Abstract
BACKGROUND: While a variety of modalities are available for the treatment of hydrocephalus, ventriculoperitoneal shunting (VPS) remains the most utilized treatment. Although efficacious, VPS is susceptible to malfunction, with catheter obstruction as the primary cause of failure in pediatric patients. Prior studies have speculated that implanted catheters trigger an immune response from the central nervous system, resulting in cellular reactivity and subsequent obstruction of the device. These cells are derived from the choroid plexus (ChP), which plays an active role in immunological surveillance. Its cellular components contain some of the putative cells that contribute to ventricular catheter occlusion. CASE DESCRIPTION: The case illustrated herein is a patient with a functionally obstructed polyvinylpyrrolidone (PVP)-coated catheter, with ChP occluding the catheter fenestrations. While silicone catheter obstruction typically presents with fibrosis and microglial reaction, the illustrated case demonstrates the absence of an immunological response. PVP-coated catheters appear to deter cellular attachment which may dampen the immune response to the catheter in the brain. However, the case discussed postulates that ChP can still obstruct PVP-coated catheters through growth and expansion into the catheter holes and lumen, even without an immune response. CONCLUSION: This case report highlights the complexity of novel catheter designs constructed from nonimmunogenic materials while considering catheter hole configuration and size to deter ChP growth into the catheter holes and the lumen to prevent cellular catheter occlusion.