Skull Base Defect Associated with Spontaneous Intraventricular Pneumocephalus in a Patient with Ventriculo-peritoneal Sh
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Hellenic Journal of Surgery (2020) 92:3-4, 143-146
Skull Base Defect Associated with Spontaneous Intraventricular Pneumocephalus in a Patient with Ventriculo-peritoneal Shunt Alejandro Augusto Ortega Rodriguez, Laura Torres Brunet, José Luís Caro Cardera
Abstract We report the case of an 81-year-old male patient who presented severe spontaneous intraventricular pneumocephalus after two months of ventriculoperitoneal shunt placement for adult chronic hydrocephalus associated with neurologic progressive deterioration and a recent history of hypoacousia. During the process of diagnosis, on simple and finecut Computerized Tomography a porencephalic cyst was discovered in association with an osteodural defect in the petrous bone. A surgical revision was scheduled and an approach to the tegmen tympani was performed, covering the defect with fasciomuscular flap and fibrin glue. There were no complications and a remarkable clinicoradiologic improvement was achieved. Key words: Bone defect; pneumocephalus; skull base; ventriculoperitoneal shunt.
Introduction Spontaneous pneumocephalus is an uncommon entity seen as a complication of ventriculoperitoneal shunt (VPS) placement when the air enters into the intracranial cavity through a dural adhesion caused by a bone defect in the cranial base. It is facilitated by a chronic siphon effect made by shunting. Pneumocephalus may be immediate, occurring in the first days after shunt placement, or delayed, appearing months or years later. We explain the onset manifestations, the radiologic features and the treatment performed.
Case Presentation Clinical presentation and diagnostic workup
We report the case of an 81-year-old male with a programmable VPS for previous history of adult chronic hydrocephalus. The patient was discharged without complications and he confirmed symptoms improving at the first outpatient consultation. Two months later, he came to the emergency room for progressive reappearance of his previous symptoms and lethargy. A non-enhanced Computerized Tomography MD, Neurosurgery Department, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Girona, Spain Corresponding author: Alejandro Augusto Ortega Rodriguez MD Neurosurgery Department, Hospital Universitari de Girona Doctor Josep Trueta, Avinguda de França S/N, 17007, Girona, Spain Tel.: +34972940200, Fax: +34972228296 e-mail: [email protected] Received Jun 2, 2020; Revised Jun 30, 2020; Accepted Jul 2, 2020
Hellenic Journal of Surgery 92
(CT) was performed, revealing severe intraventricular pneumocephalus in both frontal and temporal horns and a temporal porencephalic cavity in contact between petrous bone and temporal horn (Figure 1a-b). Due to abdominal distension, an abdominal X-ray and after an abdominal CT were done, with no signs of bowel perforation. The pressure of the shunt was modified and under the suspicious of cranial base defect, a fine-cut CT was scheduled. There was evidence of right tegmen tympani thinning and occupation of mastoid cells (Figure 1c). Patient’s relatives
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