Case Report

Long-term Air-exposed Functioning Hydrocephalus Valve with No Infection

Authors: Andreas T. Kouyialis, MD, George Stranjalis, MD, Stefanos Korfias, MD, Damianos E. Sakas, MD

Abstract

One of the reasons for shunt infection is valve erosion through the skin. In such cases, it is common practice to instantly relocate the shunt to avoid infection. We present a 77-year-old female patient with a 15-month history of hydrocephalus valve extrusion. Despite her poor mental status, clinical condition and hygiene, and the prolonged extrusion period, she developed neither a local nor a cerebrospinal fluid (CSF) infection. The patient was ultimately treated with shunt removal and repositioning. An extensive literature review revealed no previous report of such a case. This case indicates that under rare conditions, central nervous system (CNS) implantable devices might not become contaminated and may remain functional, even if they remain exposed for prolonged periods.


Key Points


* Shunt surgery is considered simple but has the highest failure rate among all neurosurgical procedures.


* Among shunt surgery-related complications, infection remains the foremost problem and is fatal if not treated properly.


* Central nervous system shunt infections are dominated by organisms with features that facilitate the colonization and subsequent infection of the shunt.


* Patients with shunt infection have a lower cure and a higher mortality rate when treated with antibiotics alone, in contrast to treatment with shunt removal and antibiotic administration.


* Under rare conditions, cerebrospinal fluid shunts might not get infected, even if they remain exposed for a long period of time.

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