PMC9805611_01
Preoperative MRI: Ventriculomegaly with minimal periventricular lucency.
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F1
This was further confirmed by radiographic imaging [Figure 1], Pre and post lumbar puncture, gait assessment, and Mini Mental State Examination Score.
Immediate post ventriculopleural shunt: No change in ventricular size, dilated frontal horn, and temporal horn.
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F2
Immediate post-operative, improvement in the gait was noted; however, CT brain [Figure 2], neither showed any evidence of reduction in the ventricular size, nor presence of features of shunt over drainage.
Post ventriculopleural shunt over drainage of the shunt with collapsed ventricles and bilateral subdural hygroma.
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F3
At this point, he was diagnosed with gross bilateral subdural hygroma caused by shunt over drainage at the valve pressure of 110 mmH2O which was treated by increasing shunt pressure to 180 mmH2O and surgical evacuation of hygroma [Figure 3].
MRI brain: Pan ventriculomegaly with patent shunt in situ.
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F4
A month later, he presented again with altered sensorium and ventriculomegaly [Figure 4].
Progressive change of the height of external ventricular drainage tube in cm with increasing intracranial pressure. F(foot) in the image denotes direction towards which the image is being scrolled.
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F5
Once the ICP values reached up to the 9.0 mmH2O, with documented improvement in patients clinioradiological state [Figure 5], plan was made to adjust the existing valve to 80 mmH2O, place an antisiphon device (to prevent position related overdrainage), and finally, replace the shunt to ventriculopleural shunt (-5 mmHg negative pressure) [Figure 6].
Post ventriculopleural shunt and chest X-ray showing the intrapleural. F(foot) in the image denotes direction towards which the image is being scrolled.
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F6
Once the ICP values reached up to the 9.0 mmH2O, with documented improvement in patients clinioradiological state [Figure 5], plan was made to adjust the existing valve to 80 mmH2O, place an antisiphon device (to prevent position related overdrainage), and finally, replace the shunt to ventriculopleural shunt (-5 mmHg negative pressure) [Figure 6].