Flexible neuroendoscopic surgery in the treatment of ventriculoperitoneal shunt blockage with ventriculitis

Abstract

  The patient was a 66‒year‒old Japanese man who had received a ventriculoperitoneal shunt 20 years ago. He was brought to our department due to a convulsion. Hydrocephalus and a central nervous system (CNS) infection were suspected, and he was treated with shunt pressure adjustment and antibiotics. Magnetic resonance imaging on the 25th and the 33rd hospital days showed circumferential enhancement surrounding the ventricles, and on the 35th hospital day we observed that the shunt valve did not refill. We attempted to control the infection while managing the patient’s hydrocephalus by performing external lumbar cerebrospinal fluid (CSF) drainage, but the CSF cell count remained elevated. We thus removed the shunt on the 49th hospital day. Since the ventricular catheter could not be removed by simple traction, we used a flexible neuroendoscope to observe the catheter and identified adhesions accompanied by granulation and neovascularization along the entire length of the catheter. We were able to remove the catheter by dissection and hemostasis by using a monopolar probe endoscope, without complications. The use of a flexible neuroendoscope may be a useful option for the safe removal of a blocked shunt, as new vessels may be involved in the occlusion of the ventricular catheter in patients with long‒standing postoperative shunt malfunction and a concurrent CNS infection.