Subdural hematoma secondary to a ventriculoperitoneal shunt in a hydrocephalus patient: A case report

초록

Ventriculoperitoneal shunt is a treatment for hydrocephalus in elderly patients. However, ventriculoperitoneal shunt often causes complications. In our study we present an unusual case of repeated SDH associated with ventriculoperitoneal shunt. A 73-year-old man presenting gait disturbance, urinary frequency and ventriculomegaly in brain magnetic resonance image was treated with ventriculoperitoneal shunt. The pressure of the programmable valve was adjusted from 120 mmH2O to 90 mmH2O because there was no significant change in the size of the ventricles on computed tomography (CT) and symptoms performed 1 week after surgery. CT performed 2 months after the pressure control showed right side subdural hematoma (SDH) and midline shifting. A burr hole operation and upward shunt valve pressure control (120 mmH2O→200mmH2O) was performed. The volume of hematoma was decreased in the CT performed 3 days after the operation. However, the increased SDH and midline shifting were observed on CT performed 10 days later. The second burr hole operation was performed, but acute hematoma was not drained. Finally, open craniotomy and hematoma removal were performed. As a result, the patient's mental state improved to be drowsy. Although postoperative SDH is occasionally seen, it is very rare to experience of SDH even after pressure control from the programmable valve.

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