Case presentation:
A 10-month-old boy presented to our university hospital with the history of progressive enlargement of head, multiple episodes of vomiting and decreased oral intake for 3 days. He had Congenital Hydrocephalus and underwent medium pressure VP Shunt (Chhabra Shunt) at the age of one month at some other hospital. Following VP Shunt surgery, he remained well until this visit. On clinical examination, child appeared drowsy. He had an enlarged head with tense and bulging anterior fontanelle. Scalp veins were engorged and prominent. Sunset sign was present. Shunt chamber could not be palpated. Shunt failure was suspected based on history and clinical examination and X-ray was ordered. X-Ray shunt series showed an abnormal cranial migration of VP shunt assembly inside the cranium (Fig.1, A&B). Computed Tomography (CT) brain Plain showed grossly dilated ventricles, subdural hygroma and VP shunt assembly inside the ventricles (Fig.2 A&B). Routine investigations were within normal limits. At surgery, the previous burr hole site was explored. Burr hole was about 1x1 cm in size. A rigid pediatric neuro endoscope was introduced through the burr hole and the entire shunt was seen coiled up inside the ventricle. It was removed with the help of an endoscopic grasper. A new VP shunt (Medtronic Shunt) was inserted on the opposite side. He had good postoperative recovery, improved clinically and was discharged in three days.