Shunt revision after 33 years in a patient with bilateral calcified chronic subdural hematomas

Abstract

cation of shunting procedures for infantile hydrocephalus.1,2,4 Bilateral calcified chronic SDHs may be so extensive that they give the appearance of a so-called “armored brain.”3,5 This 33-year-old man was admitted to our department with symptoms of increased intracranial pressure. According to his medical history, the patient had undergone a ventriculoatrial shunt insertion for hydrocephalus 2 months after his birth at a children’s hospital. His mild spastic quadriparesis and learning difficulties were obvious since childhood. One year before the present admission, a brain computed tomographic (CT) scan performed after a minor head injury had shown the presence of large, calcified, bilateral SDHs, together with small ventricles and a ventricular catheter in place (Fig. 1A). At admission, a new brain CT scan revealed ventricular dilation (Fig. 1B). A ventriculoperitoneal shunt was inserted in the patient. The new ventricular catheter was inserted via a right frontal bur hole near the midline, avoiding the calcified hematoma. The old shunt was left in place because the catheter was considered to be entrapped inside the calcification. The postoperative clinical course of the patient was uneventful. The patient improved and returned to his neurological status before the dysfunction of the shunt, and a postoperative CT scan confirmed a reduction of ventricular size (Fig. 1C). Chronic SDHs that remain undiagnosed during childhood may contribute to neurological impairments, therefore intensive followup is necessary after shunting procedures in infants and children. Cases of bilateral extensively calcified SDHs have been rarely reported.5 Revision of the malfunctioning shunt in cases like these may be troublesome. (DOI: 10.3171/JNS/2008/108/2/0401)