Cochlear implantation in a patient with hydrocephalus and ipsilateral non-programmable ventriculoperitoneal shunt

Cochlear implantation (CI) in patients with ventriculoperitoneal (VP) shunts poses unique challenges, including the risk of shunt infection, shunt displacement and modifications in implant placement. A female patient in her late 20s presented with the history of left cerebellopontine angle epidermoid tumour which has been excised along with sacrifice of the cochlear nerve followed by VP shunt placement on the contralateral side for hydrocephalus. Post shunt placement, the patient developed profound sensorineural hearing loss on the right side. CI was successfully performed on the side with the VP shunt, with strategic placement of the receiver-stimulator complex anteriorly and superiorly, avoiding interference and minimising shunt manipulation. At 4-years follow-up, the patient demonstrated excellent auditory outcomes with no VP shunt or CI-related complications. CI in patients with non-programmable VP shunts carries risks of VP shunt failure and meningitis but can be performed safely with rigorous preoperative planning, intraoperative modifications and well-prepared contingency plans to handle potential complications.