[Pneumocephalus after shunt in a patient with hydrocephalus. A case report and review of the literature].
Pneumocephalus in hydrocephalic shunted patients is very rare. So far only 46 cases have been described in the literature. A case of pneumocephalus in a patient with shunted hydrocephalus, and the diagnostic and therapeutic problems were described. A 38-year-old woman suffered from a subacute headache, dizziness and bradyphrenia. Eight years ago, the ventriculo-atrial shunt was implanted due to idiopathic hydrocephalus, and the shunt was changed 2 months before the present admission (ventriculo-peritoneal valve). CT and MRI revealed pneumocephalus, but neither clinical nor radiological symptoms of the CSF fistula were found. After temporary ligation of a distal catheter, the anterior fossa and a sellar area were directly repaired via right fronto-temporal craniotomy, with a good outcome. In the case of pneumocephalus in hydrocephalic shunted patients, the direct closure of the skull base fistula via craniotomy combined with restoration of the proper shunt function is usually the most effective treatment. If the site of the fistula can not be established, dural cranioplasty in the most likely site of the fistula is recommended.
Czepko
Ryszard
R
Klinika Neurochirurgii, Instytut Neurologii Collegium Medicum Uniwersytetu Jagiellońskiego w Krakowie, Kraków. rczepko@poczta.onet.pl
Morga
Rafał
R
Uhl
Henryka
H
D000328:Adult; D003399:Craniotomy; D005260:Female; D005402:Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D006849:Hydrocephalus / Q000150:complications / Q000601:surgery*; D019586:Intracranial Hypertension / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D011007:Pneumocephalus / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*