19 year old male patient from a district hospital for hydrocephalia surgery.
He had a history of approximately 1 year of evolution of left hemicraneal headache that worsened with exertion.
In recent weeks headache increased in intensity and frequency.
Neurological examination showed only bilateral papilledema.
The patient provides a magnetic resonance imaging (MRI) that shows supratentorial ventricular dilatation with Evans index of 0.43, pericranial clearance with contrast, and a small tectal lesion that does not change.
The fourth ventricle was normal.
1.
With the diagnosis of stenosis of the Silvios educate, a right frontal roof hole, an endoscopic pre acuminatum ventriculocisternostomy were performed.
A Mayfield head restraint was used (Ohio Medical Instrument Co, Inc., Cincinnati, Oh, USA).
The immediate postoperative period was uneventful although the patient complained of headache.
A new MRI was performed 48 hours after surgery and prior to scheduled hospital discharge, in which the presence of left parietal epidural hematoma with mass effect on the ipsilateral lateral ventricle is noteworthy.
1.
Then a left craniotomy was performed, affecting as there was a parietal perforation affecting the whole bone without the dura mater.
The hematoma was drained and a bleeding small dural artery was clotted.
The patient was discharged after 6 days with only a certain degree of headache.
One year after surgery the patient is asymptomatic and the tectal lesion shows no changes in MRI studies.
