Ventriculoperitoneal shunts for treating increased intracranial pressure in cryptococcal meningitis with or without ventriculomegaly.

Marcelo Corti,Ricardo Negroni,Jimena Castrelo,Osvaldo Franze,Leonardo Gilardi,Fernando Messina,Alicia Irene Arechayala,Maria Priarone

doi:10.1590/0037-8682-0176-2013

Abstract

Cryptococcosis is an opportunistic mycosis, especially in patients that are human immunodeficiency virus (HIV)-positive, and frequently involves the central nervous system. We assessed the potential of ventriculoperitoneal shunting (VPS) in preventing mortality due to uncontrollable intracranial hypertension (ICH) in 15 patients with acquired immunodeficiency syndrome (AIDS)-related cryptococcal meningitis. After 2 weeks of antifungal therapy consisting of amphotericin B deoxycholate with or without fluconazole, patients with persistent ICH underwent VPS, despite having persistent Cryptococcus neoformans infection. In 12 patients, the uncontrollable ICH was resolved by VPS. Patients with cryptococcal meningoencephalitis who have ICH must be considered for VPS even with positive cerebrospinal fluid cultures.

Highlights

Cryptococcosis is an opportunistic mycosis, especially in patients that are human immunodeficiency virus (HIV)-positive, and frequently involves the central nervous system
We assessed the potential of ventriculoperitoneal shunting (VPS) in preventing mortality due to uncontrollable intracranial hypertension (ICH) in 15 patients with acquired immunodeficiency syndrome (AIDS)-related cryptococcal meningitis
After 2 weeks of antifungal therapy consisting of amphotericin B deoxycholate with or without fluconazole, patients with persistent ICH underwent VPS, despite having persistent Cryptococcus neoformans infection

Summary

Introduction

Cryptococcosis is an opportunistic mycosis, especially in patients that are human immunodeficiency virus (HIV)-positive, and frequently involves the central nervous system. Patients with persistent elevated spinal pressure following frequent lumbar puncture drainage and having undergone 2 weeks of cumulative amphotericin B deoxycholate therapy with or without fluconazole underwent a VP shunt (Medtronic®), despite positive CSF cultures for C. neoformans. Fifteen patients (10 male and 5 female; median age, 33 years; range, 18-53 years) with cryptococcal meningitis-associated ICH were included.

Results

Conclusion