Tahrir Yassine, Hilmani Said, Lakhdar Abdelhakim
Neurosurgery Department, University Hospital Center IBN ROCHD, Casablanca, Morocco.
Ann Med Surg (Lond). 2021 Aug 8;68:102663. doi: 10.1016/j.amsu.2021.102663. eCollection 2021 Aug.
Cerebrospinal fluid over-drainage is a common complication of ventriculoperitoneal devices (Ventriculoperitoneal shunt). In terms of hemorrhage, subdural hematomas are usually more frequent lesions than epidural hematomas, which, more rarely, may also be seen after ventricular shunt procedures and may lead to rapid neurological decline and even death unless a surgical procedure can be promptly performed. In our study we report the case of a 5 years old boy with history of congenital obstructive hydrocephalus treated with a ventriculoperitoneal shunt insertion when he was 8 months old. The patient was admitted with sudden deterioration of level of consciousness secondary to tri-ventricular hydrocephalus. He underwent a shunt revision. Two weeks later, he developed a loss of consciousness with a large left extradural hematoma contralateral to the side of ventriculoperitoneal shunt. He underwent an evacuation of the hematoma with a good postoperative outcome. Epidural hematoma, especially controlateral to Ventriculoperitoneal shunt, is extremely rare. The pathophysiology and the possible use of a programmable valve to prevent these lesions are briefly discussed.
脑脊液过度引流是脑室腹腔分流装置（脑室腹腔分流术）的常见并发症。在出血方面，硬膜下血肿通常比硬膜外血肿更常见，硬膜外血肿在脑室分流术后较少见，但也可能出现，并且可能导致迅速的神经功能衰退甚至死亡，除非能及时进行手术。在我们的研究中，我们报告了一例5岁男孩的病例，该男孩有先天性梗阻性脑积水病史，8个月大时接受了脑室腹腔分流术。患者因三脑室脑积水导致意识水平突然恶化入院。他接受了分流器翻修术。两周后，他出现意识丧失，并在脑室腹腔分流术对侧出现巨大的左侧硬膜外血肿。他接受了血肿清除术，术后效果良好。硬膜外血肿，尤其是脑室腹腔分流术对侧的硬膜外血肿极为罕见。本文简要讨论了其病理生理学以及使用可编程瓣膜预防这些病变的可能性。
