Department of Neurosurgery, Juntendo University, Tokyo, Japan.
Department of Neurosurgery, Juntendo University, Tokyo, Japan
BMJ Case Rep. 2021 Apr 8;14(4):e241392. doi: 10.1136/bcr-2020-241392.
Brain injury with ventricle puncture is a well-known complication of ventriculoperitoneal (VP) shunting. However, parenchymal injuries caused by a shunt tunneller are rare. Herein, we present a case of penetrating brain injury caused by a shunt tunneller during VP shunting. An 83-year-old woman with brainstem glioma underwent VP shunting to control hydrocephalus due to tumour growth. She underwent brainstem tumour biopsy with a lateral suboccipital approach. After the shunting, CT showed a linear haematoma in the left occipital lobe far from the site of the ventricular puncture. MRI revealed a small contusion in the left cerebellar hemisphere, disconnection of the left tentorial membrane and linear haematoma on a straight line. These facts suggested that the shunt tunneller had penetrated the skull through the craniotomy of the posterior fossa. This is a rare complication of VP shunting, with limited cases reported in the literature.
脑损伤伴脑室穿刺是脑室-腹腔（VP）分流术的已知并发症。然而，分流管隧道器引起的实质损伤则较为罕见。本文报道了一例因 VP 分流术时使用分流管隧道器导致穿透性脑损伤的病例。一位 83 岁的女性因脑干胶质瘤生长导致脑积水而行 VP 分流术。她采用枕下入路行脑干肿瘤活检。分流术后 CT 显示左枕叶远离脑室穿刺部位的线性血肿。MRI 显示左小脑半球小挫伤、左天幕分离和直线上的线性血肿。这些事实提示分流管隧道器已穿透颅骨，通过后颅窝的开颅术进入。这是 VP 分流术的罕见并发症，文献报道的病例有限。
