Minimally Invasive Removal of Retained Subcutaneous Ventriculoperitoneal Shunt Catheter Using an Endoscopic Vein Harvesting System: A Technical Note.

BACKGROUND: Retained old cerebrospinal fluid diversion shunt catheters in the neck, chest, or abdominal walls are frequently encountered in patients with lifelong shunt-dependent hydrocephalus who have undergone multiple shunt revisions. Particularly in cases where years and decades go between shunt revisions, the distal catheter portion can get calcified and nearly impossible to remove. Most patients tolerate a retained shunt catheter without problems. In some patients, however, retained catheters can cause pain and discomfort, particularly over the clavicle with head movements. Albeit trivial, we are unaware of innovative solutions to this problem. Here, we describe the use of an endoscopic vein harvest device used in cardiothoracic surgery to completely remove an old, calcified shunt catheter. METHODS: Removal of a calcified ventriculoperitoneal shunt catheter using an endoscopic vein harvesting system was performed in a 32-year-old man with shunt-dependent hydrocephalus from premature birth. At 14 years of age, the patient had his only shunt revision consisting of a new distal catheter being placed adjacent to the old catheter. The patient presented with significant discomfort from the retained original shunt catheter. RESULTS: Using the endoscopic vein harvesting system, the shunt catheter was removed minimally invasively and the patient had complete resolution of his symptomatology. CONCLUSIONS: The endoscopic vein harvesting system used in cardiothoracic surgery is a suitable instrument to remove long segments of a retained ventriculoperitoneal shunt catheter minimally invasively through a small skin incision. To our knowledge, this is the first report of minimally invasive removal of a retained ventriculoperitoneal catheter.