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Year : 2015  |  Volume : 63  |  Issue : 6  |  Page : 1009-

Authors' reply

Manish Agarwal, Virendra Deo Sinha 
 Department of Neurosurgery, S.M.S Medical College, Jaipur, Rajasthan, India

Correspondence Address:
Manish Agarwal
Department of Neurosurgery, S.M.S Medical College, Jaipur, Rajasthan

How to cite this article:
Agarwal M, Sinha VD. Authors' reply.Neurol India 2015;63:1009-1009

How to cite this URL:
Agarwal M, Sinha VD. Authors' reply. Neurol India [serial online] 2015 [cited 2020 Aug 7 ];63:1009-1009
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Full Text


Thank you for appreciating our work and for giving your valuable opinion regarding the endoscopic management of the intraventricular migrated shunt. The query raised by you is genuine. The exact sequence of events in the case reported was as follows:

The child was operated for an occipital encephalocoele using a medium pressure ventriculo-peritoneal shunt immediately after birth. At three months of age, he presented in altered sensorium with decreased oral intake. The upper and lower ends of the shunt were explored, found to be functioning well and replaced. He did well until he was six months of age, when he again presented with gradual enlargement of the head with a tense anterior fontanel, engorged scalp veins, and positive sunset sign. There was a small pulsatile swelling at the parietal burr hole site. The shunt catheter was not palpable anywhere across the chest wall. The shunt catheter was not visible on the plain chest and abdominal radiographs. X-ray skull and computed tomography (CT) of the head showed the entire shunt catheter lying inside the cranium, confirming the upward migration.

We think that the cause of upward migration of shunt was due to the poor technique of shunt placement during re-exploration when the child was three months of age. Probably, poor pericranial fixation of the tube, and a larger dural opening at the burr hole site led to this complication.

These details might have been missed during the multiple editing during the paper writing process. Thank you for pointing out this out.

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Conflicts of interest

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