Spontaneous Tension Pneumocephalus: A Rare Complication of Shunting

BACKGROUND: Spontaneous tension pneumocephalus (STP) is a rare but serious complication derived from shunting procedures. Few cases have been published with purely intraventricular location. Treatment options and physiopathology considerations are discussed in this case report. CASE DESCRIPTION: A 75-year-old woman with a 15-year-old lumboperitoneal (LP) shunt insertion was treated with a ventriculoperitoneal shunt for her normotensive hydrocephalus. Two months later she was brought to the emergency room showing symptoms of lethargy and confusion. A helicoidal computed tomography (CT) scan revealed a bone defect in the floor of the right temporal fossa. The patient underwent a temporal craniotomy for closing the bone and dural defect, and the LP shunt was removed, at which point her condition improved. CONCLUSIONS: A high-resolution CT scan of the skull base is useful to localize the point where the air enters into the intracranial cavity in STP cases. Coexistent or preceding otologic symptoms might direct the suspicion toward an otogenic origin. Shunt removal, or adjusting the opening pressure, if feasible, is recommended. Otherwise, dural repair and covering of the bone defect have acceptable rates of success and should be performed before any other more aggressive techniques to avoid the risk of hearing loss.