Distal ventriculoperitoneal shunt failure caused by silicone allergy

Case report

Restricted access

✓ The placement of a ventriculoperitoneal (VP) shunt is the most common form of treatment for hydrocephalus. Although allergic reactions to the silicone in shunt hardware are very rare, the authors describe a case of silicone allergy causing multiple ventricular shunt revisions. A 24-year-old man, who had undergone multiple VP shunt revisions, presented with shunt malfunction caused by allergic reaction of the tissues surrounding the shunt tubing. The patient's existing silicone-based shunt was replaced with a new polyurethane system, including the proximal and distal catheters as well as the valve mechanism. Contrary to recommendations in previous studies of silicone shunt allergies, long-term immunosuppression was not initiated. The patient was followed up for more than 8 years without recurrence of an allergic reaction to the shunt. This outcome indicates that replacing the original silicone-based shunt system with a polyurethane-based system alone is sufficient in the treatment of a silicone shunt allergy.

Article Information

Address reprint requests to: Paul P. Wang, M.D., Department of Neurological Surgery, Johns Hopkins University School of Medicine, Phipps 101, 600 North Wolfe Street, Baltimore, Maryland 21287. email: ppwang@jhmi.edu.

© AANS, except where prohibited by US copyright law.

Headings

References

1

Brownlee JDBrodkey JSSchaefer IK: Colonic perforation by ventriculoperitoneal shunt tubing: a case of suspected silicone allergy. Surg Neurol 49:21241998Surg Neurol 49:

2

Carroll RP: Acute inflammatory reaction to silicone stents. Ophthal Plast Reconstr Surg 5:711989 (letter)Carroll RP: Acute inflammatory reaction to silicone stents. Ophthal Plast Reconstr Surg 5:

3

Carver EDBraude BMAtkinson ARGold M: Anaphylaxis during insertion of a ventriculoperitoneal shunt. Anesthesiology 93:5785792000Anesthesiology 93:

4

Darcey DLipscomb HJEpling CPate WCherry LPBernstein J: Clinical findings for residents near a polyurethane foam manufacturing plant. Arch Environ Health 57:2392462002Arch Environ Health 57:

5

Goldblum RMPelley RPO'Donell AAPyron DHeggers JP: Antibodies to silicone elastomers and reactions to ventriculoperitoneal shunts. Lancet 340:5105131992Lancet 340:

6

Gower DJLewis JCKelly DL Jr: Sterile shunt malfunction. A scanning electron microscopic perspective. J Neurosurg 61:107910841984J Neurosurg 61:

7

Hunsaker DHMartin PJ: Allergic reaction to solid silicone implant in medial thyroplasty. Otolaryngol Head Neck Surg 113:7827841995Otolaryngol Head Neck Surg 113:

8

Jimenez DFKeating RGoodrich JT: Silicone allergy in ventriculoperitoneal shunts. Childs Nerv Syst 10:59631994Childs Nerv Syst 10:

9

Jordan DRNerad JA: An acute inflammatory reaction to silicone stents. Ophthal Plast Reconstr Surg 3:1471501987Ophthal Plast Reconstr Surg 3:

10

Kashima MLTunkel DECummings CW: Latex allergy: an update for the otolaryngologist. Arch Otolaryngol Head Neck Surg 127:4424462001Arch Otolaryngol Head Neck Surg 127:

11

Kirwan L: Two cases of apparent silicone allergy. Plast Reconstr Surg 96:2362371995Kirwan L: Two cases of apparent silicone allergy. Plast Reconstr Surg 96:

12

Marcusson JABjarnason B: Unusual skin reaction to silicone content in breast implants. Acta Derm Venereol 79:1361381999Acta Derm Venereol 79:

13

Naim JOLanzafame RJvan Oss CJ: The effect of silicone-gel on the immune response. J Biomater Sci Polym Ed 7:231321995J Biomater Sci Polym Ed 7:

14

Narini PPSemple JLHay JB: Repeated exposure to silicone gel can induce delayed hypersensitivity. Plast Reconstr Surg 96:3713801995Plast Reconstr Surg 96:

15

Pulec JL: Endolymphatic subarachnoid shunt failure caused by silastic allergy. Ear Nose Throat J 77:6146201998Pulec JL: Endolymphatic subarachnoid shunt failure caused by silastic allergy. Ear Nose Throat J 77:

16

Semple JLNarini PHay JBSzalai JP: Silicone gel and delayed hypersensitivity. Plast Reconstr Surg 101:2492501998Plast Reconstr Surg 101:

17

Shanklin DRSmalley DL: Dynamics of wound healing after silicone device implantation. Exp Mol Pathol 67:26391999Exp Mol Pathol 67:

18

Smalley DLShanklin DR: T-cell-specific response to silicone gel. Plast Reconstr Surg 98:9159161996Plast Reconstr Surg 98:

19

Snow RBKossovsky N: Hypersensitivity reaction associated with sterile ventriculoperitoneal shunt malfunction. Surg Neurol 31:2092141989Surg Neurol 31:

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 13 13 12
Full Text Views 101 101 20
PDF Downloads 29 29 8
EPUB Downloads 0 0 0

PubMed

Google Scholar