title: Ventriculoperitoneal shunt malfunction caused by proximal catheter fat obstruction.
abstract: Ventriculoperitoneal (VP) shunt placement is the mainstay of treatment for hydrocephalus, yet shunts remain vulnerable to a variety of complications. Although fat droplet migration into the subarachnoid space and cerebrospinal fluid pathways following craniotomy has been observed, a VP shunt obstruction with fat droplets has never been reported to our knowledge. We present the first reported case of VP shunt catheter obstruction by migratory fat droplets in a 55-year-old woman who underwent suboccipital craniotomy for removal of a metastatic tumor of the left medullocerebellar region, without fat harvesting. A VP shunt was inserted 1month later due to communicating hydrocephalus. The patient presented with gait disturbance, intermittent confusion, and pseudomeningocele 21days after shunt insertion. MRI revealed retrograde fat deposition in the ventricular system and VP shunt catheter, apparently following migration of fat droplets from the fatty soft tissue of the craniotomy site. Spinal tap revealed signs of aseptic meningitis. Steroid treatment for aseptic "lipoid" meningitis provided symptom relief. MRI 2months later revealed partial fat resorption and resolution of the pseudomeningocele. VP shunt malfunction caused by fat obstruction of the ventricular catheter should be acknowledged as a possible complication in VP shunts after craniotomy, even in the absence of fat harvesting.
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel.
authors.forename: Cezar José
authors.initials: CJ
authors.lastname: Mizrahi
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel. Electronic address: spektor@hadassah.org.il.
authors.forename: Sergey
authors.initials: S
authors.lastname: Spektor
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel.
authors.forename: Emil
authors.initials: E
authors.lastname: Margolin
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel.
authors.forename: Yigal
authors.initials: Y
authors.lastname: Shoshan
authors.affiliation: Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Eliel
authors.initials: E
authors.lastname: Ben-David
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel; Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: José E
authors.initials: JE
authors.lastname: Cohen
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel.
authors.forename: Samuel
authors.initials: S
authors.lastname: Moscovici
mesh_terms: D017667:Adipocytes / Q000473:pathology*; D057785:Catheters / Q000009:adverse effects*; D002552:Cerebral Ventricles / Q000000981:diagnostic imaging / Q000601:surgery; D003399:Craniotomy / Q000009:adverse effects; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*
keywords: Aseptic meningitis; Craniotomy; Fat migration; Fat obstruction; Hydrocephalus; Ventriculoperitoneal shunt malfunction