Cerebral Venous Thrombosis Complicated by Hemorrhagic Infarction Secondary to Ventriculoperitoneal Shunting

Abstract

While a delayed intracerebral hemorrhage at the site of a ventricular catheter has occasionally been reported in literature, a delayed hemorrhage caused by venous infarction secondary to ventriculoperitoneal shunting has not been previously reported. In the present case, a 68-year-old woman underwent ventriculoperitoneal shunting through a frontal burr hole, and developed a hemorrhagic transformation of venous infarction on the second postoperative day. This massive venous infarction was caused by bipolar coagulation and occlusion of a large paramedian cortical vein in association with atresia of the rostral superior sagittal sinus. Thus, to eliminate the risk of postoperative venous infarction, technical precautions to avoid damaging surface vessels in a burr hole are required under loupe magnification in ventriculoperitoneal shunting.

Delayed Intraventricular Hemorrhage following a Ventriculoperitoneal Shunt Placement: Exploring the Surgical Anatomy of a Rare Complication

“…In their case, a right occipital ICH and associated IVH occurred in a 64-year-old woman, six days after the operation for hydrocephalus secondary to subarachnoid hemorrhage [ 6 ]. Son and Park [ 5 ] reported a 68-year-old woman who underwent VPS through a frontal burr hole and developed hemorrhagic transformation of a massive venous infarction on the second postoperative day [ 5 ].…”

“…Ventriculoperitoneal shunt (VPS) placement is one of the most common surgical procedures done by neurosurgeons worldwide [ 1 ]. It is a routine procedure for cerebrospinal fluid (CSF) diversion and is associated with many complications [ 2 , 3 ], such as shunt malfunction and revision [ 4 ], shunt contamination and infection (meningitis) [ 3 , 4 ], seizures, subdural hemorrhage [ 3 ], and intraparenchymal cerebrovascular accidents (infarcts and hemorrhage) [ 5 , 6 ]. Bleeding into the brain parenchyma or ventricles is an infrequently reported complication in adults who undergo insertion of a VPS [ 4 ].…”

“…Bleeding into the brain parenchyma or ventricles is an infrequently reported complication in adults who undergo insertion of a VPS [ 4 ]. Delayed postoperative intracerebral hemorrhage (ICH) after VPS surgery, at the site of the ventricular catheter [ 5 ], is a quite rare and potentially severe event [ 2 , 3 ].…”

Delayed Distant Intracerebral Hematoma after Ventriculoperitoneal Shunt in a Child

“…Some prefer to make small hole by monopolar cautery so that shunt fits snugly, to prevent leakage of CSF into the subcutaneous plane. 1,5 Delayed intracerebral hematoma was first described by Matsumura et al 2 in 1985. There are only 19 reported cases of delayed intracerebral hematoma of which only 1 is similar to our case (►Table 1).…”

“…The most common complications include shunt obstruction, overdrainage, disconnection, infection, and malposition. 1,2 Intracerebral hematomas are also known to occur along the shunt path and are mostly clinically silent. 3 Here, we report a case of postoperative delayed intracerebral hematoma in a boy because of unusual presentation.…”