Tension pneumoventricle following exposure of shunt chamber

Abstract

Pneumocephalus is the presence of air within the intracranial vault. Intraventricular pneumocephalus, also known as pneumoventricle is relatively rare and commonly occurs following cerebrospinal fluid diversion procedures. This may occur immediately or be delayed. Although a small amount of pneumoventriculus is asymptomatic and may not require any treatment, when present under tension it needs to be evacuated. We present a case of tension pneumoventricle following exposure of the shunt chamber, which resulted in deterioration of the patients' neurological condition and required evacuation.

Tension pneumoventricle after resection of a fourth ventricle choroid plexus papilloma: An unusual postoperative complication

“…[13] One case occurred following wound dehiscence, resulting in exposure of the shunt chamber. [2] Tension pneumoventricle was also described after resection of a cerebellar medulloblastoma, associated with hydrocephalus and CSF leakage from the suture line;[8] and after surgical resection of a cerebellar medulloblastoma and insertion of a ventriculoperitoneal shunt due to a petrous bone defect. [5] Another interesting case occurred after the removal of an acoustic neurinoma and a CSF shunt procedure due to a concomitant hydrocephalus.…”

“…[11] Prevention of this complication is made by proper layered closure. [2] In the case of postoperative CSF leak treated with lumbar drainage, the drain must be removed immediately, since it favors more air intake. [10] In our case, external drainage was not applied during surgery and we have not observed a wound with dehiscence as the possible entry point of air; neither the patient had a lumbar drain.…”

“…[26] It is commonly associated with head injury, craniotomies,[371013] or the insertion of a lumbar drain. [6] Intraventricular pneumocephalus, also known as pneumoventricle, commonly follows cerebrospinal fluid (CSF) diversion procedures and fourth ventricular surgery.…”

“…[6] Intraventricular pneumocephalus, also known as pneumoventricle, commonly follows cerebrospinal fluid (CSF) diversion procedures and fourth ventricular surgery. [4] Pneumoventricle is mostly asymptomatic, not requiring treatment,[2710] and takes approximately 2–3 weeks for complete reabsorption of any air present. [12] Tension pneumoventricle, which means the presence of air in the ventricles under pressure, is a rare incident that suggests a connection between the atmosphere and the intracranial cavity.…”

Tension pneumoventricle after excision of third ventricular tumor in sitting position

“…It has been reported primarily following cerebrospinal fluid (CSF) diversion procedures. [2] Small amounts of air in ventricle is asymptomatic and do not require any active intervention. However, the presence of tension pneumoventricle (symptomatic intraventricular air) may lead to significant clinical deterioration.…”