Complications and subsequent removal of retained shunt hardware after endoscopic third ventriculostomy: case series

Report of 3 cases

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This case series highlights multiple complications and subsequent removal of retained shunt hardware in pediatric patients after successful endoscopic third ventriculostomy (ETV). Removal or retention of existing shunt hardware following ETV represents an important dilemma. Prior studies have reported infections and organ perforation related to nonfunctioning shunts but none in the context of successful ETV. Data obtained in 3 children with hydrocephalus treated at the authors' institution were retrospectively reviewed after the patients experienced complications due to retained shunt hardware following ETV. Etiologies of hydrocephalus included tectal glioma and intraventricular hemorrhage. All 3 patients had a history of multiple shunt revisions and underwent urgent ETV in the setting of a shunt malfunction. In each case, the entire shunt system was left in situ, but it became the source of subsequent complications. Two of the 3 patients presented with the shunt infected by gram-negative bacilli 10 days and 4.5 months postoperatively, respectively. The remaining patient experienced wound dehiscence over the shunt valve 4.5 months after ETV. In all patients, the complications were managed successfully by removing the shunt hardware. None of the patients required repeat shunt insertion from the time of removal throughout the follow-up period (mean 24 months, range 9–36 months). During the study period, a total of 6 patients with indwelling shunt hardware underwent ETV with the expectation of being shunt independent. Among these 6 patients, 3 experienced no complications from the retained hardware whereas 3 patients (50%) ultimately experienced adverse consequences related to retained hardware. This case series illustrates complications involving retained shunt hardware after successful ETV. These examples support consideration of shunt removal at the time of ETV in the appropriate context.

Abbreviations used in this paper:ETV = endoscopic third ventriculostomy; EVD = external ventricular drain; IVH = intraventricular hemorrhage; VP = ventriculoperitoneal.

Article Information

Address correspondence to: Edward S. Ahn, M.D., Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 560A, Baltimore, Maryland 21287. email:

Please include this information when citing this paper: published online April 5, 2013; DOI: 10.3171/2013.3.PEDS12489.

© AANS, except where prohibited by US copyright law.



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    Case 2. Complex hydrocephalus. Axial head CT scan (left) and sagittal MR image (right) prior to ETV, showing complex hydrocephalus and abnormal ventricular septations. The complexity of the ventricular system explains the need for multiple catheter exchanges and endoscopic fenestrations in the setting of persistent ventriculitis.


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