Subcutaneous emphysema and pneumocephalus following Ventriculoperitoneal Shunt (VPS) surgery for hydrocephalus: a case report

Muhammad Arifin Parenrengi; Muhammad Wildan Hakim; Wihasto Suryaningtyas

doi:10.15562/bmj.v12i2.4455

Subcutaneous emphysema and pneumocephalus following Ventriculoperitoneal Shunt (VPS) surgery for hydrocephalus: a case report

Muhammad Arifin Parenrengi ,

Muhammad Wildan Hakim ,

Wihasto Suryaningtyas ,

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DOI: https://doi.org/10.15562/bmj.v12i2.4455 |
Published: 2023-07-04

Abstract

Link Video Abstract: https://youtu.be/vfAwOXSjbCE

Background: Hydrocephalus is still commonly found in pediatric neurosurgery managed by endoscopic third ventriculostomy (ETV) and Ventriculoperitoneal Shunt (VPS). Subcutaneous emphysema and pneumocephalus as a complication of VPS surgery is rare. Subcutaneous emphysema is the presence of air in the skin, while pneumocephalus is the presence of air in the intracranial space. This case study aims to evaluate subcutaneous emphysema and pneumocephalus following ventriculoperitoneal shunt surgery for hydrocephalus.

Case Presentation: We report an 11-month-old girl with hydrocephalus due to aqueductal stenosis who postoperatively had subcutaneous emphysema and pneumocephalus. 1 week after VPS insertion, there was a crepitation under the skin of the neck and chest. The patient occasionally appeared breathless and had a fever. The respiratory rate increased with rales on the right lung, along with the gradually decreased consciousness, and the abdominal wound slowly became dehiscent. There was subcutaneous emphysema along the shunt track and pneumocephalus.

Conclusion: The interest, in this case, could be that of the patient’s other morbid conditions, including pneumonia and the dehiscent abdominal wound on the post-VP shunt insertion incision that may have also contributed to causing the subcutaneous emphysema and pneumocephalus.

References

Estey CM. Congenital Hydrocephalus. Vet Clin North Am Small Anim Pract. 2016;46(2):217-229.
Giordano M. Complications of CSF shunting in hydrocephalus. Child’s Nervous System. 2015;31(7):1207.
McAllister JP 2nd. Pathophysiology of congenital and neonatal hydrocephalus. Semin Fetal Neonatal Med. 2012;17(5):285-294.
Beuriat PA, Puget S, Cinalli G, Blauwblomme T, Beccaria K, Zerah M, et al. Hydrocephalus treatment in children: long-term outcome in 975 consecutive patients. J Neurosurg Pediatr. 2017;20(1):10-18.
Aydoseli A, Akcakaya MO, Aras Y, Boyali O, Unal OF. Emergency management of an acute tension pneumocephalus following ventriculoperitoneal shunt surgery for normal pressure hydrocephalus. Turk Neurosurg. 2013;23(4):564-567.
Garg N, Devi I, Dua R, Arivazhagan A. Tension pneumoventricle following exposure of shunt chamber. Br J Neurosurg. 2008;22(1):121-122.
Paquette M, Terezhalmy GT, Moore WS. Subcutaneous emphysema. Quintessence Int. 2002;33(6):478-479.
Najera Aguilar E, Castle Ramirez M, Bollar Zabala A, Urculo Bareño E. Delayed spontaneous pneumocephalus in ventriculoperitoneal shunting: two case reports and literature review. Neurocirugia (Astur). 2014;25(2):86-89.
Shankar PS. Subcutaneous emphysema from bronchocavitary subcutaneous fistula. Lung India. 2008;25(2):73-74.
Fox A, Sheick H, Ekwobi C, Ho-Asjoe M. Benign surgical emphysema of the hand and upper limb: gas is not always gangrene--a report of two cases. Emerg Med J. 2007;24(11):798-799.
Perrin RG, Bernstein M. Tension pneumoventricle after placement of a ventriculoperitoneal shunt: a novel treatment strategy. Case report. J Neurosurg. 2005;102(2):386-388.
Sachkova A, Schemmerling T, Goldberg M, Solomiichuk V, Rohde V, von Eckardstein KL, et al. Predictors of ventricular tension pneumocephalus after posterior fossa surgery in the sitting position. Acta Neurochir (Wien). 2018;160(3):525-538.
Isa MM, Thayeb A, Yani A, Hutagalung MBZ. Post total splenectomy outcome in thalassemia patients. Bali Medical Journal. 2019;8(3):764-767.
Wardhana DPW, Maliawan S. Operative nuances of endoscopic third ventriculostomy for pediatric obstructive hydrocephalus. Bali Medical Journal. 2018;7(2):351-355.
Arifin MT, Purnomo F, Muttaqin Z, Bakhtiar Y, Andar E, Priambada D, et al. Cerebrospinal fluid contents and risk of shunt exposure in hydrocephalus. Bali Medical Journal. 2019;8(3):661-663.

