Putaminal hemorrhage potentially attributable to over-drainage of cerebrospinal fluid following ventriculoperitoneal shunt surgery in moyamoya disease: A case report

VP shunt placement for hydrocephalus in patients with MMD following intraventricular hemorrhage necessitates careful management of shunt pressure settings. Given the fragile condition of collateral vessels in MMD, aggressive reductions in shunt pressure should be avoided. Instead, gradual and controlled adjustments are recommended to minimize the risk of over-drainage and subsequent hemorrhagic complications. Regular imaging, such as frequent computed tomography scans, is essential to monitor ventricular size and guide cautious pressure modulation.