RESUMO
Background: The intracranial migration of a ventriculoperitoneal shunt (VPS) has been previously described, it is a very rare event, and the mechanisms of this migration have not yet been elucidated. Case Description: Newborn at 38 weeks of gestation by cesarean section, with congenital hydrocephalus due to Dandy-Walker malformation that required right Frazier VPS placement. At 2-month follow-up, computed tomography of the skull showed cranial migration of VPS and dysfunction. At evaluation, there were signs of systemic infection. External ventricular drainage was placed and an intravenous antibiotic scheme for Gram-positive bacteria was started. After 3 months, cerebrospinal fluid cultures were negative and definitive VPS was decided. Conclusion: Different possible mechanisms have been proposed, such as negative intraventricular pressure, positive intra-abdominal pressure, use of valveless catheters, excessive burr hole size, as well as such as occipital ventricular access, thin cortical mantle, incorrect distal and proximal fixation, short distance between the peritoneum and ventricles, and a possible inflammatory reaction to the catheter material (silicone). A combination of these different mechanisms contributes to proximal shunt migration. Although the placement of a VPS is a procedure well taught since the 1st years of neurosurgical residency, it is not exempt from complications. Although, as was previously stated in this paper, the incidence of a complete cranial VPS migration is extremely rare, and only a few cases are documented, it is still important to report this type of cases and to try to elucidate the possible mechanisms involved.
RESUMO
BACKGROUND: Traumatic spinal cord injury (TSCI) is a devastating problem typically associated with multi-organ disorders. Studies regarding TSCI and their attendant comorbidities are scarce from developing countries. METHODS: The electronic files of 147 patients with TSCI (2017-2018) were reviewed; 78% of patients were males averaging 38 years of age. The following variables associated with the TSCI included age, sex, etiology of trauma, vertebral level, fracture classification, Frankel grade, treatment, complications, and mortality. RESULTS: Of interest, most cases involved thoracic injuries with attendant chest trauma resulting from falls from substantial heights. CONCLUSION: In Mexico, the majority of TSCI occur in young males (average age 38) who have sustained falls from significant heights resulting in thoracic fractures with a high frequency of chest injuries. By providing such information for developing countries, we may develop future strategies to TSCI in vulnerable populations.