Management of intracardiac migrated ventriculoperitoneal shunts: illustrative case.

Abstract

Background: Ventriculoperitoneal (VP) shunts are pivotal in managing hydrocephalus but are not without complications, including the rare but serious phenomenon of intracardiac migration. With only 32 cases previously documented, this complication lacks a robust evidence base, making each new case an important contribution to clinical understanding and management strategies. This paper presents an illustrative case alongside a comprehensive review of intracardiac VP shunt migrations, aiming to elucidate management principles for this daunting scenario.

Observations: The review identified 32 previous cases of intracardiac VP shunt migration. Including the authors' case, patients ranged in age from 6 to 81 years, with a predominance of male patients. Common symptoms included headaches and cardiorespiratory issues, although some cases were asymptomatic. Manual withdrawal of the catheter was successful in some cases, while others required interventional radiology or surgical extraction via venotomy or similar.

Lessons: Intracardiac migration of VP shunts is a rare but significant complication. Early detection and a multidisciplinary approach are essential for effective management. Future research should focus on refining surgical techniques to prevent migration and to understand better the mechanisms involved. Enhanced awareness and diagnostic strategies can improve patient outcomes and reduce the risk of such complications. https://thejns.org/doi/10.3171/CASE24871.