal shunt. (B) No hydrocephaly and dilatation of fourth ventricles on MRI sagittal view T1 sequence. The syrinx has completely regressed (C) on MRI sagittal view T2 sequence.