Managing ventriculoperitoneal shunt exposure in adult patients: surgical options and implant removal prevention

Background: Ventriculoperitoneal shunt exposure is rare. Small series reporting on managing this complication mainly focus on the pediatric population, where wound breaks over cerebrospinal fluid (CSF) chambers are observed most frequently. However, case series on adult patients are missing. Methods: Between June 2004 and December 2019, 18 patients underwent ventriculoperitoneal shunt revision due to implant exposure. Pertinent data were retrospectively collected from the hospital database. Their full clinical history, laboratory values, neuroradiological imaging, pre-treatment CSF characteristics, photographic and video material, and surgery types were reviewed. Results: The ventricular catheter was exposed in eight patients (the frontal region in six and the occipital region in two), the valve chamber at the retroauricular region in six, the shunt tube in seven (at the neck in four, the supraclavicular region in two, and the abdominal incision in one). Multiple exposure sites were found in two cases. Two patients with CSF infections benefitted from system removal and temporary external ventricular drainage until infection control was achieved. The remaining 16 patients underwent on-ward revision (wound curettage, skin mobilisation, and re-suture over the exposed part of the shunt), which was effective in 14 patients, but further revision was required in two patients. Conclusions: While rare, ventriculoperitoneal shunt exposure is a serious complication. In our experience, a prompt and accurate on-ward revision could save the implant in most patients without CSF infections.