RESUMO
BACKGROUND: Pneumocephalus is a rare complication presenting in the postoperative period of a thoracoscopic operation. We report a case in which tension pneumocephalus occurred after thoracoscopic resection as well as the subsequent approach of surgical management. CASE SUMMARY: A 66-year-old man who received thoracoscopic resection to remove an intrathoracic, posterior mediastinal, dumbbell-shaped, pathology-proven neurogenic tumor. The patient then reported experiencing progressively severe headaches, especially when in an upright position. A brain computed tomography scan at a local hospital disclosed extensive pneumocephalus. Revision surgery for resection of the pseudomeningocele and repair of the cerebrospinal fluid leakage was thus arranged for the patient. During the operation, we traced the cerebrospinal fluid leakage and found that it might have derived from incomplete endoscopic clipping around the tumor stump near the dural sac at the T3 level. After that, we wrapped and sealed all the possible origins of the leakage with autologous fat, tissue glue, gelfoam, and duraseal layer by layer. The patient recovered well, and the computed tomography images showed resolution of the pneumocephalus. CONCLUSION: This report and literature review indicated that the risk of developing a tension pneumocephalus cannot be ignored and should be monitored carefully after thoracoscopic tumor resection.
RESUMO
The most common procedure to manage hydrocephalus is a ventriculoperitoneal shunt. Other alternatives include a ventriculoatrial (VA) shunt, ventriculopleural shunt, lumboperitoneal shunt, or ventriculocisternal shunt. The VA shunt is a relatively rare procedure for hydrocephalus. As reported, several complications of VA shunt include obstructions, malposition, shunt infections, endocarditis, heart failure, tricuspid regurgitation, intra-atrial thrombus, and pulmonary hypertension. In this case report and literature review, we discuss a rare case of intramuscular migration of a venous tube 1 year after VA shunt implantation. We also report all the possible locations of migration after placement of VA shunt.