Failure of a Torkildsen shunt after functioning for 50 years

Case report

Restricted access

Mechanical obstruction is a severe complication of ventricular catheter use. Its incidence was shown to be high in the 1960s and 1970s, with up to 41% of the catheters becoming obstructed within 10 years after surgery. The authors present what is to their knowledge the first reported case of a patient with failure of a Torkildsen shunt after 50 years of functioning. A 60-year-old woman presented with increasing gait ataxia, decline in cognitive functions (including short-term memory loss), and slight urinary incontinence. The diagnosis of hydrocephalus and thus malfunction of the Torkildsen shunt implanted 50 years previously was confirmed by MR images, which revealed a prominent triventricular hydrocephalus. The patient subsequently underwent endoscopic third ventriculostomy (ETV), the current surgical treatment of choice, resulting in total resolution of her neurological symptoms and amelioration of cerebral tissue distension. Decrease in ventricle dilation and success of the ETV were confirmed on postoperative follow-up MR images.

Abbreviation used in this paper: ETV = endoscopic third ventriculostomy.

Article Information

* Drs. Zinn and Bozinov contributed equally to this case report.

Address correspondence to: Pascal O. Zinn, M.D., Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, Massachusetts, 02215. email: pzinn@bidmc.harvard.edu.

Please include this information when citing this paper: published online August 28, 2009; DOI: 10.3171/2009.7.JNS09729.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Preoperative axial T2-weighted MR image demonstrating hydrocephalus with marked enlargement of the lateral ventricles and distension of the cerebral tissue. Note the position of the Torkildsen catheter (A).

  • View in gallery

    Preoperative sagittal T2-weighted MR image showing findings typical of aqueductal stenosis with ballooning of the third and lateral ventricles and a normal-sized fourth ventricle.

  • View in gallery

    Intraoperative endoscopic view. Note the prominent proximal part of the Torkildsen catheter, placed in the third ventricle and having remained in place for 50 years.

  • View in gallery

    Intraoperative endoscopic view showing the basilar artery after successful ETV.

  • View in gallery

    Postoperative axial T2-weighted MR image, obtained 3 months after ETV, showing a relative decrease in hydrocephalus and decrease in distention of the cerebral tissue.

  • View in gallery

    Postoperative sagittal T2-weighted MR image demonstrating development of an adequate flow signal through the floor of the third ventricle, reflecting successful ETV. Note the improvement in configuration of the third ventricle, with resolution of the distension.

References

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 80 80 12
Full Text Views 76 76 0
PDF Downloads 149 149 0
EPUB Downloads 0 0 0

PubMed

Google Scholar