Intracranial Granuloma and Unbalanced Epilepsy as Complications of a Subdural Peritoneal Shunt

Abstract

Many children require placement of a subdural peritoneal shunt for congenital or acquired hydrocephalus, certain cystic malformations, or subdural hematomas. The device may be placed temporarily or permanently. As many complications have been reported, the indications for placement are limited. We report the case of a male child who required a subdural peritoneal shunt because of a subdural hematoma as a complication of abusive head trauma in early childhood. For technical reasons, the intracranial portion could not be extracted. The child’s development was marked by residual hemiparesis and balanced epilepsy. Eleven years later, the epilepsy had worsened, and a left frontal nodular formation in contact with the intracranial portion of the drain was identified, surrounded by perilesional edema. Surgical excision was performed. The histopathological examination revealed a chronic inflammatory infiltrate with superinfection by multisensitive Staphylococcus epidermidis. Antibiotic therapy was associated for 8 weeks. The control cerebral MRI at 8 weeks revealed a scarred cavity with a marked reduction in the left frontal perilesional edema, along with improvement in his epilepsy. Few similar cases have been reported in the literature. Maintaining exogenous material in the intracranial space carries a risk, even many years later, which suggests it should be systematically removed when no longer indicated or functional.