Right Frontal Insertion of Rickman Reservoir

PIG Meeting: 8th April 2021

63-year-old lady normal pressure hydrocephalus.

History of headaches and dizzy spells.


  • IDDM with suboptimal glycaemic control, HbA1C = 12%
  • On 110 units of Ultra-long and rapid-acting insulin per day
  • Previous endocrine reviews reveal poor glycaemic control over many years
  • Compliant with medications but doesn’t have a glucometer
  • No known diabetic complications but history difficult due to neurological symptoms
  • COPD – NYHA 3 dyspnoea, current smoker


  • Very keen for the procedure to proceed as symptoms limiting quality of life
  • Difficult to ascertain reasons for poor glycaemic control
  • Patient unaware of potential implications to health, particularly in the perioperative period
  • Distance patient, postponement on the day of surgery would be a major inconvenience to the patient
  • Unable to contact proceduralist, junior team members contacted and happy to continue


  • Endocrine and GP review organised but limited time
  • Should we try and admit the patient the night before and commence an insulin infusion?
  • Risk of no bed being available then procedure could be postponed
  • Consensus that procedure is high risk for postoperative infection and should be postponed


  • Operating Surgeon eventually contacted – happy to defer until glycaemic control improved.
  • Expediate endocrine and GP reviews