Related Experiment Video
Updated: Jan 16, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Delayed onset of pneumocephalus 14 years after ventriculoperitoneal shunt placement: illustrative case
Saori Ueda1, Katsuya Ueno1, Haruna Isozaki1
1Department of Neurosurgery, Kansai Medical University, Hirakata, Osaka, Japan.
Insights
Delayed-onset pneumocephalus can occur 14 years after ventriculoperitoneal (VP) shunt placement in patients with a history of skull base fracture. This rare complication highlights the importance of long-term monitoring for individuals with shunts and prior head trauma.
Area of Science:
- Neurosurgery
- Neurology
- Radiology
Background:
- Pneumocephalus is a known complication following head trauma or surgery, usually appearing within 48 hours.
- Delayed-onset pneumocephalus is infrequently reported in medical literature.
- This case presents pneumocephalus developing 14 years post-ventriculoperitoneal (VP) shunt insertion for posttraumatic hydrocephalus.
Purpose of the Study:
- To report a rare case of delayed-onset pneumocephalus.
- To highlight potential long-term complications of ventriculoperitoneal shunts in patients with skull base fractures.
- To emphasize the importance of considering delayed complications in neurosurgical patients.
Main Methods:
- Case report of a 16-year-old female with a history of severe head trauma and skull base fracture.
- Patient underwent ventriculoperitoneal (VP) shunt placement at age 2 for posttraumatic hydrocephalus.
- Diagnosis of pneumocephalus was made 14 years after VP shunt surgery via CT imaging.
Main Results:
- The patient presented with sudden headache 14 years after VP shunt placement.
- CT scan revealed significant left-sided pneumocephalus.
- Improvement was noted after adjusting the VP shunt valve pressure settings; the shunt was later removed.
Conclusions:
- Patients with a history of skull base fracture and a VP shunt are at risk for developing pneumocephalus even after extended latency periods.
- This case underscores the possibility of late-onset complications associated with cerebrospinal fluid shunting systems.
- Long-term vigilance is crucial for patients with shunts and predisposing factors like skull base defects.
Background:
Pneumocephalus is a known complication of trauma or head surgery, typically occurring within 48 hours of injury. However, delayed-onset pneumocephalus has been rarely documented in the literature. Here, the authors report a case of pneumocephalus that developed 14 years after ventriculoperitoneal (VP) shunt placement for posttraumatic hydrocephalus.
Observations:
A 16-year-old girl with a history of skull base fracture, including a left petrous bone fracture, diffuse brain injury, and subarachnoid hemorrhage caused by a traffic accident at 2 years of age, underwent VP shunt placement for posttraumatic hydrocephalus 1 month after the injury. Fourteen years after the shunt surgery, she developed a sudden headache and was diagnosed with pneumocephalus. CT imaging revealed significant left-sided pneumocephalus. Although the exact point of air entry was not identified, her condition improved following adjustments to the Strata II shunt valve pressure settings. Eventually, the shunt was removed to prevent further infections. No CSF leakage was observed, and the patient experienced no recurrence of symptoms.
Lessons:
Patients with a VP shunt and a history of skull base fracture may develop pneumocephalus even after a prolonged period. https://thejns.org/doi/10.3171/CASE25118.
Related Concept Videos
01:27Pneumothorax-II
Clinical Manifestations:
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...