Background: Ventriculoperitoneal (VP) shunts remain one of the viable treatment modalities for hydrocephalus. A growing number of shuntdependent women are reaching reproductive age, yet pregnancy in the presence of a VP shunt poses significant risks, including shunt malfunction, raised intracranial pressure (ICP), and neurological deterioration. The choice of anaesthesia for operative delivery in shunted patients is a critical clinical decision, as regional anaesthesia may be relatively contraindicated in the setting of elevated ICP.

Case Presentation: We report the case of a 29-year-old woman with a five-year history of VP shunt insertion for late-onset aqueductal stenosis, who presented with sudden loss of consciousness immediately following Caesarean section performed under regional anaesthesia. She had a preceding 12-month history of progressive blurring of vision, with brain magnetic resonance imaging (MRI) during antenatal follow-up demonstrating ventriculomegaly. Physical examination following her acute deterioration revealed a Glasgow Coma Scale (GCS) score of 12/15 and bilateral papilledema. Brain computed tomography (CT) confirmed marked ventriculomegaly with loss of white and grey matter differentiation and a ventricular catheter tip displaced within the brain parenchyma.

Management: Emergency VP shunt revision was performed under general anaesthesia. Intraoperatively, the shunt connection point was found to have migrated caudally, with the ventricular catheter disconnected from the valve. The old shunt hardware was removed and replaced with new hardware. The procedure was uneventful.

Outcome: By the first postoperative day, the patient's GCS had improved to 15/15 with marked reduction in visual symptoms. She was discharged on the fifth postoperative day with complete resolution of blurring of vision. At one-week follow-up, sustained neurological improvement was documented.

Conclusion: This case underscores the importance of multidisciplinary management of shunt-dependent pregnant women. Regional anaesthesia should be avoided in patients with known or suspected shunt malfunction and raised ICP. Preconception counselling, close antenatal neurosurgical surveillance, and timely surgical intervention are essential to prevent morbidity. In resource-limited settings such as Nigeria, heightened clinical suspicion and early referral remain paramount.