Flexible endoscopy for removal of a migrated fractured ventricular catheter in an adult: A case report and technical note.

BACKGROUND

Ventricular cerebrospinal fluid shunt is standard care for hydrocephalus but carries risks such as obstruction, infection, and rarely, catheter fracture with migration. Flexible ventricular endoscopy can facilitate safe retrieval for retained positionally labile fragmaents.

CASE DESCRIPTION: A 55-year-old woman presented with a previous aneurysmal subarachnoid hemorrhage and secondary hydrocephalus. After a shunt malfunction and ventriculitis, imaging showed that the proximal segment of a previous ventricular catheter had migrated from the frontal horn toward the aqueduct of Sylvius. Through a right precoronal approach, a flexible endoscope was advanced, ventricles were systematically inspected to localize the fragment, but without evidence of the migrated catheter. Assuming secondary migration along the roof of the lateral ventricle, the retained catheter was mobilized into sight by continuous irrigation and facilitated into the foramen of Monro, where it was easily captured with endoscopic microforceps and removed under direct visualization without hemorrhage.

CONCLUSION

In selected adults with intraventricular migrated catheter fragments - particularly in the setting of infection and migratory intraventricular hardware located close to critical structures such as the aqueduct - flexible endoscopy provides a minimally invasive option to retrieve foreign bodies safely when trajectories of rigid endoscopy can be limited by the degrees of movement required for optimal visualization.