Case Report: A case report of dry tap during ventriculostomy

Area of Science:

• Neurosurgery
• Neurology
• Medical Imaging

Background:

• Pneumocephalus is an exceptionally rare complication following ventriculoperitoneal (VP) shunt insertion.
• Dry taps during ventricular puncture can necessitate multiple attempts, increasing complication risks like tension pneumocephalus, seizures, and shunt failure.
• Post-traumatic hydrocephalus can present with raised intracranial pressure, requiring intervention such as VP shunting.

Purpose of the Study:

• To report a rare case of pneumocephalus after VP shunt insertion.
• To discuss the management of pneumocephalus in this context.
• To identify preventive measures for this complication.

Main Methods:

• Case report of a patient with post-traumatic hydrocephalus.
• Description of the VP shunt insertion procedure, including challenges with ventricular puncture (dry tap).
• Post-operative imaging (CT scan) to identify pneumoventriculi and management with 100% oxygen therapy.

Main Results:

• A dry tap during ventricular puncture for VP shunt insertion led to pneumoventriculi, confirmed by CT scan.
• The patient was successfully managed with 100% oxygen, showing gradual improvement.
• No immediate complications such as tension pneumocephalus or shunt failure were observed.

Conclusions:

• Procedural modifications, including head-down positioning, adequate dural incision, and minimizing cerebrospinal fluid (CSF) egress, can help prevent pneumocephalus.
• 100% oxygen administration is an effective management strategy for pneumocephalus.
• Careful surgical technique is crucial to avoid complications during VP shunt placement, especially in cases with challenging ventricular access.