Cerebral spinal fluid overdrainage from shunt tap using large bore coring needle: A case report

Background: Tapping a ventriculoperitoneal shunt percutaneously using a coring needle, such as a butterfly needle, is a common neurosurgical practice despite manufacturers' recommendation to use a Huber type non-coring needle. Case Description: A 26-year-old woman, with congenital hydrocephalus and history of multiple shunt revision and shunt taps, presented with symptoms consistent with intracranial hypotension. During her shunt revision, cerebrospinal fluid (CSF) was found to be leaking from her shunt reservoir defects which were believed to be caused by prior shunt taps. An in vitro study duplicated this finding in which several areas of leak were observed from the valve tapped using the coring needle, while none was observed from the valve tapped using the non-coring needle. Conclusion: Taping a shunt using a coring needle can damage the shunt reservoir and cause CSF overdrainage.