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Delayed isolated tension intraventricular pneumocephalus after ventriculoperitoneal shunt
J-F Mineo1, D H Phong, R Seizeur
1Department of Neurosurgery, La Cavale Blanche Hospital, University of Bretagne Occidental, boulevard Tanguy-Prigent, 29200 Brest. jfmineo@hotmail.com
Objective And Importance:
Delayed and isolated tension intraventricular pneumocephalus without air in the pericerebral subarachnoid spaces is an exceptional complication of a ventriculoperitoneal (VP) shunt. We purpose an explanation for the development of such delayed pneumocephalus.
Clinical Presentation:
A 14-year-old boy developed headaches and right-side hearing loss three months after surgical resection of a cerebellar medulloblastoma and insertion of a VP shunt. CT-scan showed isolated intraventricular pneumocephalus without air in the pericerebral subarachnoid spaces. A petrous bone defect was discovered and surgically repaired with clinical and radiographic resolution of pneumocephalus.
Conclusion:
We presume that the brain tIssue plugging the bony defect retracted following the placement of the shunt and eventually there was rupture through the pia-mater into the lateral ventricle. This could explain why isolated intraventricular occurred, as opposed to air in the subarachnoid spaces.