# Delayed recovery of consciousness from anesthesia due to exacerbation of hydrocephalus caused by a ventriculoperitoneal shunt malfunction during general anesthesia in the prone position: a case report

## TL;DR

A patient with a VP shunt had delayed recovery from anesthesia due to shunt malfunction during prone positioning surgery, leading to worsened hydrocephalus.

## Contribution

Highlights the risk of VP shunt malfunction during prone positioning and its impact on postoperative consciousness recovery.

## Key findings

- Delayed awakening occurred after surgery due to VP shunt occlusion in the prone position.
- Postoperative CT confirmed hydrocephalus exacerbation, resolved after shunt reservoir pumping.
- Patient recovered fully with no neurological issues after shunt intervention.

## Abstract

Dysfunction of ventriculoperitoneal (VP) shunts can lead to decreased levels of consciousness. We report a case of delayed emergence from anesthesia due to the malfunction of a VP shunt during neurosurgery in the prone position.

A 75-year-old male with a history of VP shunt for a fourth ventricle obstruction underwent cerebral vascular anastomosis in the prone position. His preoperative level of consciousness was clear. The surgery under general anesthesia was completed without any particular issues. After discontinuation of anesthesia, the patient did not awaken for over an hour. Postoperative CT revealed exacerbated hydrocephalus, likely from VP shunt occlusion. After pumping the reservoir of the VP shunt, the patient regained consciousness. He was extubated and discharged from ICU on the second postoperative day with no neurological issues.

For surgical patients with a VP shunt, anesthesia management must consider the risk of shunt malfunction due to patient positioning.