Pneumocephalus following ventriculoperitoneal shunt. Case report

Area of Science:

• Neurosurgery
• Otolaryngology
• Radiology

Background:

• Hydrocephalus necessitates cerebrospinal fluid (CSF) diversion, often via ventriculoperitoneal (VP) shunting.
• VP shunts can malfunction, leading to complications like pneumocephalus (air within the cranial vault).

Observation:

• A patient developed massive pneumocephalus post-VP shunting.
• Diagnostic imaging and surgical exploration revealed congenital tegmen tympani defects.
• Intermittent negative intracranial pressure from the shunt facilitated air ingress through these defects.

Findings:

• Congenital defects in the tegmen tympani were the source of recurrent pneumocephalus.
• Shunt function correlated with air entry; occlusion prevented pneumocephalus and CSF leakage.
• Surgical repair of the middle ear defects successfully resolved the pneumocephalus.

Implications:

• Highlights the importance of considering congenital skull base abnormalities in shunt complications.
• Suggests a link between negative intracranial pressure, CSF leaks, and air entrainment.
• Demonstrates the efficacy of surgical repair for pneumocephalus secondary to tegmen tympani defects.