Tension pneumoventricle in a patient with a ventriculoperitoneal shunt and an ethmoidal meningoencephalocele

Abstract

Background: Tension pneumoventricle is a rare, life-threatening complication. It has been rarely described in patients with ventriculoperitoneal (VP) shunts. Case Description: A 28-year-old male patient with a VP shunt became progressively lethargic after falling from his wheelchair. Skull X-rays and head CT scan showed abundant air inside the ventricles. He was taken to the operating room, and the shunt was revised without improvement. Two days later, a frontal external ventricular drain was placed to remove the air. In the investigation toward the etiology of the pneumoventricle, a review of previous head CT scans and brain MRIs showed that the patient had a small left frontonasal meningoencephalocele extending into the ethmoid, which had been unnoticed. He underwent repair of the defect with adequate sealing of the frontal skull base. Conclusion: In a shunted patient with moderate or severe symptoms from a tension pneumoventricle, external ventricular drainage is required to remove the air as the shunt is inadequate.

Management and Treatment of Delayed Posttraumatic Tension Pneumoventricle in Low-Income Countries: A Report of Two Rare Cases and Literature Review

“…However, we assume that our second patient (Patient 2) developed a simple acute posttraumatic pneumoventricle, which subsequently worsened, given the evolution of his clinical picture. Moreover, cases of secondary worsening of the penumoventricle are the most frequently reported [1,2,7,9]. Monitoring the persistence or reappearance of posttraumatic cerebrospinal rhinorrhea is essential because it is one of the rst signs of worsening clinical conditions, as we observed in our patients.…”

“…Monitoring the persistence or reappearance of posttraumatic cerebrospinal rhinorrhea is essential because it is one of the rst signs of worsening clinical conditions, as we observed in our patients. In addition, certain skull base abnormalities, such as congenital bony malformations (paranasal sinus pneumoceles, pneumosinus, ethmoidal meningocele), previous skull base surgery, ventricular approaches, and tumors, may increase the risk of posttraumatic tension pneumoventricle [1,2,5,9,11].…”

“…Pneumocephalus was de ned as the presence of air in the epidural, subarachnoid, intraparenchymal, or intraventricular space (pneumoventricle) [1][2][3][4]. The pneumoventricle is mainly observed after intracranial surgery, and skull base pathology is complicated by an osteodural defect, which is particularly traumatic, or sometimes spontaneous [5,6].…”