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  • “The Noodle Sign”: Subgaleal Migration of Proximal and Distal Ventriculoperitoneal Shunt Catheter - Case Report

    Final Number:

    Juneyoung L Yi BA, MD; Zulma Sarah Tovar-Spinoza MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2011 Annual Meeting

    Introduction: Ventriculoperitoneal shunts are an established mechanism for cerebrospinal fluid (CSF) diversion in patients presenting with hydrocephalus. Both proximal and distal migration of the shunt catheter has been described in the literature. We present a case of unusual migration of both shunt ends into the subgaleal space.

    Methods: Retrospective single case study

    Results: An 11 month old female with a history of shunted hydrocephalus, cerebral palsy and spasticity presented to the emergency room with a two day history of nausea, vomiting and bulging left occipital area and a one day history of increasingly worsening lethargy. Plain films and CT scan of the head revealed the shunt’s ventricular and peritoneal catheter had migrated and coiled into the subgaleal space. The patient had been emergently taken to the operating room for mechanical failure of the VPS, which involved broken retention sutures for the shunt valve. Intraoperatively, the patient received a complete revision of the shunt, including anchoring of the shunt valve to the periosteal layer and securing of the burr hole with a subgaleal flap.

    Conclusions: Mechanical failure of a VPS may occur secondary to movement of the shunt valve and/or catheter despite adequate anchoring with retention sutures. This may be facilitated by the use of absorbable sutures as well as frequent propulsive motions, including flexion-extension of the cervical spine, especially in patients with cerebral palsy patients with severe spasticity. Revision procedures may involve the use of non-absorbable suture material as well as strategic placement of the shunt catheter track in more lateral positions to avoid frequent subjection to propulsive forces.

    Patient Care: Prevention of ventriculoperitoneal shunt revisions due to mechanical failure

    Learning Objectives: Technical tips for securing ventriculoperitoneal shunts


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