Ventriculoatrial shunt (VA) is one of the oldest solutions for hydrocephalus. However over subsequent years various complication of VA shunt such as obstructions, malposition, shunt infections, cardiac complications such as endocarditis, traumatic perforation, heart failure, tricuspid regurgitation, intraatrial thrombus, and pulmonary hypertension are reported. Hence, VA shunt procedure has fallen into disrepute. Still VA shunt may be a good option in selected patients with hostile peritoneum. Newer placement strategies and monitoring methods have been put forward to reduce complication following VA shunt. In this case report, we share a rare case of endocarditis with tricuspid regurgitation following a migrated retained calcified shunt tube in the right ventricle of heart 30 years after of VA shunt that was successfully managed.

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Chronic subdural hematomas (CSDHs) and its management comprise a majority work in a neurosurgical specialty. The effectiveness of surgery is beyond doubt and sometimes even lifesaving in severe cases. However, the straightforward surgery is sometimes complicated by the associated comorbidities of the patient. Comorbidities in the form of coagulopathies secondary to chronic liver diseases, drugs (warfarin, ecosprin, clopidogrel), thrombocytopenia secondary to systemic illness are always a challenge to deal with in patients with CSDH. The authors encountered a patient with thrombocytopenia secondary to systemic HIV infection who presented with CSDH. Her coagulation profile was severe enough to preclude surgery. She was managed conservatively with tranexamic acid and responded well. The authors present the challenges they faced in the course of successful management of this patient.

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FoQOsD may be as effective as conventional DC in managing intracranial hypertension. This procedure mainly avoids a revision cranioplasty. A prospective randomized controlled trial with a large sample size may be initiated for obtaining more accurate data.