• Tan-Si Chu, Tan-Huy Chu, Tri-Dung Huynh, Hoang-Vu Mai, Van-Dinh Phan, Bao-Ngoc Dang, Quoc-Dat Tran, and Xuan-Sang Le.
• Department of Neurosurgery, Tam Anh Hospital, Ho Chi Minh City, Vietnam.
• Medicine (Baltimore). 2023 Nov 10; 102 (45): e35967e35967.

Introduction And Patient ConcernsWe report on a 45-year-old woman who has a ventriculoperitoneal shunt (VPS), experienced drowsy mental status, with hypesthesia and hemiplegia on the left side. Ten days ago she underwent laparoscopic cholecystectomy (LC). Computed tomography revealed tension pneumocephalus, with severe compression on the right side of the brain.Interventions And DiagnosisShe underwent 2 surgeries, the first surgery was to place a subdural drainage catheter, however, the pneumocephalus relapsed after withdrawing the catheter, and the later surgery was to replace the new VPS.OutcomesAfter replacing the VPS, the patient recovers completely after 10 weeks of follow-up.ConclusionTo our knowledge, this is the first report of LC-induced tension pneumocephalus in a patient with VPS. The purpose of this study is to share our experience, with the hypothesized mechanism being the retrograde air through the VPS valve because of high abdominal pressurization. We recommend noting the existence of the VPS when the LC or any abdominal laparoscopy is performed. The VPS should be clamped during any laparoscopic procedure until complete depressurization. Furthermore, all patients with VPS who have neurological deterioration after abdominal laparoscopy should be treated as having the diagnosis of a tension pneumocephalus. These patients need emergency surgery to replace VPS and set the valve for high-pressure, which can result in a quick and complete recovery.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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