Delayed Pneumoventricle Following Endonasal Cerebrospinal Fluid Rhinorrhea Repair with Thecoperitoneal Shunt

Area of Science:

• Neurosurgery
• Neurology
• Radiology

Background:

• Pneumocephalus and pneumoventricle are recognized complications in neurosurgical practice, often resulting from trauma or iatrogenic causes.
• Iatrogenic pneumocephalus can occur after intracranial surgery or cerebrospinal fluid (CSF) diversion procedures.
• While small pneumoventricles post-shunt are typically self-limiting, tension pneumoventricle is a rare but critical emergency.

Observation:

• This report details a rare case of delayed tension pneumoventricle with temporal pneumatocele.
• The patient underwent transnasal endoscopic repair of a CSF fistula followed by a thecoperitoneal shunt.
• The condition presented late after the initial surgical interventions.

Findings:

• Delayed tension pneumoventricle and pneumatocele following CSF rhinorrhea repair and CSF diversion is exceptionally rare.
• The presented case highlights a late-onset manifestation of this serious complication.
• Prompt recognition and surgical management are crucial for favorable outcomes.

Implications:

• This case underscores the importance of considering delayed tension pneumoventricle in patients with neurological decline after CSF diversion procedures.
• Neurosurgeons and neurologists must be vigilant for this rare but life-threatening complication.
• Early diagnosis and intervention can prevent severe morbidity and mortality associated with tension pneumoventricle.