Proof of the patent subcutaneous fibrous tract in children with V-P shunt malfunction

A connective tissue sheath that forms around the peritoneal catheter of sil icone ventriculo-peritoneal (V-P) shunt tubing is quite often observed in c hildren with V-P shunts. However, proof of the passage of cerebrospinal flu id (CSF) through these sheaths has been reported in only one published stud y to date. We present four cases associated with chronic malfunction of the V-P shunt peritoneal catheter. In these cases, CSF passage through the sub cutaneous fibrous tract, which had a pericatheter connective tissue sheath, was demonstrated around the V-P shunt peritoneal catheter. In the first ca se the patient suffered intermittent headache attacks over a long period of time; abdominal migration of the peritoneal catheter was detected. The sec ond patient, who had been asymptomatic in the follow-up period with an outg rown peritoneal catheter, was admitted with acute hydrocephalus symptoms. A peritoneal catheter disconnection was detected in another patient, who had had multiple shunt revisions previously. In the last case, an obstruction of the peritoneal catheter was detected. The existence of the subcutaneous fibrous tract and its function were demonstrated by radio-opaque shuntogram in two cases and radionuclide shuntogram in the other two cases. In all fo ur cases V-P shunt re vision was performed. Within this study, the possible passage of CSF through a fibrous tract in cases of migration, outgrowth, d isconnection or obstruction of the peritoneal shunt catheter was demonstrat ed. In conclusion, patients with shunt malfunction with a well-grown perica theter fibrous sheath who are either asymptomatic or minimally symptomatic and show no evidence of active ventricular dilatation on their cranial CT s can should not be regarded as having arrested hydrocephalus until radio-opa que or radionuclide shuntogram studies have been done.