Abstract
BACKGROUND: 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. OBSERVATIONS: 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. LESSONS: Patients with a VP shunt and a history of skull base fracture may develop pneumocephalus even after a prolonged period. https://thejns.org/doi/10.3171/CASE25118.