J Neurosurg Pediatrics 1: 237-239, 2008

Treatment of recurrent ventriculoperitoneal shunt failure associated with persistent cerebrospinal fluid eosinophilia and latex allergy by use of an “extracted” shunt

Case report

Michael J. Ellis, M.D.¹, Colin J. Kazina, B.Sc., M.D.¹, Marc R. Del Bigio, M.D., Ph.D., F.R.C.P.C.², and Patrick J. McDonald, M.D., M.H.Sc., F.R.C.S.C.¹

¹Section of Neurosurgery, Department of Surgery; and ²Department of Pathology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada

Abbreviations used in this paper: CSF = cerebrospinal fluid; VP = ventriculoperitoneal.

Address correspondence to: Patrick J. McDonald, M.D., M.H.Sc., F.R.C.S.C., Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg Children's Hospital, GB126–820 Sherbrook Street, Winnipeg, Manitoba, Canada R3A 1R9. email: pmcdonald@hsc.mb.ca.

DOI: 10.3171/PED/2008/1/3/237

Shunt failure is commonly associated with infection or mechanical obstruction of the shunt system. The presence of eosinophilia in the cerebrospinal fluid (CSF) has been associated with CSF shunt failure and may be related to both latex and shunt allergies. The authors describe the case of a child with a latex allergy who presented with 10 episodes of shunt failure over a period of 93 months. Cerebrospinal fluid sampling demonstrated persistent eosinophilia (3–36%) and negative cultures. Pathological examination of the ventricular catheter on 3 occasions demonstrated mechanical obstruction by inflammatory debris consisting largely of eosinophils and multinucleated giant cells. On the suspicion that the child might have some uncharacterized allergy to the shunt hardware, shunt replacement was performed using an “extracted” shunt system. The child has remained free of shunt malfunction for > 2 years since the last surgery. Immune responses to unpolymerized silicone are discussed.

Children and Silicone

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