Dry Tap during Ventriculostomy-Lessons to be Learnt

Pneumocephalus following Ventriculoperitoneal (VP) shunt is an exceptionally rare entity. We report such event after an attempt of ventricular puncture (ventriculostomy) for VP shunt and then discuss the management of the same. The dry tap can lead to multiple attempts for ventriculostomy with added risk of complications. It can add dilemma as to what the subsequent management would be.There is also increased risk of tension pneumocephalus, seizures and shunt failure due to blockage by air bubbles. Head down positioning, adequate cruciate dural incision prior to cortex puncture and avoiding excessive egress of CSF are certain nuainces that will help to prevent such complication during the procedure.