A standard ventriculoperitoneal shunt placement complicated by tension pneumocephalus without an identified trigger

Tension pneumocephalus (TP) develops in most cases as a result of head trauma. This phenomenon has also been described in patients with intracranial neoplasms, and after cranial base and paranasal sinus surgical procedures. TP may be a complication of a nontraumatic spontaneous cerebrospinal fluid (CSF) rhinorrhea after successful ventriculoperitoneal (VP) shunt placement due to congenital cranial base fistula. TP complication has been reported after lumbar puncture, spinal anesthesia or CSF drainage via a lumbar spinal catheter. In the above-mentioned instances, the provoking factors for a TP caused by the connection of the intracranial space and external environment have been well established. We report a case of a TP after a VP shunt placement in a patient with normal pressure hydrocephalus (NPH). The patient we describe had no history of cerebrospinal nontraumatic rhinorrhea, or head trauma. Computed tomography (CT) of the anterior fossa and petrous bones revealed no defects. The chest and abdominal CT were unremarkable. Due to progressive enlargement of the pneumocephalus the decision to remove the VP shunt was made, with a good clinical postoperative outcome. As the remission of TP in the postoperative course occurred without further VP shunt dependency, the situation is unique as it has not been described so far.