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Fatal ventriculoperitoneal shunt occlusions diagnosed at autopsy

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Abstract

The placement of a ventriculoperitoneal (VP) shunt is frequently used in the management of chronic hydrocephalus. Failure of the shunt may occur due to physical obstruction, which is a recognized complication. Autopsy examination of deceased individuals with chronic disability is often not performed, which contributes to the difficulty in determining the frequency of mortality from VP shunts. Examination, when it does occur, should focus on the patency and positioning of the shunt, and this evaluation is especially important when the cause of death is poorly defined. In this report, we describe two cases of death caused by obstruction of VP shunts documented at autopsy. The first death was determined to be secondary to cerebellar edema with uncal and tonsillar herniation after posterior left VP shunt occlusion. The second was due to VP shunt occlusion resulting in diffuse cerebral edema and ventricular enlargement with compression and hemorrhage of the cerebellar tonsils and medulla.

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References

  1. Aschoff A, Kremer P, Hashemi B, Kunze S. The scientific history of hydrocephalus and its treatment. Neurosurg Rev. 1999;22:67–93.

    Article  CAS  Google Scholar 

  2. Reddy GK, Bollam P, Caldito G. Long-term outcomes of ventriculoperitoneal shunt surgery in patients with hydrocephalus. World Neurosurg. 2014;81:404–10.

    Article  Google Scholar 

  3. Browd SR, Ragel BT, Gottfried ON, Kestle JRW. Failure of cerebrospinal fluid shunts: part I: obstruction and mechanical failure. Pediatr Neurol. 2006;34:83–92.

    Article  Google Scholar 

  4. Fowler JB. Mesfin FB. Ventriculoperitoneal shunt—updated Feb. 2020;14 https://www.ncbi.nlm.nih.gov/books/NBK459351. .

  5. Blount JP, Campbell JA, Haines SJ. Complications in ventricular cerebrospinal fluid shunting. Neurosurg Clin N Am. 1993;4:633–56.

    Article  CAS  Google Scholar 

  6. Collins P, Hockley AD, Woollam DHM. Surface ultrastructure of tissues occluding ventricular catheters. J Neurosurg. 1978;48:609–13.

    Article  CAS  Google Scholar 

  7. Singh D, Saxena A, Jagetia A, Singh H, Tandon MS, Ganjoo P. Endoscopic observations of blocked ventriculoperitoneal (VP) shunt: a step toward better understanding of shunt obstruction and its removal. Br J Neurosurg. 2012;26:747–53.

    Article  Google Scholar 

  8. Kano T, Kawauchi H. Fibrous encapusulation of the peritoneal catheter in peritoneal shunt: case report. Surg Neurol Int. 2017;8:132.

    Article  Google Scholar 

  9. Kano T. Fibrous capsule formation of the peritoneal catheter tip in ventriculoperitoneal shunt: two case reports. Surg Neurol Int. 2014;5:5451–4.

    Article  Google Scholar 

  10. McGirt MJ, Leveque JC, Wellons JC, Villavicencio AT, Hopkins JC, Fuchs HE, et al. Cerebrospinal fluid shunt survival and etiology of failures: a seven-year institutional experience. Pediatr Neurosurg. 2002;36:248–55.

    Article  Google Scholar 

  11. Piatt JH, Garton HJ. Clinical diagnosis of ventriculoperitoneal shunt failure among children with hydrocephalus. Pediatr Emerg Care. 2008;24:201–10.

    Article  Google Scholar 

  12. Zorc JJ, Krugman SD, Ogborn J, Benson J. Radiographic evidence for suspected cerebrospinal fluid shunt obstruction. Pediatr Emerg Care. 2002;18:337–40.

    Article  Google Scholar 

  13. Vassivyadi M, Tataryn ZL, Alkherayf F, Udjust K, Ventureyra EC. The necessity of shunt series. J Neurosurg Pediatr. 2010;6:468–73.

    Article  Google Scholar 

  14. Bryant MJ, McEniery J, Walker DG, Campbell R, Lister B, Sargent P, et al. Preliminary study of shunt related death in paediatric patients. J Clin Neurosci. 2004;11:614–5.

    Article  CAS  Google Scholar 

  15. Garton HJL, Kestle JRW, Drake JM. Predicting shunt failure on the basis of clinical symptoms and signs in children. J Neurosurg. 2001;94:202–10.

    Article  CAS  Google Scholar 

  16. Bober J, Rochlin J, Marneni S. Ventriculoperitoneal shunt complications in children: an evidence-based approach to emergency department management. Pediatr Emerg Med Pract. 2016;13:1–22.

    PubMed  Google Scholar 

  17. Prahlow JA. Investigation of deaths of chronically disabled persons and institutionalized persons. Acad Forensic Pathol. 2014;4:262–89.

    Article  Google Scholar 

  18. Hanzlick R, Goodin J. Mind your manners part III: individual scenario results and discussion of the National Association of medical examiners manner of death questionnaire 1995. Am J Forensic Med Pathol. 1997;18:228–45.

    Article  CAS  Google Scholar 

  19. Prahlow JA, McClain JL. Deaths due to medical therapy. In: Froede RC, editor. Handbook of forensic pathology. 2nd ed. Northfield, IL: College of American Pathologists; 2003. p. 381–92.

    Google Scholar 

  20. Caplan MJ. A medical examiner’s experience with the evaluation of deaths associated with complications of diagnostic and therapeutic procedures (therapeutic complications/periprocedural deaths) – revisited (abstract). Am Acad Forensic Sci Ann Meet Proc. 1999:164–5.

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Acknowledgements

The authors thank the medical librarians at WMU for their support.

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  1. Western Michigan University Homer Stryker MD School of Medicine, 300 Portage Street, Kalamazoo, MI, 49007, USA

    Joshua White, Phillip Key & Joseph A. Prahlow

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  1. Joshua White
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  2. Phillip Key
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  3. Joseph A. Prahlow
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Correspondence to Phillip Key.

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White, J., Key, P. & Prahlow, J.A. Fatal ventriculoperitoneal shunt occlusions diagnosed at autopsy. Forensic Sci Med Pathol 16, 697–701 (2020). https://doi.org/10.1007/s12024-020-00309-1

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  • DOI: https://doi.org/10.1007/s12024-020-00309-1

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