PMC8769428_01
Preoperative brain CT showing hydrocephalus (A), brain CT on postoperative day 1 after first shunt revision surgery showing improvement of hydrocephalus (B), and brain CT on postoperative day 3 showing progressed ventriculomegaly with intraventricular hemorrhage and parenchymal pericatheter hemorrhage (C) (the white arrows show intraventricular hemorrhage and the white arrowhead shows parenchymal pericatheter hemorrhage).
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F1
CT scan showed progressive ventricular enlargement and disappearance of the sulcus (Fig. 1A), which suggested shunt malfunction. Chest abdominal CT showed that the abdominal tube had come out of the abdominal cavity. Brain CT on postoperative day 1 showed a decreased ventricular size and a tiny volume of ventricular hematoma that formed a slight niveau in the ventricles (Fig. 1B). The parenchymal pericatheter hemorrhage was also noticed (Fig. 1C); consequently, emergency shunt reconstruction was performed.
Subcutaneous hemorrhagic bruises along the shunt pathway.
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F2
Subcutaneous hemorrhagic bruises were also observed along the shunt pathway in the right neck and chest (Fig. 2).
Intraoperative picture (A) and schematic representation (B) of shunt valve obstructed by hematoma (hematoma in the programmable portion of the valve is colored red).
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F3
The programmable portion of the valve was filled with a hematoma (Fig. 3), which was considered to cause the acute shunt occlusion, while there was no hematoma in reservoir portion of the valve, which was filled with slightly bloody CSF.