Revisiting the disabling potential of calcified ventriculoperitoneal shunt tubing causing intractable neck pain with a novel technique for operative excision: illustrative case.

BACKGROUND: Ventriculoperitoneal (VP) shunt calcification is considered a rare complication of long-term shunt placement. It may present with disabling neck pain and/or limited motion in the neck due to extensive calcifications associated with pathological soft tissue reaction and irritation, occasionally necessitating surgical removal of the calcified hardware. The W-plasty technique is used in plastic surgery to minimize postoperative scarring and pain and particularly performed in neck dissections. OBSERVATIONS: A 49-year-old male with a long-standing VP shunt was referred to the neurosurgery department for debilitating pain and extensive calcifications along the entire neck portion of the shunt catheter. He had previously been seen at the emergency department 9 years prior for similar symptoms, and comparisons of the most recent neck CT study to that performed 9 years prior revealed lateral calcification growth of 0.97-6.83 mm when measured at the upper cervical levels. Using a long-segment W-plasty incision, the authors were able to remove large metacarpal bone-sized calcifications with excellent pain and cosmetic outcomes. LESSONS: This case highlights the importance of monitoring VP shunt calcifications over time and considering surgical removal before symptoms become debilitating. The W-plasty technique provides adequate exposure with good clinical outcomes. https://thejns.org/doi/10.3171/CASE26539.