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Delayed pneumocephalus following shunting for hydrocephalus.
[hydrocephalus with stenosis of the aqueduct of sylvius]
Delayed
pneumocephalus
is
a
rare
but
well-reported
complication
of
cerebrospinal
fluid
diversion
procedures
.
In
most
cases
the
air
enters
the
intracranial
cavity
via
a
skull
base
defect
.
We
report
a
case
of
hydrocephalus
secondary
to
aqueduct
stenosis
.
The
patient
developed
pneumocephalus
2
months
after
successful
placement
of
a
ventriculoperitoneal
shunt
.
We
describe
an
attempt
at
endoscopic
diagnosis
and
repair
of
the
fistula
.
This
was
unsuccessful
,
presumably
because
the
defect
was
too
small
to
localize
even
with
the
use
of
intrathecal
fluorescein
.
We
subsequently
performed
a
conventional
craniotomy
and
anterior
fossa
repair
with
placement
of
an
antisiphon
device
.
We
suggest
that
in
certain
cases
,
when
patients
present
with
long
-standing
hydrocephalus
,
it
may
be
advisable
to
insert
either
a
high
-pressure
valve
or
antisiphon
device
as
a
primary
measure
.