Migration and Coiling of Peritoneal Catheter into the Subgaleal Space: A Very Rare Complication of Subgaleoperitoneal Shunt
A 32-year-old male patient underwent a craniectomy and duraplasty with artificial dura due to an infected compound depressed skull fracture at another hospital. Eighteen months later, the patient underwent cranioplasty using methylmetacrylate for the skull defect which crossed the sagittal suture line. After the cranioplasty, the scalp progressively grew due to leakage of the cerebrospinal fluid (CSF) into the subgaleal space (). Conservative treatments such as direct aspiration of the CSF followed by compression with elastic bandage and continuous lumbar drainage were not effective. The patient underwent SP shunting for persistent cranial pseudomeningocele. Two short catheters were placed into the subgaleal space and connected to a distal catheter using a Y-shaped rigid connector without any valve systems (). The cranial shunt catheter was anchored at the level of the connector. Following the SP shunt, the pseudomeningocele were relieved. Six months later, the patient again presented with scalp swelling and headaches. Simple X-ray of the skull revealed a migrated and coiled shunt catheter under the scalp (). The peritoneal catheter was seen by an abdominal radiography. The patient was treated by removing the entire shunt catheter and the dura was covered with a subgaleal flap to prevent CSF leak. After the operation, the subgaleal CSF collection disappeared () and the patient is currently doing well without further complications.