title: Ventricular peritoneal shunt malfunction after operative correction of scoliosis: report of three cases.
abstract: BACKGROUND
  Two of the most common disease processes associated with hydrocephalus in children are spina bifida and intraventricular hemorrhage of prematurity, both of which are known to be also associated with spinal deformity in later childhood. The occurrence of shunt malfunction after mechanical injury or stress to the hardware has been well documented. Newer techniques in the treatment of neuromuscular scoliosis, including anterior release with segmental fixation, have resulted in more powerful corrections of these large spinal deformities. A new potential cause of shunt malfunction is the aggressive correction of scoliosis.
  
  
  OBJECTIVE
  To report patients with neuromuscular curves averaging 100° who were subsequently recognized to have perioperative shunt malfunction.
  
  
  METHODS
  Three case studies from a university hospital setting were included.
  
  
  METHODS
  All three children were young adolescents and had-long term shunts. Two of the children had spina bifida and a third had cerebral palsy. All children underwent anterior release of their scoliosis with posterior segmental instrumentation, with unit rods and sublaminar wires. All had significant correction of their scoliosis.
  
  
  METHODS
  Malfunctioning of the ventriculoperitoneal shunts were recorded.
  
  
  METHODS
  Chart reviews of three cases were analyzed.
  
  
  RESULTS
  Two children had shunt malfunctions within a month of their surgery, and one child had intraoperative recognition and externalization of the shunt.
  
  
  CONCLUSIONS
  Older children undergoing repair of neuromuscular scoliosis are often preadolescents or adolescents who have the same indwelling shunt systems originally implanted in early infancy. The shunt may be brittle and calcified, and the peritoneal catheter may be short. The correction of scoliosis often results in an almost instantaneous growth of a few inches. Because of the potential difficulty in recognizing shunt malfunction in the perioperative period, consideration should be given for elective revision of the peritoneal catheter in children at risk.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, 90 Bergen St., Suite 3200, Newark, NJ 07103, USA. Electronic address: lawrencelai1998@yahoo.com.
authors.forename: Lawrence P
authors.initials: LP
authors.lastname: Lai
authors.affiliation: Department of Neurosurgery, Stony Brook University, 24 Research Way, Suite 200, Stony Brook, NY 11794, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Egnor
authors.affiliation: Department of Orthopedic Surgery, Stony Brook University, 4 Technology Dr., Suite 11 and 12, East Setauket, NY 11733, USA.
authors.forename: Wesley V
authors.initials: WV
authors.lastname: Carrion
authors.affiliation: Department of Orthopedic Surgery, Stony Brook University, 4 Technology Dr., Suite 11 and 12, East Setauket, NY 11733, USA.
authors.forename: Susan S
authors.initials: SS
authors.lastname: Haralabatos
authors.affiliation: Department of Orthopedic Surgery, Stony Brook University, 4 Technology Dr., Suite 11 and 12, East Setauket, NY 11733, USA.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Wingate
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000150:complications* / Q000601:surgery; D002648:Child; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D008297:Male; D011475:Prosthesis Failure / Q000209:etiology*; D012189:Retrospective Studies; D012600:Scoliosis / Q000150:complications / Q000601:surgery*; D016135:Spinal Dysraphism / Q000150:complications* / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects*; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt
keywords: Cerebral palsy; Malfunction; Scoliosis; Spina bifida; Surgery; Ventriculoperitoneal shunt