Scrotal Migration of Lumboperitoneal Shunt Catheter in an Adult -Case Report-

Abstract

A 57-year-old man presented with recurrent parasagittal anaplastic meningioma of frontoparietal region. The tumor was extensively removed, and the dura was repaired with Gore-Tex surgical membrane. After the operation, subcutaneous cerebrospinal fluid (CSF) collection was observed in the fronto-parietal area and a lumboperitoneal shunt was placed. Four weeks after the shunt procedure, he complained of right scrotal swelling and recurrence of the CSF collection. Radiography revealed the coiled catheter in the scrotum. The catheter was surgically removed through a small incision in the skin of the scrotum under local anesthesia. Lumboperitoneal shunt is a simple and useful procedure to control CSF pressure, but catheter migration has been reported in infants and children. Shunt catheter can migrate into the scrotum even in an adult, as the vaginal process, through which the catheter seemed to have entered the scrotum, is patent in 5% of the adult population. In these cases, direct removal through a small incision is appropriate to remove the catheter.

Complications of CSF Shunting in Hydrocephalus

“…[ 49 , 55 , 71 ]. The drainage may also be affected by an inadequate absorption of hyperproteic CSF by the peritoneum resulting in ascites as happens with opticchiasmatic tumors [ 86 ]. Multi-compartmental hydrocephalus drained by multiple catheters may lead to symptoms and signs of malfunction by an asymmetrical distribution of forces within the diverse cavities of the CNS.…”

“…Treatment entails externalization of the catheter and drainage of the pseudocyst. If the fl uid is sterile, the existing shunt may be reimplanted or moved to a different site [ 86 ]. Infected pseudocysts require shunt removal, EVD placement, and antibiotics ( Fig.…”

“…Oncotic pressure of intraperitoneal fl uid is increased by infl ammation from infection, foreign body reactions to the catheter, or shuntdisseminated metastasis [ 86 ]. Ascites with abdominal distention and respiratory compromise may occur within weeks, months, or even years after shunt placement.…”

“…Some authors believe that children below the age of 3 years with moderate or greater ventriculomegaly should be operated on based on the fact that we cannot guarantee that they will not undergo a future brain damage and that it is preferable to err on the side of implanting a valve [ 86 ]. Children beyond 5 years of age with stable ventriculomegaly might be watched if their intellectual achievements are in the normal range and remain stable.…”

“…8.4 ) and regarded 11 patients with the Mini-Holter valve where intussusception of the valve ends into the valve tubing was noticed, possibly due to the siphoning effect. The same type of valve was mechanically disrupted in a case report in which the proximal metallic portion was "dislocated" out of its silicone sheath, possibly due to the growth-related traction applied to the fi xed valve [ 86 ]. In a recent retrospective study, the fi xed pressure-gravityassisted valve paediGAV (Aesculap AG & Co. KG, Tuttligen, Germany) and the programmable differential pressure Codman Hakim (Codman &Shurtlef, Inc., Raynham, USA) were compared and there was no signifi cant difference regarding shunt failure of mechanical etiology [ 7 ].…”