• Alexander Verhaeghe, Stijn De Muynck, Jan W Casselman, and Nikolaas Vantomme.
• Department of Neurosurgery, Sint-Jan Hospital Brugge, University Hospitals Leuven, Brugge, Belgium. Electronic address: alexander.verhaeghe@uzleuven.be.
• World Neurosurg. 2018 Aug 1; 116: 174-177.

BackgroundPneumocephalus is usually seen in trauma or cranial surgery. It is rarely reported as a delayed complication of ventriculoperitoneal shunt placement for hydrocephalus secondary to trauma, tumor, or aqueduct stenosis. We describe a case of intraventricular pneumocephalus manifesting 10 months after placement of a shunt for normal-pressure hydrocephalus.Case DescriptionA pressure-regulated ventriculoperitoneal shunt was implanted in an 81-year-old patient after diagnosis of normal-pressure hydrocephalus. He showed postoperative clinical improvement. Routine computed tomography performed 2 months after the procedure showed no abnormalities. He presented 10 months after shunting with a subacute deterioration of gait. Imaging revealed major intraventricular pneumocephalus and a left-sided temporal porencephalic cyst with a small, bony defect in the left petrous bone. A middle fossa approach was performed, and the temporal defect was covered with fascia of the temporal muscle. This resulted in a gradual resolution of pneumocephalus.ConclusionsPneumocephalus after shunting for NPH is rare and described as a complication only during the first 2 postoperative months. This case is unique, as the pneumocephalus developed 10 months after shunting. The combination of an occult, possibly congenital, skull base defect and the insertion of a shunt resulted in delayed intraventricular and intraparenchymal pneumocephalus.Copyright © 2018 Elsevier Inc. All rights reserved.

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