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Hydrocephalus is a common neurosurgical disease affecting approximately 40 per 100,000 people. Cerebrospinal fluid diversion devices are essential in the management of this pathology. These devices include internal shunts and external ventricular drains. Infection is the most significant complication resulting from the high frequency of appearance and the consequences it involves, since it is associated with increased morbidity and mortality. It also involves increased hospital costs (approximately 40,000 euro per episode). In the present report the authors make a comprehensive review of cerebrospinal fluid diversion devices and their most important complication: infection. The authors make special emphasis on the epidemiology, aetiology, pathogenesis, risk factors, symptoms and signs, diagnosis, treatment and prevention of infection.

Retropharyngeal pseudomeningocele after atlanto-occipital dislocation is a rare complication, with only five cases described in the literature. It develops when a traumatic dural tear occurs allowing cerebrospinal fluid outflow, and it often appears associated with hydrocephalus. We present a case of a 29-year-old female who suffered a motor vehicle accident causing severe brain trauma and spinal cord injury. At hospital arrival the patient scored three points in the Glasgow Coma Scale. Admission computed tomography of the head and neck demonstrated subarachnoid hemorrhage and atlanto-occipital dislocation. Three weeks later, when impossibility to disconnect her from mechanical ventilation was noticed, a magnetic resonance imaging of the neck showed a large retropharyngeal pseudomeningocele. No radiological evidence of hydrocephalus was documented. Given the poor neurological status of the patient, with spastic quadriplegia and disability to breathe spontaneously due to bulbar-medullar injury, no invasive measure was performed to treat the pseudomeningocele. Retropharyngeal pseudomeningocele after atlanto-occipital dislocation should be managed by means of radiological brain study in order to assess for the presence of hydrocephalus, since these two pathologies often appear associated. If allowed by neurological condition of the patient, shunting procedures such as ventriculo-peritoneal or lumbo-peritoneal shunt placement may be helpful for the treatment of the pseudomeningocele, regardless of craniocervical junction management.

Correct monitoring of ICP is fundamental for diagnosing ICH, and even more importantly, providing appropriate treatment in a timely manner.

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