Light and electron microscopic, and immunohistochemical analysis of deposits in the proximal ends of ventriculoperitoneal shunt catheters

The ventriculoperitoneal shunt is accepted as the simplest and most effective treatment for hydrocephalus. The major problem with these devices is obstruction of the proximal end of the tubing. In this study, we examined deposits in the proximal ends of Codman shunts from 20 of our patients whose catheter failed. Light microscopic examination revealed that the deposited material contained fibrin, other proteinaceous material, erythrocytes, lymphocytes, macrophages, eosinophils, leukocytes, giant cells, and evidence of neovascularization. Electron microscopy confirmed the presence of fibrin, other proteinaceous material, many phagocytic cells, giant cells, and bacteria within the cytoplasm of these two types of cells. Immunohistochemically, the deposited material stained intensely for IgA, moderately for IgG, and weakly for IgM. This report discusses on ventriculoperitoneal shunt failure and the types of deposits that accumulate at the proximal end of the catheter, and reviews the relevant literature. The authors conclude that such deposits do cause shunt failure.