From the Research
No, a subdural drain terminating along the floor of the left middle cranial fossa is not a normal finding on a computed tomography (CT) head scan in an adult with a history of hydrocephalus as a child. Typically, the ventricular catheter should be positioned within the lateral ventricle, with the distal end terminating in the peritoneal cavity. The middle cranial fossa is not the intended location for proper shunt placement. This abnormal positioning could explain potential headaches and may indicate shunt malfunction or migration. The patient should be promptly referred to a neurosurgeon for evaluation, as improper shunt placement can lead to inadequate cerebrospinal fluid drainage, persistent hydrocephalus, and neurological complications. Imaging findings like this warrant urgent follow-up, especially in a patient with a history of hydrocephalus presenting with headaches, as these symptoms could indicate increased intracranial pressure requiring shunt revision or replacement, as seen in cases of subdural hygroma due to a ruptured arachnoid cyst in the middle cranial fossa 1. Key considerations in the management of such cases include the potential for subdural effusion and hydrocephalus following decompressive craniectomy 2, as well as the importance of close clinical follow-up and imaging for patients with a history of traumatic brain injury or hydrocephalus 3. In terms of treatment options, the placement of lumboperitoneal shunts has been shown to be a safe procedure for the treatment of communicating hydrocephalus, although complications such as obstruction or migration of the peritoneal catheter can occur 4. Overall, the management of subdural drains and shunts requires careful consideration of the individual patient's history and clinical presentation, as well as the potential risks and benefits of different treatment options, as highlighted in cases of posterior fossa subdural effusion due to head trauma 5.