Tension pneumoencephalus after placement of cysto-peritoneal shunt in a child

Abstract

The presence of pneumocephalus is common in neurosurgery and its causes include trauma, infections, tumors and surgery. It is usually found accidentally in neuroimaging. We report the case of a 13 years old male who had a Galeasi III temporal cyst and had a cystoperitoneal shunt surgery 37 days earlier. He developed severe headache, nausea and vomiting, clinical intracranial hypertension and a massive pneumocephalus in the CT-scan with mass effect. There was never evidence of shunt dysfunction and no evidence of lesions in the skull of cranial base. It was necessary to drain the air by direct aspiration, antibiotics were not used, and the patient never had fever or evidence of infection. This case illustrates an unusual presentation of spontaneous pneumocephalus without an evident cause.