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.