A complicated case of ventriculoperitoneal shunt migration into the right heart ventricle after malresorptive hydrocephalus: illustrative case.

BACKGROUND

Malresorptive hydrocephalus occurs when CSF is inadequately absorbed, often following surgery. Ventriculoperitoneal (VP) shunt implantation is a well-established intervention to manage hydrocephalus by diverting excess CSF to the peritoneal cavity.

OBSERVATIONS: This case report describes a rare complication following VP shunt implantation in a 62-year-old male patient with malresorptive hydrocephalus after prior aneurysm clipping. Despite laparoscopic intraoperative confirmation of correct intraperitoneal VP shunt catheter placement, postoperative imaging revealed migration of the shunt catheter into the right heart ventricle, having perforated the internal jugular vein during its insertion. The catheter formed a knot within the venous system, requiring a combined effort by surgeons of various specialties for safe removal and repositioning. After successful shunt repositioning, the patient's hydrocephalus resolved with marked improvement in clinical symptoms.

LESSONS: This case highlights the need for early recognition of shunt complications via imaging and multispecialty management. https://thejns.org/doi/10.3171/CASE25607.