Modified method for prophylaxis against unishunt system complications with presentation of total intraventricular migration of unisystem ventriculoperitoneal shunt

Abstract

This report is a case of shunted hydrocephalus in which the Unishunt system was placed without the clips (lock and slip). Upward migration of the whole system into the lateral ventricle was discovered 1 month after surgery. The shunt was reinserted, placing the proximal “lock-clip” under the cranial flap and the distal “slip-clip” subcutaneously at the abdominal area. The skin over the slip-clip ulcerated, so it was repositioned and fixed deep in the abdominal muscle, extraperitoneally. Different factors caused the migration: negative sucking intraventricular pressure; pushing, positive intra-abdominal pressure; the course of the subcutaneous tract of the tube not being straight; incorrect fixation of the ends of the system; faulty handling of the baby. Choosing the type of shunt, its pressure opening, antisiphon device, uni- or multi-component, and following a straight line between the ventricular and abdominal inlets are all important factors that guard against migration and assure fixation. The modified fixation method using clips is recommended as a routine technique, especially in emaciated babies, to guard against skin ulceration.