{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T10:13:48Z","timestamp":1779185628653,"version":"3.51.4"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"13","license":[{"start":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T00:00:00Z","timestamp":1759104000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2025,9,29]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Pneumocephalus is a known complication of trauma or head surgery, typically occurring within 48 hours of injury. However, delayed-onset pneumocephalus has been rarely documented in the literature. Here, the authors report a case of pneumocephalus that developed 14 years after ventriculoperitoneal (VP) shunt placement for posttraumatic hydrocephalus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 16-year-old girl with a history of skull base fracture, including a left petrous bone fracture, diffuse brain injury, and subarachnoid hemorrhage caused by a traffic accident at 2 years of age, underwent VP shunt placement for posttraumatic hydrocephalus 1 month after the injury. Fourteen years after the shunt surgery, she developed a sudden headache and was diagnosed with pneumocephalus. CT imaging revealed significant left-sided pneumocephalus. Although the exact point of air entry was not identified, her condition improved following adjustments to the Strata II shunt valve pressure settings. Eventually, the shunt was removed to prevent further infections. No CSF leakage was observed, and the patient experienced no recurrence of symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Patients with a VP shunt and a history of skull base fracture may develop pneumocephalus even after a prolonged period.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25118\">https:\/\/thejns.org\/doi\/10.3171\/CASE25118<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25118","type":"journal-article","created":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:02:28Z","timestamp":1759795348000},"source":"Crossref","is-referenced-by-count":1,"title":["Delayed onset of pneumocephalus 14 years after ventriculoperitoneal shunt placement: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"given":"Saori","family":"Ueda","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Kansai Medical University, Hirakata, Osaka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katsuya","family":"Ueno","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kansai Medical University, Hirakata, Osaka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haruna","family":"Isozaki","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kansai Medical University, Hirakata, Osaka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kansai Medical University, Hirakata, Osaka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junichi","family":"Takeda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kansai Medical University, Hirakata, Osaka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8127-2635","authenticated-orcid":true,"given":"Masahiro","family":"Nonaka","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kansai Medical University, Hirakata, Osaka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1","key":"bib1","series-title":"Acta Neurochir (Wien)","first-page":"1","article-title":"The clinical features of pneumocephalus based upon a survey of 284 cases with report of 11 additional cases","volume":"16","author":"Markham","year":"1967","unstructured":"Markham JW.The clinical features of pneumocephalus based upon a survey of 284 cases with report of 11 additional cases. Acta Neurochir (Wien). 1967;16(1):1-78."},{"issue":"12","key":"bib2","series-title":"Childs Nerv Syst","first-page":"3601","article-title":"Tension pneumocephalus in a patient with NF1 following ventriculoperitoneal shunt-deciphering the cause and proposed management strategy","volume":"39","author":"Singh","year":"2023","unstructured":"Singh KKumar ASrivastava ASingh RPKumar R.Tension pneumocephalus in a patient with NF1 following ventriculoperitoneal shunt-deciphering the cause and proposed management strategy. Childs Nerv Syst. 2023;39(12):3601-3606."},{"issue":"9","key":"bib3","series-title":"Cureus","first-page":"e18392","article-title":"Intraventricular pneumocephalus as a complication of ventriculoperitoneal shunt","volume":"13","author":"da Silva","year":"2021","unstructured":"da Silva AJFMalta Doria AL.Intraventricular pneumocephalus as a complication of ventriculoperitoneal shunt. Cureus. 2021;13(9):e18392."},{"issue":"4","key":"bib4","series-title":"Neurol India","first-page":"616","article-title":"Delayed otogenic pneumocephalus complicating ventriculoperitoneal shunt","volume":"59","author":"Pieri","year":"2011","unstructured":"Pieri FAnania CDPerrini PPuglioli MParenti GF.Delayed otogenic pneumocephalus complicating ventriculoperitoneal shunt. Neurol India. 