Shunt dependency after cyst-peritoneal shunting for the arachnoid cyst of the temporal lobe: report of thirteen cases and literature review

Abstract

Objective To investigate the mechanism,diagnosis,and treatment of shunt dependency syndrome in patients with temporal lobe arachnoid cysts who were initially treated with cystoperitoneal (CP) shunting.Methods Thirteen patients with temporal lobe arachnoid cysts who had initially been with CP shunts placement and had developed shunt dependency syndrome were treated by the authors at Tiantan Hospital between April 2010 and January 2012.The clinical manifestation,neuroimaging findings,intracranial pressure (ICP) data,treatment methods,and therapeutic results were reviewed retrospectively.Results The study included 10 males and 3 females.The mean age at the time of development of shunt dependency was 12.3 years (range 5.5-24.0years).In most patients,neuroimaging findings showed a collapsed cyst (the cyst appeared almost unchanged in only one patient) and normal or small ventricles (only one patient had enlarged ventricles).Three patients underwent simple replacement of the shunt,four underwent ventriculoperitoneal shunt placement,and the other six underwent lumboperitoneal shunt placement.All patients experienced resolution of their symptoms postoperatively.The mean duration of follow-up was 20 months.Conclusions Shunt dependency syndrome was a rare but serious complication of cystoperitoneal (CP) shunting for arachnoid cysts.The condition was similar to the slit ventricle syndrome,but also had some differences.ICP monitoring could confirm the diagnosis when there was no significant radiological findings. Key words: Arachnoid cyst ; Cyst-peritoneal shunting; Shunt dependency ; Mechanism