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CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(01): 325-328
DOI: 10.4103/ajns.AJNS_224_18
Case Report

Delayed pneumoventricle following endonasal cerebrospinal fluid rhinorrhea repair with thecoperitoneal shunt

Shyam Krishnan
Department of Neurosurgery, Achanta Lakshmipathi Neurosurgical Centre, Voluntary Health Services Hospital, Chennai, Tamil Nadu
,
Adarsh Manuel
Department of Neurosurgery, Achanta Lakshmipathi Neurosurgical Centre, Voluntary Health Services Hospital, Chennai, Tamil Nadu
,
Madabhushi Vasudevan
Department of Neurosurgery, Achanta Lakshmipathi Neurosurgical Centre, Voluntary Health Services Hospital, Chennai, Tamil Nadu
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Pneumocephalus and pneumoventricle are well-documented in neurosurgical practice. Although both are common posttraumatic sequelae, iatrogenic causes are also well recognized. Iatrogenic causes may be seen after intracranial surgical procedures or cerebrospinal fluid (CSF) diversion procedures. Small amount of pneumoventricle postshunt procedure is usually a self-limiting condition. Rarely, the patient may develop tension pneumoventricle which requires emergency intervention. The occurrence of delayed tension pneumoventricle/pneumatocele following surgery for CSF rhinorrhea with CSF diversion procedures is very rare. We report one case of late presentation of delayed tension pneumoventricle with temporal pneumatocele in a patient who underwent transnasal endoscopic repair of CSF fistula followed by thecoperitoneal shunt. This condition is potentially lethal that requires prompt recognition and surgical treatment.

Key-words:

Cerebrospinal fluid rhinorrhea - pneumatocele - pneumocephalus - tension pneumoventricle - thecoperitoneal shunt

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Publication History

Article published online:
09 September 2022

© 2019. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Tuǧcu B, Tanriverdi O, Günaldi O, Baydin S, Postalci LS, Akdemir H, et al. Delayed intraventricular tension pneumocephalus due to scalp-ventricle fistula: A very rare complication of shunt surgery. Turk Neurosurg 2009;19:276-80.
  • 2 Ruge JR, Cerullo LJ, McLone DG. Pneumocephalus in patients with CSF shunts. J Neurosurg 1985;63:532-6.
  • 3 Horton DD, Pollay M, Reynolds AF Jr. Intraventricular pneumocephalus secondary to subcutaneous emphysema: A case report. Neurosurgery 1984;15:557-8.
  • 4 Perrin RG, Bernstein M. Tension pneumoventricle after placement of a ventriculoperitoneal shunt: A novel treatment strategy. Case report. J Neurosurg 2005;102:386-8.
  • 5 Jimenez-Jimenez E, Martí SS, Villas MV. Tension pneumocephalus related to radiotherapy for nasopharyngeal carcinoma. Case Rep Oncol Med 2014;2014:327380.
  • 6 Aoyama I, Kondo A, Nin K, Shimotake K. Pneumocephalus associated with benign brain tumor: Report of two cases. Surg Neurol 1991;36:32-6.
  • 7 Kawajiri K, Matsuoka Y, Hayazaki K. Brain tumors complicated by pneumocephalus following cerebrospinal fluid shunting – Two case reports. Neurol Med Chir (Tokyo) 1994;34:10-4.
  • 8 Gönül E, Izci Y, Sali A, Baysefer A, Timurkaynak E. Subdural and intraventricular traumatic tension pneumocephalus: Case report. Minim Invasive Neurosurg 2000;43:98-101.
  • 9 Garg N, Devi I, Dua R, Arivazhagan A. Tension pneumoventricle following exposure of shunt chamber. Br J Neurosurg 2008;22:121-2.
  • 10 Radhziah S, Lee CK, Ng I. Tension pneumoventricle. J Clin Neurosci 2006;13:881-3.
  • 11 Ruiz-Juretschke F, Mateo-Sierra O, Iza-Vallejo B, Carrillo-Yagüe R. Intraventricular tension pneumocephalus after transsphenoidal surgery: A case report and literature review. Neurocirugia (Astur) 2007;18:134-7.
  • 12 Satapathy GC, Dash HH. Tension pneumocephalus after neurosurgery in the supine position. Br J Anaesth 2000;84:115-7.
  • 13 Little JR, MacCarty CS. Tension pneumocephalus after insertion of ventriculoperitoneal shunt for aqueductal stenosis. J Neurosurg 1976;44:383-5.
  • 14 Rizzoli HV, Hayes GJ, Steelman HF. Rhinorrhea and pneumocephalus; surgical treatment. J Neurosurg 1954;11:277-83.
  • 15 Yadav YR, Parihar V, Janakiram N, Pande S, Bajaj J, Namdev H, et al. Endoscopic management of cerebrospinal fluid rhinorrhea. Asian J Neurosurg 2016;11:183-93.
  • 16 Schlosser RJ, Woodworth BA, Wilensky EM, Grady MS, Bolger WE. Spontaneous cerebrospinal fluid leaks: A variant of benign intracranial hypertension. Ann Otol Rhinol Laryngol 2006;115:495-500.
  • 17 Owler BK, Allan R, Parker G, Besser M. Pseudotumour cerebri, CSF rhinorrhoea and the role of venous sinus stenting in treatment. Br J Neurosurg 2003;17:79-83.
  • 18 Al-Sebeih K, Karagiozov K, Elbeltagi A, Al-Qattan F. Non-traumatic cerebrospinal fluid rhinorrhea: Diagnosis and management. Ann Saudi Med 2004;24:453-8.
  • 19 Schlosser RJ, Bolger WE. Spontaneous nasal cerebrospinal fluid leaks and empty sella syndrome: A clinical association. Am J Rhinol 2003;17:91-6.
  • 20 Lopatin AS, Kapitanov DN, Potapov AA. Endonasal endoscopic repair of spontaneous cerebrospinal fluid leaks. Arch Otolaryngol Head Neck Surg 2003;129:859-63.
  • 21 Banks CA, Palmer JN, Chiu AG, O'Malley BW Jr., Woodworth BA, Kennedy DW, et al. Endoscopic closure of CSF rhinorrhea: 193 cases over 21 years. Otolaryngol Head Neck Surg 2009;140:826-33.
  • 22 Davis DH, Laws ER Jr., McDonald TJ, Salassa JR, Phillips LH 2nd. Intraventricular tension pneumocephalus as a complication of paranasal sinus surgery: Case report. Neurosurgery 1981;8:574-6.
  • 23 Sasani M, Ozer FA, Oktenoglu T, Tokatli I, Sarioglu AC. Delayed and isolated intraventricular tension pneumocephalus after shunting for normal pressure hydrocephalus. Neurol India 2007;55:81-2.