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Intraventricular Bone Wax as Cause of Recurrent Cerebrospinal Fluid Infection: A Neuroradiologic Pitfall
Pietro Spennato1, Inti Enrique Escamilla-Rodrìguez2, Giuliana Di Martino1
1Department of Neurosurgery, Santobono-Pausilipon Pediatric Hospital, Naples, Italy.
Background:
Persistent or recurrent shunt infections can be secondary to predisposing factors, such as isolated compartments, cerebrospinal fluid leaks, or foreign bodies.
Case Description:
A 5-year-old girl experienced several episodes of shunt infections. After careful reevaluation of all neuroradiologic records of the patient, a foreign body in the left frontal horn of the lateral ventricle was suspected. An endoscopic approach was used to identify and remove a small fragment of bone wax.
Conclusions:
To our knowledge, this is the first report of intraventricular bone wax causing persistent CSF infection. The diagnosis was difficult because wax resembles air on computed tomography and on magnetic resonance imaging, and so it had been not noticed for months. Only its persistence on several images raised the suspicion of foreign body inside the ventricular system.
Insights
A rare case of persistent shunt infection was caused by intraventricular bone wax. Endoscopic removal of this foreign body resolved the infection, highlighting a diagnostic challenge in neuroimaging.
Area of Science:
- Neurosurgery
- Pediatric Neurosurgery
- Infectious Disease
Background:
- Persistent shunt infections can stem from factors like cerebrospinal fluid leaks or foreign bodies.
- Shunt infections pose a significant challenge in managing hydrocephalus.
Observation:
- A 5-year-old girl presented with recurrent shunt infections.
- Neuroradiologic evaluation initially overlooked a foreign body in the lateral ventricle.
Findings:
- A fragment of bone wax was identified and removed via endoscopy.
- Bone wax mimicked air on CT and MRI, complicating early diagnosis.
Implications:
- This is the first reported case of intraventricular bone wax causing persistent cerebrospinal fluid infection.
- Early recognition of persistent foreign bodies in neuroimaging is crucial for managing shunt complications.
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