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March 1996

Radiological Case of the Month

Author Affiliations

From the Department of Neurosurgery, Division of Pediatric Neurosurgery, New York University Medical Center, New York, NY.

Arch Pediatr Adolesc Med. 1996;150(3):323-324. doi:10.1001/archpedi.1996.02170280093018

A FULL-TERM female infant presented with a 2 × 3-cm lumbar myelomeningocele, which was surgically repaired within 12 hours of birth. The patient developed a cerebrospinal fluid leak from her wound on the 10th day of life, and a computed tomographic scan showed hydrocephalus. A ventriculoperitoneal shunt was inserted. By the fifth week of life, the patient was experiencing episodes of inhalatory stridor and nasal regurgitation during feedings. Shunt revisions were required on three occasions due to cerebrospinal fluid leak and shunt malfunction as well as one episode of shunt infection requiring temporary externalization. Postoperative radiographs were performed (Figure 1). Routine postoperative radiographs were performed after the last revision (Figure 2, left and right). Clinically, the shunt tubing could not be palpated subcutaneously below the level of the fourth rib. The patient was returned to surgery for removal of the distal tubing and reinsertion of the catheter into the peritoneal