Extensive Calcification of a Ventriculoperitoneal Shunt Causing Late Mechanical Failure in a Child.

Calcification of ventriculoperitoneal shunt (VPS) systems is a rare late complication that may result in mechanical shunt failure and the recurrence of hydrocephalus. We report the case of a nine-year-old girl with a longstanding VPS who presented with progressive headache, vomiting, vertigo, decreased visual acuity, and clinical signs of raised intracranial pressure. Radiographs and computed tomography demonstrated extensive calcification involving both the intracranial ventricular catheter and the extracranial distal shunt tract, associated with recurrent hydrocephalus. Given the anticipated risk of intraventricular or intraparenchymal hemorrhage associated with the removal of the densely adherent calcified catheter, the original shunt was left in situ, and a new contralateral VPS was inserted. The patient experienced complete resolution of symptoms following surgery and was discharged neurologically intact. Although rare, extensive VPS calcification should be considered in patients presenting with delayed shunt dysfunction years after implantation. Recognition of extensive intracranial catheter calcification is particularly important, as attempts at catheter removal may carry a significant risk of hemorrhage. In carefully selected patients, placement of a new contralateral shunt while leaving the calcified catheter in situ may represent a safe and effective surgical strategy.