What question did this study set out to answer?

To report a rare case of tension pneumoventricle following VP shunt placement and discuss its underlying mechanisms.

May 20, 2026Open Access

Tension Pneumoventricle Secondary to Frontal Encephalocele Following Ventriculoperitoneal Shunt: A Case Report and Review of Pathophysiology

SDShubham DubeyGoa Medical College APAbhijit ParabGoa Medical College PSPonraj K. SundaramGoa Medical College

Key Points

To report a rare case of tension pneumoventricle following VP shunt placement and discuss its underlying mechanisms.
Detailed case report of a 24-year-old male with obstructive hydrocephalus and VP shunt placement.
Imaging including computed tomography and magnetic resonance cisternography to assess condition and identify fronto-ventricular fistula.
Surgical intervention involving bifrontal craniotomy, encephalocele excision, and dural repair.
Patient presented with cerebrospinal fluid rhinorrhea and imaging confirmed significant intraventricular air and distortion.
Surgical repair resulted in complete resolution of symptoms and imaging findings.
VP shunt-induced hypotension revealed a pre-existing skull base defect facilitating air entry, necessitating timely intervention.

Abstract

Abstract Tension pneumoventricle is an uncommon but potentially life-threatening complication of ventriculoperitoneal (VP) shunt placement. It results from the accumulation of pressurized intraventricular air, producing mass effect and neurological deterioration. Its occurrence following VP shunt surgery is exceedingly rare. A 24-year-old man with obstructive hydrocephalus due to aqueductal stenosis underwent right-sided VP shunt placement with symptomatic improvement. Two weeks later, he developed cerebrospinal fluid rhinorrhea. Computed tomography revealed significant intraventricular air with ventricular distortion consistent with tension pneumoventricle. Magnetic resonance cisternography demonstrated a left frontal encephalocele with a fistulous tract extending from the frontal sinus into the frontal horn of the lateral ventricle. The patient underwent bifrontal craniotomy, excision of the encephalocele, frontal sinus cranialization, and multilayered dural repair using a vascularized pericranial graft. Postoperative recovery was uneventful, and follow-up imaging confirmed complete resolution. VP shunt–induced intracranial hypotension may unmask occult skull base defects, facilitating air entry through a pressure-gradient mechanism. Early diagnosis and definitive surgical repair are essential to prevent recurrence and infectious complications.

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