Occult cerebrospinal fluid fistula between ventricle and extra-ventricular position of the ventriculoperitoneal shunt tip

Purpose: Ventriculoperitoneal (VP) shunt or ventriculoatrial shunt is a common operation for treatment of hydrocephalus. Usually, shunt series (plain radiographs of the skull, neck, chest and abdomen) and brain computed tomography (CT) are used to monitor the status of hydrocephalus and VP shunt. However, does the result of a brain CT really reflect the status of the hydrocephalus and shunt function? In patients with VP shunt, brain CT image only may lead to misdiagnosis of the status of the hydrocephalus and result in inadequate treatment plan. Case Report: The authors reported a 6-year-old patient with occult cerebrospinal fluid (CSF) fistula between ventricle and extra-ventricular position of the VP shunt tip on CT scan and resulted in inappropriate shunt removal. Conclusion: The patient was diagnosed to have shunt-dependent hydrocephalus with inadequate shunt removal. In this kind of patient, further studies may reduce unnecessary morbidity or mortality.