PMC9168389_01
Imaging comparison. MRI at admission (before VPS surgery): (a) axial T2 view demonstrating no hydrocephalus. The lumbar puncture confirmed the diagnosis of idiopathic intracranial hypertension. MRI at revaluation (3 months later): (b) lower axial T2, (c) upper axial T2, and (d) parasagittal T2W1 views demonstrating the catheter pathway with an intraparenchymal pericatheter cyst and perilesional edema.
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F1
Magnetic resonance imaging (MRI) was normal [Figure 1]; however, lumbar puncture with cerebrospinal fluid (CSF) pressure measurement confirmed the diagnosis of IIH (pseudotumor cerebri), requiring treatment with VPS [Figures 1 and 2]. MRI [Figure 1] revealed a round-shaped lesion, with content isointense to CSF, and a thin nonenhancing wall.
Imaging comparison. CT after VPS surgery: (a) coronal view demonstrating the catheter pathway without any parenchymal lesion. CT at revaluation (3 months later): (b) coronal view demonstrating the catheter pathway with an intraparenchymal pericatheter cyst and perilesional edema, without hydrocephalus. CT after shunt revision (postoperative): (c) coronal view demonstrating the new catheter pathway with cyst regression and mild intracystic hemorrhage.
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F2
Magnetic resonance imaging (MRI) was normal [Figure 1]; however, lumbar puncture with cerebrospinal fluid (CSF) pressure measurement confirmed the diagnosis of IIH (pseudotumor cerebri), requiring treatment with VPS [Figures 1 and 2]. Computed tomography (CT) [Figure 2] showed a parenchymal lesion around the ventricular bypass catheter with surrounding edema, but without hydrocephalus (never present in this case). Postoperative CT [Figure 2] revealed cyst regression and an intracystic hemorrhage.
Intraoperative image: view of the obstruction of the proximal catheter tip during shunt revision.
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F3
VPS revision was performed, and a proximal obstruction identified [Figure 3], then managed by catheter replacement and subsequent cyst drainage.