Endovascular Retrieval of Detached Ventriculoatrial Shunt into Pulmonary Artery in Pediatric Patient: Case Report

The management of hydrocephalus represents a neurosurgical challenge. Ventriculoperitoneal (VP) shunts are usually the treatment of choice for hydrocephalus. However, when VP shunt is not an option, ventriculoatrial (VA) shunt becomes a second choice. VA shunts have special complications such as postoperative neck hematomas, shunt nephritis, and migration of the distal segment. There are two main techniques for the retrieval of migrated VA shunt: either by retrieval of the broken segment by thoracotomy, which is highly invasive, or by transvenous approach. A 9-year-old boy presented with severe cerebral palsy, who was VP shunt dependent since birth. The patient developed generalized cerebrospinal fluid (CSF) ascites with peritonitis. The shunt was externalized and infection was treated with intravenous antibiotics. Two weeks later, and due to previous multiple abdominal procedures, it was decided to go for VA shunt and the procedure went well without complications. One month later, the patient presented to emergency department with neck swelling; shunt x-ray showed shunt breakage at clavicular level and the tip of the shunt was dislodged into the pulmonary artery. Under general anesthesia and after getting informed consent, through femoral vein, VA shunt was retrieved successfully without complications and new VP shunt was inserted. Migration of the distal segment of a broken atrial catheter is rare, but has a significant complication and is major cause of mortality. Endovascular retrieval of migrated shunts is less invasive, is feasible, and prevents further complications. There has been similar case in the adult English literature; however, to the best of our knowledge, this is the first reported case in the English literature of a successful endovascular retrieval of migrated dislodged VA shunt in pediatrics.