PMC9107938_01
Axial computed tomography scans obtained during follow-up (A) and at admission (B) showing an increase in the size of ventricles.
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Compared with her previous series of computed tomography (CT) scans, the size of the ventricles increased (Fig. 1).
A, Shuntography demonstrated that the contrast medium entered both the proximal and distal tubes. B, Magnification of the squared portion in A. Severe stenosis of the tube (black arrow) was observed where it passed the narrowed burr hole. C, Three-dimensional (3D) CT reconstruction showing the narrowing burr hole (red circle). D, Computed tomography (CT) scan immediately after the shuntography presented a reflux of the contrast medium in the ventricles. E, An axial CT scan 24 hours after the shuntography demonstrating disappearance of the contrast medium in the ventricles. N, needle; V, valve.
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The injected contrast medium entered both the proximal and distal tubes (Fig. 2A); however, some resistance was noted when injecting the contrast medium toward the ventricular tube with manual compression on the tube distal to the valve. Severe stenosis of the ventricular tube was suspected at the site of the shunt tube penetrating the burr hole of the skull (Fig. 2B). Three-dimensional (3D) CT reconstruction images were further obtained, which demonstrated that the tract of the proximal shunt tube adjacent to the burr hole was not clearly traceable distally to the burr hole (Fig. 2C). The intraventricular contrast medium was washed away on serial CT scans in 24 hours after the shuntography, indicating that the obstruction was not complete (Fig. 2D and E).
A and B, Intraoperative photos. A, The shunt tube was compressed and at the exit from the skull (black arrow). B, The burr hole was enlarged (white arrow) with a rongeur and a new interposed tube was implanted between the burr hole and the valve (white arrowhead). C, Postoperative computed tomography (CT) scans showing reduction of the ventricle size. D, 3D CT reconstruction imaging demonstrated enlargement of the burr hole (red circle).
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A follow-up of head CT for 1 week after the revision surgery showed a reduction in the size of the ventricle (Fig. 3C). A postoperative 3D CT reconstruction image showed no stenosis of the shunt tube with an enlarged burr hole (Fig. 3D).
PMC9107938_02
A and B, Intraoperative photos. A, The shunt tube was compressed and at the exit from the skull (black arrow). B, The burr hole was enlarged (white arrow) with a rongeur and a new interposed tube was implanted between the burr hole and the valve (white arrowhead). C, Postoperative computed tomography (CT) scans showing reduction of the ventricle size. D, 3D CT reconstruction imaging demonstrated enlargement of the burr hole (red circle).
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A follow-up of head CT for 1 week after the revision surgery showed a reduction in the size of the ventricle (Fig. 3C). A postoperative 3D CT reconstruction image showed no stenosis of the shunt tube with an enlarged burr hole (Fig. 3D).