Pericardial tamponade during surgical ventriculoperitoneal shunt placement : a case report and review of the literature

BACKGROUND: Cardiac tamponade is a catastrophic hemodynamic emergency. While ventriculoperitoneal (VP) shunt placement is a common neurosurgical procedure, its typical complications include obstruction and infection. No prior cases of intraoperative cardiac tamponade during VP shunt placement have been reported. CASE PRESENTATION: We present a case of life-threatening cardiac tamponade that occurred during VP shunt insertion in a patient with severe cerebral edema. The patient developed abrupt hemodynamic collapse, progressing to pulseless electrical activity requiring emergency cardiopulmonary resuscitation. CONCLUSIONS: Prompt diagnosis was achieved by point-of-care ultrasonography, and immediate pericardiocentesis was life-saving. This case illustrates a previously unreported, lethal complication of VP shunt surgery, potentially resulting from unintended cardiac penetration by the ventricular catheter. We alert anesthesiologists and neurosurgeons to consider this etiology in cases of unexplained intraoperative collapse and advocate for the ready availability of ultrasound for rapid diagnosis.