Chronic ossified epidural hematoma after ventriculoperitoneal shunt insertion. a case report

Abstract

Chronic calcified/ossified epidural hematoma is an uncommon complication of ventricular shunt surgery. There are only 4 cases related to valve-regulated shunt operations in the literature. It may be seen especially in young patients with chronic hydrocephalus, probably due to craniocerebral disproportion. The precise mechanism of the calcification or ossification of the hematoma is not known, however, the dura mater seems to play a part in this process. A 17-year-old girl with triventricular hydrocephalus was treated with a ventriculoperitoneal shunt system including a medium pressure flow control valve. She was admitted with a complaint of severe headache after three years and a bifrontal calcified/ossified epidural hematoma was seen. The calcifying hematoma was removed and the patient's headache resolved. Although the use of high or medium pressure valves, valves with an antisiphon device, adjustable pressure valves or flow control valves have been recommended to prevent this complication in previous reports, it was seen that our case had been treated with a medium pressure flow control valve.

Epidural hematoma: postoperative complication

“…6 Seyithanoglu et al reported that skull-dura adhesions are more prominent than dura-arachnoid adhesions in some patients, thus bleeding occurs in the epidural space instead of the subdural space due to cerebrospinal fluid overdrainage. 12 Other possible causes of hematoma include a coexistent bleeding disorder, bleeding from an occult dural vascular malformation and head trauma after surgery. 10 In our first case, rapid intracranial pressure reduction with VPS could have led to detachment of the dura from the calvarium.…”

“…10 Consequently, cases of chronic, calcified epidural hematomas after ventricular drainage have been reported. 12,18 EDH is a well-known complication of the VPS procedure. Louzada et al suggested using a programmable valve to prevent hematomas.…”

Shunt site chronic calcified extradural hematoma: An avoidable complication

“…[3] Most of these cases had acute hematomas, and only five of them had chronic calcified/ossified hematomas. [4] These patients were 15-35 years old. EDH contralateral to the VP shunt has been also described.…”

Burr hole site acute extradural hematoma after ventriculoperitoneal shunt surgery: a rare case report and its pathogenesis

“…However, the diagnosis may be delayed in a case with VP shunt insertion because of a reduction in CSF volume in the ventricles via a properly functioning shunt [6]. The most common initial symptom is a headache, and there may be seizures in delayed cases [6].…”