2011;59(4):616-619."},{"issue":"6","key":"bib5","series-title":"J Neurosurg","first-page":"1098","article-title":"Otogenic tension pneumocephalus complicated by eustachian tube insufflation in a patient with a ventriculoperitoneal shunt. Case report","volume":"106","author":"Nagai","year":"2007","unstructured":"Nagai HMoritake K.Otogenic tension pneumocephalus complicated by eustachian tube insufflation in a patient with a ventriculoperitoneal shunt. Case report. J Neurosurg. 2007;106(6):1098-1101."},{"issue":"4","key":"bib6","series-title":"Br J Neurosurg","first-page":"1010","article-title":"Hidden intra-meatal CSF fistula related to VP shunt as a cause for fatal tension pneumocephalus after vestibular schwannoma resection","volume":"38","author":"di Russo","year":"2024","unstructured":"di Russo PMorace RVangelista TGorgoglione NDe Angelis MEsposito V.Hidden intra-meatal CSF fistula related to VP shunt as a cause for fatal tension pneumocephalus after vestibular schwannoma resection. Br J Neurosurg. 2024;38(4):1010-1015."},{"issue":"9","key":"bib7","series-title":"J Clin Neurosci","first-page":"939","article-title":"Delayed pneumocephalus following shunting for hydrocephalus","volume":"13","author":"Honeybul","year":"2006","unstructured":"Honeybul SBala A.Delayed pneumocephalus following shunting for hydrocephalus. J Clin Neurosci. 2006;13(9):939-942."},{"issue":"1","key":"bib8","series-title":"Neurol India","first-page":"170","article-title":"Multiple spontaneous intra-diploic frontal encephalocele in a case of vestibular schwannoma with hydrocephalous","volume":"70","author":"Kumar","year":"2022","unstructured":"Kumar AMathialagan ASrivastava AK.Multiple spontaneous intra-diploic frontal encephalocele in a case of vestibular schwannoma with hydrocephalous. Neurol India. 2022;70(1):170-171."},{"key":"bib9","series-title":"J Clin Neurosci","first-page":"215","article-title":"Spontaneous pneumocephalus from nasal continuous positive airway pressure in a patient with ventriculo-peritoneal shunt","volume":"34","author":"Chee","year":"2016","unstructured":"Chee BNHAbdul Jalil MFBulluss KJ.Spontaneous pneumocephalus from nasal continuous positive airway pressure in a patient with ventriculo-peritoneal shunt. J Clin Neurosci. 2016;34:215-217."},{"issue":"2","key":"bib10","series-title":"Otolaryngol Clin North Am","first-page":"453","article-title":"Management of intracranial complications of sinus surgery","volume":"37","author":"Schnipper","year":"2004","unstructured":"Schnipper DSpiegel JH.Management of intracranial complications of sinus surgery. Otolaryngol Clin North Am. 2004;37(2):453-472, ix."},{"issue":"2","key":"bib11","series-title":"ORL J Otorhinolaryngol Relat Spec","first-page":"119","article-title":"A rare case of temporal bone pneumocephalus tracking through the internal auditory canal","volume":"83","author":"Watson","year":"2021","unstructured":"Watson WMulry EKaufman AEliades SJ.A rare case of temporal bone pneumocephalus tracking through the internal auditory canal. ORL J Otorhinolaryngol Relat Spec. 2021;83(2):119-122."},{"key":"bib12","series-title":"World Neurosurg","first-page":"365.e17","article-title":"Pathogenesis of delayed tension intraventricular pneumocephalus in shunted patient: possible role of nocturnal positive pressure ventilation","volume":"85","author":"Salem-Memou","year":"2016","unstructured":"Salem-Memou SVallee BJacquesson TJouanneau EBerhouma M.Pathogenesis of delayed tension intraventricular pneumocephalus in shunted patient: possible role of nocturnal positive pressure ventilation. World Neurosurg. 2016;85:365.e17-365.e20."},{"issue":"1","key":"bib1","series-title":"Acta Neurochir (Wien)","first-page":"1","article-title":"The clinical features of pneumocephalus based upon a survey of 284 cases with report of 11 additional cases","volume":"16","author":"Markham","year":"1967","unstructured":"Markham JW.The clinical features of pneumocephalus based upon a survey of 284 cases with report of 11 additional cases. Acta Neurochir (Wien). 1967;16(1):1-78."},{"issue":"12","key":"bib2","series-title":"Childs Nerv Syst","first-page":"3601","article-title":"Tension pneumocephalus in a patient with NF1 following ventriculoperitoneal shunt-deciphering the cause and proposed management strategy","volume":"39","author":"Singh","year":"2023","unstructured":"Singh KKumar ASrivastava ASingh RPKumar R.Tension pneumocephalus in a patient with NF1 following ventriculoperitoneal shunt-deciphering the cause and proposed management strategy. Childs Nerv Syst. 2023;39(12):3601-3606."