BackgroundVentriculoperitoneal shunt (VPS) placement is an established procedure for the treatment of hydrocephalus of diverse etiologies in children and adults. Abdominal cerebrospinal fluid pseudocyst, which is potentially life threatening, is a rare complication and usually occurs during childhood. However, with increasing longevity following successful treatment, it can also occur in adults.Case presentationHere we describe a 22-year-old man who was admitted to our hospital because of diffuse abdominal distention. A VPS was placed 21 years earlier to treat hydrocephalus secondary to spina bifida. Abdominal computed tomography (CT) revealed a homogeneous low-density fluid collection adjacent to the VPS catheter tip, causing stomach obstruction. Thus a peritoneal pseudocyst around VPS was suspected and emergency laparotomy was performed. The large mass was localized in the left upper abdomen between the stomach and mesentery of the transverse colon, exactly at the omental bursa. The cystic mass was opened and 1500 ml of clear fluid was drained; the distal end of the VPS was repositioned outside the mass. Thus, an abdominal cerebrospinal fluid pseudocyst as a complication of VPS was diagnosed.ConclusionGastroenterological surgeons should be aware of this possible complication, and this complication should be considered during differential diagnosis of an acute abdomen complaint.

We report a case where a dural arteriovenous fistula (DAVF) was treated successfully with single-stage surgically assisted transcranial transvenous embolization. For this purpose, direct puncture of the transverse sinus was made with the patient in the prone position.Case Presentation: A 78-year-old female presented with pulsatile tinnitus and ataxia. Cerebral angiography confirmed the presence of a left transverse-sigmoid sinus DAVF with retrograde cortical venous reflux. As transvenous approach via the femoral vein was not possible, transcranial approach with direct puncture of transverse sinus was used for embolization of the fistula in the prone position with Prone View. Angiography demonstrated complete occlusion.Conclusion: Direct puncture of transverse sinus with Prone View may be considered a safe and effective approach when other approaches are not feasible.

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