Subcutaneous emphysema and pneumocephalus following Ventriculoperitoneal Shunt (VPS) surgery for hydrocephalus: a case report

Background: Hydrocephalus is still commonly found in pediatric neurosurgery managed by endoscopic third ventriculostomy (ETV) and Ventriculoperitoneal Shunt (VPS). Subcutaneous emphysema and pneumocephalus as a complication of VPS surgery is rare. Subcutaneous emphysema is the presence of air in the skin, while pneumocephalus is the presence of air in the intracranial space. This case study aims to evaluate subcutaneous emphysema and pneumocephalus following ventriculoperitoneal shunt surgery for hydrocephalus. Case Presentation: We report an 11-month-old girl with hydrocephalus due to aqueductal stenosis who postoperatively had subcutaneous emphysema and pneumocephalus. 1 week after VPS insertion, there was a crepitation under the skin of the neck and chest. The patient occasionally appeared breathless and had a fever. The respiratory rate increased with rales on the right lung, along with the gradually decreased consciousness, and the abdominal wound slowly became dehiscent. There was subcutaneous emphysema along the shunt track and pneumocephalus. Conclusion: The interest, in this case, could be that of the patient’s other morbid conditions, including pneumonia and the dehiscent abdominal wound on the post-VP shunt insertion incision that may have also contributed to causing the subcutaneous emphysema and pneumocephalus.