},{"issue":"9","key":"bib3","series-title":"Cureus","first-page":"e18392","article-title":"Intraventricular pneumocephalus as a complication of ventriculoperitoneal shunt","volume":"13","author":"da Silva","year":"2021","unstructured":"da Silva AJFMalta Doria AL.Intraventricular pneumocephalus as a complication of ventriculoperitoneal shunt. Cureus. 2021;13(9):e18392."},{"issue":"4","key":"bib4","series-title":"Neurol India","first-page":"616","article-title":"Delayed otogenic pneumocephalus complicating ventriculoperitoneal shunt","volume":"59","author":"Pieri","year":"2011","unstructured":"Pieri FAnania CDPerrini PPuglioli MParenti GF.Delayed otogenic pneumocephalus complicating ventriculoperitoneal shunt. Neurol India. 2011;59(4):616-619."},{"issue":"6","key":"bib5","series-title":"J Neurosurg","first-page":"1098","article-title":"Otogenic tension pneumocephalus complicated by eustachian tube insufflation in a patient with a ventriculoperitoneal shunt. Case report","volume":"106","author":"Nagai","year":"2007","unstructured":"Nagai HMoritake K.Otogenic tension pneumocephalus complicated by eustachian tube insufflation in a patient with a ventriculoperitoneal shunt. Case report. J Neurosurg. 2007;106(6):1098-1101."},{"issue":"4","key":"bib6","series-title":"Br J Neurosurg","first-page":"1010","article-title":"Hidden intra-meatal CSF fistula related to VP shunt as a cause for fatal tension pneumocephalus after vestibular schwannoma resection","volume":"38","author":"di Russo","year":"2024","unstructured":"di Russo PMorace RVangelista TGorgoglione NDe Angelis MEsposito V.Hidden intra-meatal CSF fistula related to VP shunt as a cause for fatal tension pneumocephalus after vestibular schwannoma resection. Br J Neurosurg. 2024;38(4):1010-1015."},{"issue":"9","key":"bib7","series-title":"J Clin Neurosci","first-page":"939","article-title":"Delayed pneumocephalus following shunting for hydrocephalus","volume":"13","author":"Honeybul","year":"2006","unstructured":"Honeybul SBala A.Delayed pneumocephalus following shunting for hydrocephalus. J Clin Neurosci. 2006;13(9):939-942."},{"issue":"1","key":"bib8","series-title":"Neurol India","first-page":"170","article-title":"Multiple spontaneous intra-diploic frontal encephalocele in a case of vestibular schwannoma with hydrocephalous","volume":"70","author":"Kumar","year":"2022","unstructured":"Kumar AMathialagan ASrivastava AK.Multiple spontaneous intra-diploic frontal encephalocele in a case of vestibular schwannoma with hydrocephalous. Neurol India. 2022;70(1):170-171."},{"key":"bib9","series-title":"J Clin Neurosci","first-page":"215","article-title":"Spontaneous pneumocephalus from nasal continuous positive airway pressure in a patient with ventriculo-peritoneal shunt","volume":"34","author":"Chee","year":"2016","unstructured":"Chee BNHAbdul Jalil MFBulluss KJ.Spontaneous pneumocephalus from nasal continuous positive airway pressure in a patient with ventriculo-peritoneal shunt. J Clin Neurosci. 2016;34:215-217."},{"issue":"2","key":"bib10","series-title":"Otolaryngol Clin North Am","first-page":"453","article-title":"Management of intracranial complications of sinus surgery","volume":"37","author":"Schnipper","year":"2004","unstructured":"Schnipper DSpiegel JH.Management of intracranial complications of sinus surgery. Otolaryngol Clin North Am. 2004;37(2):453-472, ix."},{"issue":"2","key":"bib11","series-title":"ORL J Otorhinolaryngol Relat Spec","first-page":"119","article-title":"A rare case of temporal bone pneumocephalus tracking through the internal auditory canal","volume":"83","author":"Watson","year":"2021","unstructured":"Watson WMulry EKaufman AEliades SJ.A rare case of temporal bone pneumocephalus tracking through the internal auditory canal. ORL J Otorhinolaryngol Relat Spec. 2021;83(2):119-122."},{"key":"bib12","series-title":"World Neurosurg","first-page":"365.e17","article-title":"Pathogenesis of delayed tension intraventricular pneumocephalus in shunted patient: possible role of nocturnal positive pressure ventilation","volume":"85","author":"Salem-Memou","year":"2016","unstructured":"Salem-Memou SVallee BJacquesson TJouanneau EBerhouma M.Pathogenesis of delayed tension intraventricular pneumocephalus in shunted patient: possible role of nocturnal positive pressure ventilation. World Neurosurg. 2016;85:365.e17-365.e20."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/10\/13\/article-CASE25118.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/10\/13\/article-CASE25118.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/10\/13\/article-CASE25118.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T11:14:54Z","timestamp":1769685294000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/10\/13\/article-CASE25118.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,29]]},"references-count":24,"journal-issue":{"issue":"13"},"URL":"https:\/\/doi.org\/10.3171\/case25118","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,29]]}}}