When Bone Dust Goes Astray: Intraventricular Migration and Chemical Meningitis After Etv — a Case Report Publisher

Summary: Can a lumbar puncture trigger a rare brain-surgery complication? A case report describes ventricular bone dust and possible meningitis; causation is unclear. #Neurosurgery #CaseReport

Moznebiisfahani M ; Askariardehjani N
Source: Heliyon Published:2026

Abstract

Background Normal pressure hydrocephalus (NPH) is a potentially reversible condition characterized by the triad of gait disturbance, urinary incontinence, and cognitive impairment. Endoscopic third ventriculostomy (ETV) is a recognized treatment option, particularly when patients demonstrate a positive response to CSF tap tests. Although generally safe, ETV may rarely be complicated by alterations in cerebrospinal fluid (CSF) dynamics. Case presentation We report a 75-year-old man presenting with progressive gait disturbance and intermittent urinary incontinence. Brain CT and a high-volume CSF tap test supported the diagnosis of probable normal pressure hydrocephalus (NPH), with significant clinical improvement following CSF removal. The patient underwent ETV, and the frontal burr-hole was sealed with autologous bone dust collected during drilling. Immediate postoperative recovery was uneventful, with minimal pneumocephalus on CT. Lumbar puncture revealed normal opening pressure. Four days later, he presented with low-grade fever and serous frontal wound discharge, prompting lumbar puncture to evaluate a possible postoperative infection. The CSF obtained at that time showed mild inflammatory changes. Within 24 hours after lumbar puncture, fever worsened and mild confusion developed. Follow-up CT demonstrated newly apparent hyperdense particulate material within the lateral ventricle adjacent to the previous burr-hole trajectory. Although the temporal association raised the possibility that lumbar puncture contributed to displacement of the bone dust through altered CSF pressure dynamics, the exact timing of migration could not be established. CSF analysis showed sterile inflammatory changes, and the overall clinical and laboratory findings were most compatible with chemical meningitis. Management and outcome The patient received intravenous corticosteroids, with full resolution of symptoms within one week. At six-month follow-up, he remained asymptomatic with normal gait and no evidence of infection or recurrent complications. Conclusion This case highlights a rare postoperative complication in which autologous bone dust was found within the ventricular system following lumbar puncture, with a temporal association suggesting a possible link to cerebrospinal fluid pressure alterations and subsequent chemical meningitis. Awareness of this potential phenomenon may help guide postoperative management, avoid unnecessary early lumbar puncture, and inform selection of more stable burr-hole closure techniques. © 2026 The Authors.