The patient a Yemeni citizen was operated by me 13-April-2003 for progressive hydrocephalus, after what he recovered and disappeared.

The patient then came 31-October-2024 complaining of headache for one month with somnolence. Check CT-scan was done 2017 and 2018 were normal with ventricles normal in shape and the shunt in place. CT-scan done 22-October-2024 showing widened ventricles. The patient is in somnolence with blurred vision. The pump of the device is not functioning. He was sent to X-rays to rule out rupture of the device. The device is intact and reaching the pelvic cavity. CRP was 29 mg/L.  The family telling that he felt down yesterday for what MRI of the brain done to rule out subdural hematoma and admitted 02-November-2024. Mannitol 25 mg I/V  started Q 8 h. with Foley's catheter and antibiotics started.

The cranial and abdominal parts of the shunt were exposed. The intra-abdominal tip was showing very small amount of clear CSF. Inspection of the reservoir, showed intact ventricular part, but the distal end had a small gap between the tube and reservoir. Trail to use the old tube to obtain the tunneling failed and even removal of the tube from above and below was impossible due to calcifications around the tube that one third above and one third fro below ere removed and the middle third was left in place. Using passer the new Medtronic PS Medical delta medium pressure was inserted to the ventricular part. The coming CSF was in huge quantity. It was possible to see the omintum,  but was scarous. Routine closure of the wounds.

The patient showed delayed recovery and was sent to the ward. The patient was seen 5 hours after surgery and vision was preserved and the level of consciousness was better.

Too early now.

The patient has has progressive hydrocephalus which could lead to blindness if left without surgical interference.