This child neurology case involves a two-year-old male patient who underwent a ventriculoperitoneal shunt exploration and revision procedure. The procedure was complicated by apparent injury to paraventricular white matter resulting in severe right-sided hemiparesis. The patient also experienced a possible seizure episode during the procedure and additional seizure-like movements in the postoperative period. Also, during his postoperative course, he demonstrated several stereotypic events and abnormal movements. Prior to this operation, the patient had a baseline hemiparesis on the left that was very mild, but following the procedure, it was more apparent. He retained a significant amount of right-sided hemiparesis, with a significant degree of motor weakness. The treating physician concluded in his progress notes that this situation was likely related to the dissection technique required to free the adherent ventricular catheter, with possible excessive heat being released from the electrocautery device.
Question(s) For Expert Witness
- 1. Did the surgeon use the proper technique when dissecting away the old catheter from the first procedure?
Expert Witness Response E-004664
At the time of shunt revision, the catheter is usually stuck or entrapped by surrounding tissue. If it is not free from underlying tissues when it is removed, it can cause bleeding and even stroke. The techniques used to free the catheter can lead to brain injury. All of these are relatively uncommon but known risks of shunt surgery. Bleeding could certainly cause seizures, as could tissue injury. Seizures could cause the transient weakness this patient experienced and tissue injury could lead to permanent weakness.