Background/Aims: Obstruction is the most common complication of ventriculoperitoneal shunts in patients with hydrocephalus. Despite technical advances, rates of obstruction have barely decreased and remain at over 40% of cases. Patients suffering from preterm-related posthaemorrhagic hydrocephalus are considered a group with a particularly high risk of obstruction. The aim of the present study was to review our series of patients with preterm-related posthaemorrhagic hydrocephalus and analyse the occurrence of the first ventricular shunt obstruction as well as the related clinical and radiological factors. Methods: We conducted a retrospective review of 103 cases treated from 1982 to 2010. Descriptive analysis, raw and adjusted bivariate correlations and survival analysis were performed. Results: Over the course of the follow-up, 42 patients presented at least one episode of obstruction that required proximal revision. Medium-opening pressure valves were associated with a higher rate of obstruction compared to low-opening pressure valves; however, in our series this association became statistically significant only in patients with a weight of over 2,000 g at the time of surgery (odds ratio 6.75). The occurrence of previous infection and the development of late slit ventricle syndrome were also significantly associated with obstruction of the ventricular catheter (odds ratios 3.35 and 4.27, respectively). Conclusions: Rates of shunt obstruction in preterm-related posthaemorrhagic hydrocephalus remain high but do not seem to be higher than in other groups of paediatric hydrocephalus. Prevention of infection and the use of the appropriate type of valve design can help to decrease the incidence of proximal shunt obstruction, which in turn could decrease the incidence of symptomatic slit ventricle syndromes.

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Background:Symptomatic arachnoiditis after posterior fossa surgical procedures such as decompression of Chiari malformation is a possible complication. Clinical presentation is generally insidious and delayed by months or years. It causes disturbances in the normal flow of cerebrospinal fluid and enlargement of a syrinx cavity in the upper spinal cord. Surgical de-tethering has favorable results with progressive collapse of the syrinx and relief of the associated symptoms.Case Description:A 30-year-old male with Chiari malformation type I was treated by performing posterior fossa bone decompression, dura opening and closure with a suturable bovine pericardium dural graft. Postoperative period was uneventful until the fifth day in which the patient suffered intense headache and progressive loose of consciousness caused by an acute posterior fossa epidural hematoma. It was quickly removed with complete clinical recovering. One year later, the patient experienced progressive worsened of his symptoms. Upper spinal cord tethering was diagnosed and a new surgery for debridement was required.Conclusions:The epidural hematoma compressing the dural graft against the neural structures contributes to the upper spinal cord tethering and represents a nondescribed cause of postoperative fibrosis, adhesion formation, and subsequent recurrent hindbrain compression.

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