Proximal Migration of Lumboperitoneal Shunt Catheter Up To Cervical Spine
Lumboperitoneal (LP) shunt had been in use as an internal cerebrospinal fluid (CSF) diversion for a variety of different indications, namely benign intracranial hypertension, communicating hydrocephalus, slit ventricle syndrome and CSF fistulas. Generally considered to be a simple surgical procedure but certain potential complications are associated with this technique, including chronic subdural hematoma, subarachnoid haemorrhage, acquired Chiari malformations and migration of the shunt tubing.1, 2 Proximal intrathecal migration of LP shunt catheter tip, high up in the cervical spine is a rare reported complication.3, 4, 5, 6, 7, 8 If doubtful on X-rays, Computed Topography (CT) scan confirms the diagnosis. Although multi factorial, this proximal migration is usually because of a faulty technique when anchoring sutures are loosened or cut. Measures employed to avoid this potential complication include appropriate technique for securing the LP shunt tube at the proximal lumbar and the distal peritoneal insertion sites with suture collars, thus enabling fixation of the tube. We report a case of an obese middle age female who developed proximal migration of the lumbar tube up to cervical spine, after having undergone LP shunt for pseudotumor cerebri.
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