Armored brain and the need for surveillance imaging in shunted patients: A case report

The occurrence of chronic subdural hematoma (CSDH) in patients with ventriculoperitoneal shunts is a well known complication, with calcification of these hematomas being being a rare occurrence; delayed diagnosis is frequent, significantly complicating management, particularly when the calcification presents as an ’armored’ type, characterized by extensive, dense calcification encasing the brain. We present a unique case of a 23-year-old female patient, previously shunted for Dandy-Walker malformation in childhood, who developed massive bilateral calcified CSDH, a challenging case successfully managed through craniotomy and hematoma evacuation. Surgical excision of calcified CSDH, while complex, can be effectively performed in carefully selected young patients, however, the potential for irreversible brain atrophy due to long-term mass effect highlights the critical need for vigilant neuroimaging surveillance, as early detection and intervention of CSDH in shunted patients are paramount to facilitate simpler surgical procedures and improve outcomes.