PMC7771393_01
Preoperative and postoperative radiological studies. (a-c) Axial head computed tomography (CT) images obtained 7 weeks before current admission, that is, 1 week after placement of the latest ventriculoperitoneal shunt (VPS) (arrow), show persistence of hydrocephalus. (d) Lateral abdominal X-ray showing a coiled distal catheter (head arrow). (e-g) Head scan performed at admission demonstrating enlargement of the ventricular system in addition to a large extra-axial low-density collection over the right hemisphere (asterisk) with underlying effaced sulci and a minor subdural interhemispheric component (arrow). (h) Abdominal CT scan displaying multiple loops of the distal end of the VPS at the abdominal wall (arrow). (i-k) Postoperative CT scan performed after 4 days after intraperitoneal repositioning of the distal catheter demonstrates complete resolution of both hydrocephalus and the subdural collection. (l) Postoperative X-ray confirms correct intra-abdominal position of the VPS.
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F1
Following her last VPS implantation, symptoms of high intracranial pressure (ICP) notably improved but ventricle enlargement remained almost unchanged on computed tomography (CT) [Figures 1a-c]. In addition, a coiled distal catheter was found on the abdominal X-ray, which was misinterpreted, probably due to patient obesity, as being in the correct position inside the peritoneal cavity [Figure 1d]. An urgent cranial CT demonstrated hydrocephalus in addition to a large low-density subdural collection over the right hemisphere with a minor right interhemispheric component [Figures 1e-g]. This revealed multiple loops of the distal catheter and CSF fluid accumulation at the subcutaneous space [Figure 1h]. Following surgery, all symptoms resolved, and postoperative CT performed on day 4 showed resolution of both hydrocephalus and subdural CSF accumulation [Figures 1i-k]. Moreover, postoperative abdominal X-ray confirmed correct placement of the distal peritoneal catheter [Figure 1l].
Preoperative and postoperative magnetic resonance imaging studies. (a and b) T2-weighted MR images obtained 1 year before current admission (at a time with adequate functioning of her internal cerebrospinal fluid diversion system). Note the tumor occupying the third ventricle (arrow). (c and d) Images obtained 2 months after correct placement of the distal catheter demonstrates recovery of previous ventricular size and lack of subdural accumulation.
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F2
After the 2-month follow-up, the clinical and radiological courses remain satisfactory [Figure 2].