[1] Estey CM. Congenital Hydrocephalus. Vet Clin North Am Small Anim Pract. 2016;46(2):217-229.

[2] Giordano M. Complications of CSF shunting in hydrocephalus. Child’s Nervous System. 2015;31(7):1207.

[3] McAllister JP 2nd. Pathophysiology of congenital and neonatal hydrocephalus. Semin Fetal Neonatal Med. 2012;17(5):285-294.

[4] Beuriat PA, Puget S, Cinalli G, Blauwblomme T, Beccaria K, Zerah M, et al. Hydrocephalus treatment in children: long-term outcome in 975 consecutive patients. J Neurosurg Pediatr. 2017;20(1):10-18.

[5] Aydoseli A, Akcakaya MO, Aras Y, Boyali O, Unal OF. Emergency management of an acute tension pneumocephalus following ventriculoperitoneal shunt surgery for normal pressure hydrocephalus. Turk Neurosurg. 2013;23(4):564-567.

[6] Garg N, Devi I, Dua R, Arivazhagan A. Tension pneumoventricle following exposure of shunt chamber. Br J Neurosurg. 2008;22(1):121-122.

[7] Paquette M, Terezhalmy GT, Moore WS. Subcutaneous emphysema. Quintessence Int. 2002;33(6):478-479.

[8] Najera Aguilar E, Castle Ramirez M, Bollar Zabala A, Urculo Bareño E. Delayed spontaneous pneumocephalus in ventriculoperitoneal shunting: two case reports and literature review. Neurocirugia (Astur). 2014;25(2):86-89.

[9] Shankar PS. Subcutaneous emphysema from bronchocavitary subcutaneous fistula. Lung India. 2008;25(2):73-74.

[10] Fox A, Sheick H, Ekwobi C, Ho-Asjoe M. Benign surgical emphysema of the hand and upper limb: gas is not always gangrene--a report of two cases. Emerg Med J. 2007;24(11):798-799.

[11] Perrin RG, Bernstein M. Tension pneumoventricle after placement of a ventriculoperitoneal shunt: a novel treatment strategy. Case report. J Neurosurg. 2005;102(2):386-388.

[12] Sachkova A, Schemmerling T, Goldberg M, Solomiichuk V, Rohde V, von Eckardstein KL, et al. Predictors of ventricular tension pneumocephalus after posterior fossa surgery in the sitting position. Acta Neurochir (Wien). 2018;160(3):525-538.

[13] Isa MM, Thayeb A, Yani A, Hutagalung MBZ. Post total splenectomy outcome in thalassemia patients. Bali Medical Journal. 2019;8(3):764-767.

[14] Wardhana DPW, Maliawan S. Operative nuances of endoscopic third ventriculostomy for pediatric obstructive hydrocephalus. Bali Medical Journal. 2018;7(2):351-355.

[15] Arifin MT, Purnomo F, Muttaqin Z, Bakhtiar Y, Andar E, Priambada D, et al. Cerebrospinal fluid contents and risk of shunt exposure in hydrocephalus. Bali Medical Journal. 2019;8(3):661-663.

Subcutaneous emphysema and pneumocephalus following Ventriculoperitoneal Shunt (VPS) surgery for hydrocephalus: a case report

Abstract

References

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