Symptomatic subcutaneous emphysema following lumboperitoneal shunt placement: illustrative case

BACKGROUND Secondary normal pressure hydrocephalus is a common complication in the chronic phase after subarachnoid hemorrhage or intracerebral hemorrhage, with an incidence of approximately 30%. Lumboperitoneal (LP) shunts are often selected for older patients due to their less invasive nature. However, postoperative complications such as infection, catheter malfunction, and subdural hematoma are known. OBSERVATIONS The authors present the first known case of symptomatic subcutaneous emphysema following LP shunt surgery, necessitating reoperation. The patient was a markedly thin woman (BMI 13.3), and the cause of the complication was determined to be a combination of shallow subcutaneous catheter placement and failure to evacuate retained air prior to closure. LESSONS In thin patients, LP shunt catheters should be placed in deeper layers to minimize dead space and prevent air retention. In addition, care must be taken to release subcutaneous air before wound closure, especially in procedures performed in the lateral decubitus position. https://thejns.org/doi/10.3171/CASE25584