Pathogenesis of Delayed Tension Intraventricular Pneumocephalus in Shunted Patient: Possible Role of Nocturnal Positive Pressure Ventilation

详细信息    查看全文

• 作者：Sidi Salem-Memou¹ ; Bernard Vallee¹ ; ² ; Timothé ; e Jacquesson¹ ; ² ; Emmanuel Jouanneau¹ ; ² ; Moncef Berhouma¹ ; ^{berhouma.moncef@gmail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Hydrocephalus ; Pneumoventricle ; Ventriculoperitoneal shunt ; Pneumocephalus ; Sleeping apnea ; Nocturnal positive pressure ventilation
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：85
• 期：Complete
• 页码：365.e17-365.e20
• 全文大小：1018 K

文摘

Delayed intraventricular pneumocephalus is a very rare and potentially serious complication of ventriculoperitoneal shunt. It can occur several months or years after shunting. Its pathogenesis is unclear. We herein discuss the underlying mechanisms and particularly the possible role of positive pressure ventilation.

Case Description

A 60 year-old man presented with a lateral ventricle neurocytoma microsurgically resected complicated by a late-onset (15 months) postoperative hydrocephalus requiring an adjustable ventriculoperitoneal (VP) shunt. One month later, the patient was diagnosed with a sleep apnea and required a continuous positive airway pressure (CPAP) device. A few weeks afterward the patient presented with headaches and alteration of consciousness. CT-Scan revealed a massive intraventricular pneumocephalus associated with a millimetric left petrous bone defect. A transient breakout of the positive ventilation and a subtemporal surgical repair of the defect led to the rapid resolution of the pneumocephalus.

Discussion

Delayed intraventricular pneumocephalus requires two conditions: a VP shunt and an osteodural defect. The CPAP may play an important trigger role in the pathogenesis of this complication through a ball valve mechanism. The management relies on transient suspension of the positive ventilation and the surgical repair of the identified defect with or without pressure adjustments of the valve.

Conclusion

Intraventricular pneumocephalus is a potentially serious complication of patients with a VP shunt and receiving positive pressure ventilation. The introduction of a CPAP device must be discussed with the neurosurgeon beforehand in shunted patients.