Cerebrospinal Fluid Shunting in Children with Hydrocephalus and Increased Intracranial Pressure Secondary to Human Immunodeficiency Virus–Related Cryptococcal Meningitis

Abstract

Hydrocephalus and increased intracranial pressure secondary to human immunodeficiency virus-related cryptococcal meningitis are rare in children. The role and outcomes of cerebrospinal fluid (CSF) shunting in children are not well reported. We report our experience with CSF shunting in the management of this condition in children over a 14-year period. This was a retrospective review of data collected from a single neurosurgery unit. Data collected included demographics, clinical characteristics, Glasgow Coma Scale score, lumbar puncture opening pressure, antiretroviral therapy, laboratory results, neuroimaging findings, shunting procedures, complications, and mortality. Seventeen children underwent CSF shunting. Median age was 10 years (range, 6-13), most being male (76%). All children were on antiretroviral therapy. Median Glasgow Coma Scale score was 15 (interquartile range [IQR], 14-15). Clinical characteristics included headaches (100%), visual impairment (82%), and seizures (47%). Lumbar puncture opening pressure was >30 cm H2O in 88% of children. Median CD4 count was 45 cells/μL (IQR, 17-56). Computed tomography brain scans showed hydrocephalus in 14 children (82%). Surgical procedures included ventriculoperitoneal shunts (82%) and lumboperitoneal shunts (18%). Shunt complications included infection (18%) and obstruction (18%). Staphylococcus aureus was cultured in all infections. Median follow-up was 45 months (IQR, 7.5-74). Three children (18%) died during the admission period. Ten children (59%) were alive at 1 year follow-up. This study is the largest series reporting on CSF shunting of hydrocephalus and increased intracranial pressure in children with human immunodeficiency virus-related cryptococcal meningitis. Treatment with ventriculoperitoneal shunt and lumboperitoneal shunt regardless of the CD4 count is an important option in suitable children to reduce mortality.