Author: Joshua Alexander and Rob Heros
A 9 and ? year old boy with L 4 level myelomeningocele came to The Spina Bifida Clinic at UNC for a regular follow-up visit. His main complaint was a headache and some right sided neck stiffness over the past several weeks. The headaches came and went and were not bad enough to stop him from playing and enjoying other activities. They did not wake him up from sleep and did not make him feel nauseous. He didn?t remember hitting his head or hurting his neck He wasn?t taking any new medicines and he felt ?good? otherwise. He had received a ventriculoperitoneal (VP) shunt soon after birth to treat hydrocephalus (a buildup of fluid in the brain) and his shunt had last been revised (replaced) when he was two years old.
On his physical examination he was awake and alert and feeling ?fine?. His shunt appeared to be working well (the reservoir located on the side of his head was easy to depress and refilled quickly), but the shunt tubing was more prominent than usual and felt tight along the right side of his head & neck. He was not able to move his neck freely because of the tightness of the tubing. The rest of his exam did not show any new problems.
Several x-rays were taken from his head down to his stomach to check his shunt tubing.
No kinks or tube breaks were found, but the end of his tubing was higher up in his abdomen than what had been seen on earlier x-rays.
Upon further discussion with the child?s neurosurgeon and family, it was determined that this child had outgrown his current shunt tubing and, because it was giving him neck pain (and possibly contributing to his headaches), an elective operation would be performed to add length to the tubing in his body in order to decrease the pull of the tube on his neck and head.
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