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CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(02): 342-346
DOI: 10.1055/s-0043-1768573
Case Report

Refractory Delayed Pneumocephalus after Transsphenoidal Cyst Drainage for Rathke's Cleft Cyst in a Patient with a Cerebrospinal Fluid Shunt

Tetsuo Hashiba
1   Department of Neurosurgery, Kansai Medical University, Osaka, Japan
,
Masahiro Nonaka 
1   Department of Neurosurgery, Kansai Medical University, Osaka, Japan
,
Haruka Iwamura
1   Department of Neurosurgery, Kansai Medical University, Osaka, Japan
,
Takamasa Kamei
1   Department of Neurosurgery, Kansai Medical University, Osaka, Japan
,
Junichi Takeda
1   Department of Neurosurgery, Kansai Medical University, Osaka, Japan
,
Akio Asai
1   Department of Neurosurgery, Kansai Medical University, Osaka, Japan
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Abstract

A 75-year-old man presented with bilateral lower limb weakness to our hospital from another clinic. Radiological examinations implied the possibilities of idiopathic normal pressure hydrocephalus (iNPH) and a suprasellar cyst, but both were observed conservatively at that time. Due to the progressive gait disturbance, a lumboperitoneal shunt was implanted 1 year later. The clinical symptoms improved, but the cyst had grown after another year, causing visual impairment. Transsphenoidal drainage of the cyst was performed, but delayed pneumocephalus occurred. Repair surgery was performed with temporary suspension of shunt function, but pneumocephalus relapsed two and a half months after the resumption of shunt flow. In the second repair surgery, the shunt was removed because it was assumed that it would prevent closure of the fistula by lowering intracranial pressure. Two and a half months later, after confirming involution of the cyst and no pneumocephalus, a ventriculoperitoneal shunt was implanted, and cerebrospinal fluid (CSF) leakage has not relapsed since then. The coexistence of idiopathic normal pressure hydrocephalus (iNPH) and Rathke's cleft cyst (RCC) is rare, but it can occur. RCC can be cured by simple drainage, but delayed pneumocephalus can occur in cases whose intracranial pressure decreases due to CSF shunting. When simple drainage without sellar reconstruction for RCC is attempted after CSF shunting for coexistent iNPH, attention should be paid to changes in intracranial pressure, and it is desirable to stop the flow of the shunt for a certain period.

Keywords

delayed pneumocephalus - idiopathic normal pressure hydrocephalus - lumboperitoneal shunt - Rathke's cleft cyst - transsphenoidal surgery

Ethical Approval and Informed Consent

This study was approved by the Ethics Committee of Kansai Medical University (No. 2020055). Need for written patient consent was waived by the Ethics Committee because data were deidentified.




Publication History

Article published online:
06 June 2023

© 2023. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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