Traumatic Migration of a Shunt Valve Into the Cyst

Abstract

Hardware migration is an unavoidable complication of intracranial shunt surgeries. Traumatic dislodgement of a valve into the skull occurred in a young boy with a cystoperitoneal shunt following a head injury. Shortly before admission, he fell off his wheelchair and hit his head on the floor. Medical treatment was initiated to manage the patient for traumatic intracranial hemorrhage, and he was subsequently discharged home. However, 2 weeks after discharge, computed tomography (CT) showed a migrating valve and associated meningitis. The CT scan showed that the shunt valve was deep in the temporal cyst. The dislodged shunt valve was left in situ because the parents did not want surgical intervention. The author demonstrates how this complication develops and suggests preventive measures through reviews on the migration of the shunt into the cranium.

Keywords: Arachnoid cysts; Head trauma; Meningitis.

FIGURE 1. Traumatic migration of a shunt valve into the cranium. (A) Head scan shows acute hemorrhages in the epidural and subdural space with minimal pneumocephalus. There is a scalp contusion over the left side of the head. (B) Neck X-ray reveals a calcification and fragmentation in the disconnected distal shunt tubing. (C) This section depicts the burr hole-type reservoir to be in the correct position. (D & E) The size of the perforation is larger than the base of the device in the inset. Note the valve migrating into the deep portion of the cyst at the second admission.