Epidural hematoma following ventriculoperitoneal shunt insertion: Case report and literature review

Surgery Case Reports Pub Date : 2025-07-21 DOI:10.1016/j.sycrs.2025.100139

Chizowa Okwuchukwu Ezeaku , Edward Oluwole Komolafe

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Abstract

Background

The insertion of a ventriculoperitoneal shunt (VPS) is the most commonly performed procedure for managing hydrocephalus worldwide. The occurrence of an epidural hematoma (EDH) following this procedure is exceedingly rare and potentially life-threatening. We report an illustrative case. Additionally, we present a comprehensive and up-to-date review highlighting risk factors, pathophysiology, and management. Finally, recommendations are provided to prevent this unfortunate complication.

Case presentation

A 22-year-old male presented with a three-month history of recurrent headaches and progressive visual loss. Neuroimaging findings were consistent with hydrocephalus secondary to aqueductal stenosis. He subsequently underwent right frontal ventriculoperitoneal shunt insertion. However, one day later, he experienced focal seizures accompanied by worsening headaches, necessitating a repeat cranial CT scan that revealed a massive bifrontal acute epidural hematoma, for which he underwent surgical evacuation. He is currently being followed up on an outpatient basis.

Conclusion

EDH after VPS occurs more frequently in paediatric, young and middle-aged populations. Identifying those at risk, selecting an appropriate shunt, and preventing CSF overdrainage and intraoperative bleeding are crucial preventive measures. Early diagnosis through careful postoperative monitoring, combined with a low threshold for neuroimaging, should facilitate timely surgical intervention.

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脑室腹腔分流器置入后的硬膜外血肿：1例报告及文献复习

背景脑室腹腔分流术（VPS）是世界范围内治疗脑积水最常用的手术。硬膜外血肿（EDH）的发生是非常罕见的，并可能危及生命。我们报告一个说明性的案例。此外，我们提出了一个全面的和最新的审查强调危险因素，病理生理和管理。最后，提出了预防这种不幸并发症的建议。22岁男性，有三个月复发性头痛及进行性视力丧失病史。神经影像学表现与继发于输水管狭窄的脑积水一致。他随后接受了右额脑室腹腔分流术。然而，一天后，他出现局灶性癫痫发作，并伴有头痛加剧，需要再次进行颅脑CT扫描，发现双额侧严重急性硬膜外血肿，为此他接受了手术撤离。他目前正在门诊接受随访。结论VPS后edh多见于儿童、青壮年人群。识别高危人群，选择合适的分流器，防止脑脊液过引流和术中出血是至关重要的预防措施。通过仔细的术后监测进行早期诊断，并结合较低的神经影像学阈值，应有助于及时的手术干预。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Surgery Case Reports

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