Izuchukwu Iloabachie¹*, Ikechukwu Valentine Okpalike^1,2, Bright Uche Nwekeala^1,3, Okoro Peter Ejike^1,4, Hillary Chukwuma¹, Chibuike Ukeni Akaa^1,3, Anthony Ilukwe¹, Uko Kalu Uko¹ and Abumere Enahoro¹

¹Neurosurgery Division, Department of Surgery, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria
²Neurosurgery Unit, Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
³Neurosurgery Unit, Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
⁴Neurosurgery Unit, Department of Surgery, Enugu State University Teaching Hospital, Parklane, Enugu State, Nigeria

*Corresponding Author: Izuchukwu Iloabachie, Neurosurgery Division, Department of Surgery, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria.

Received: May 01, 2024; Published: June 11, 2024

Abstract

Background: Ventriculoperitoneal shunt surgery for chronic hydrocephalus with raised intracranial pressure has expectant subdural haematoma among other possible complications. This is due to rupture of the bridging veins between the dura mater and brain especially with rapid decompression of the intracranial pressure. This haematoma mechanism is clearly understood and sudden deterioration of the patient with neurologic deficits clearly indicate need for urgent neuroimaging to confirm diagnosis. Although a rare complication, epidural haematoma can occur following cerebrospinal fluid diversion for chronic hydrocephalus.

Purpose: To report a case of acute extradural haematoma following ventriculoperitoneal shunt in an adult with chronic hydrocephalus and the review of related literatures.

Methods: Literatures regarding occurrence of acute extradural haematoma, pathophysiology and management were reviewed.

Case Presentation: A 43-year-old female patient who had right sided ventriculoperiotoneal shunt for communicating hydrocephalus with raised intracranial pressure. She deteriorated on the second day post-surgery which necessitated urgent cranial computed tomography scan for which finding of acute epidural haematoma was noted.

Conclusions: Ventriculoperitoneal shunt insertion for patients with hydrocephalus may be associated with either common or rare complications and the incidence of rare complications are higher with chronic hydrocephalus with raised intracranial pressure. A high index of suspicion, meticulous surgical skill set and close monitoring are key to early intervention and good outcome.

 Keywords: Ventriculoperitoneal Shunt; Hydrocephalus; Intracranial Pressure; Extradural Haematoma

References

1. Bondurant CP and Jimenez DF. “Epidemiology of cerebrospinal fluid shunting”. Pediatric Neurosurgery 23 (1995): 254-259.
2. Scarff JE. “Treatment of hydrocephalus: an historical and critical review of methods and results”. Journal of Neurology, Neurosurgery and Psychiatry 26 (1963): 1-26.
3. Patwardhan RV and Nanda A. “Implanted ventricular shunts in the United States: the billion-dollar-ayear cost of hydrocephalus treatment”. Neurosurgery 56 (2005): 139-144.
4. Payr E. “Drainage der Hirnventrikel mittels frei transplantirter Blutgefasse; Bemerkungen über Hydrocephalus”. Archiv Fur klinische chirurgie 87 (1908): 801-885.
5. Rıckham PP and Roberts JR. “Treatment of Hydrocephalus”. British Medical Journal 1 (1960): 1887.
6. Paiva WS., et al. “Management of supratentorial epidural hematoma in children: Report on 49 patients”. Arquivos de Neuro-Psiquiatria 68 (2010): 888-892.
7. Meguins LC., et al. “Contralateral extradural hematoma following decompressive craniectomy for acute subdural hematoma (the value of intracranial pressure monitoring): A case report”. Journal of Medical Case Reports 8 (2014): 153.
8. Iwakuma T and Brunngraber CV. “Chronic extradural hematomas: a study of 21 cases”. Journal of Neurosurgery 38 (1973): 488-493.
9. Naradzay JF., et al. “Cerebral ventricular shunts”. Journal of Emergency Medicine 2 (1999): 311-322.
10. Vinay B., et al. “Delayed incidental diagnosis of postoperative extradural hematoma following ventriculoperitoneal shunt”. Journal of Neurosciences in Rural Practice 6.1 (2015): 94-96.
11. Sengupta RP and Hankinson J. “Extradural haemorrhage - A hazard of ventricular drainage”. Journal of Neurology, Neurosurgery and Psychiatry 35 (1972): 297-303.
12. Yucel E and Nilüfer TAS. “Late acute spontaneous giant epidural hematoma after ventriculoperitoneal shunt surgery: A Case Report”. Journal of Emergency Medicine Case Reports 12.2 (2021): 45-47.
13. Seyithanoglu H., et al. “Chronic ossified epidural hematoma after ventriculoperitoneal shunt insertion: A Case Report”. Turkish Neurosurgery 20.4 (2010): 519523.
14. Odake G and Matsumoto S. “Supratentorial epidural hematoma as a complication of internal decompression-one personal and 42 reported cases”. Neurologia Medico-Chirurgica (Tokyo) 21.8 (1981): 897905.
15. Mishra SS., et al. “Shunt site chronic calcified extradural hematoma: an avoidable complication”. Journal of Pediatric Neurosciences 9.2 (2014): 166-168.
16. Louzada PR., et al. “Bilateral extradural haematoma after acute ventricular over-drainage”. Brain Injury 26 (2012): 95-100.
17. Power D., et al. “Contralateral extradural haematoma after insertion of a programmable-valve ventriculoperitoneal shunt”. Journal of the Royal Society of Medicine 92.7 (1999): 360-361.
18. Harkness W. “Contralateral extradural haematoma after ventriculoperitoneal shunt insertion”. Journal of the Royal Society of Medicine 92.10 (1999): 547.

Citation

Citation: Izuchukwu Iloabachie., et al. “Early Acute Spontaneous Giant Extradural Haematoma Following Ventriculoperitoneal Shunt Surgery in an Adult with Chronic Communicating Hydrocephalus: A Case Report”. Acta Scientific Neurology 7.7 (2024): 25-28.

Copyright

Copyright: © 2024 Izuchukwu Iloabachie., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.