Cerebrospinal Fluid Pseudocyst Research Articles

An unusual complication of a ventriculoperitoneal shunt: Endoscopic ultrasound-guided drainage of a giant cerebrospinal fluid pseudocyst.

An unusual complication of a ventriculoperitoneal shunt: Endoscopic ultrasound-guided drainage of a giant cerebrospinal fluid pseudocyst.

Intra-axial Hepatic Cerebrospinal Fluid Pseudocyst: An Unusual Complication of Ventriculoperitoneal Shunt Placement

Intra-abdominal Cerebrospinal Fluid (CSF) pseudocysts are a well-known and potentially serious complication of Ventriculoperitoneal (VP) shunt placement. These cysts are often found within the peritoneal cavity or along the serosal surface of solid organs. Here, we present an unusual case of an intrahepatic CSF pseudocyst in a 14-year-old female patient with a VP shunt placed three years ago, following the excision of a cerebellar pilocytic astrocytoma. The child presented with complaints of right hypochondriac pain and tenderness for one month. On ultrasound of the abdomen, the right lobe of the liver showed a complex anechoic cystic collection with multiple thick internal septations. A Contrast-enhanced Computed Tomography (CECT) examination revealed a well-defined hypodense collection in segments IV and V of the liver with a VP shunt tube within. Based on clinical and imaging features, differentials of intra-axial intrahepatic CSF pseudocyst, complex hepatic cyst, peri-shunt hemorrhagic cyst, and biliary cystadenoma were considered. Aspiration of the cyst revealed clear, colourless, non purulent, non sanguineous fluid which tested positive for beta-2-transferrin, confirming the collection to be a CSF pseudocyst. An elective laparoscopic cyst excision with shunt revision was performed with no recurrence on follow-up. The present case highlights the uncommon occurrence of intrahepatic CSF pseudocysts post-VP shunt, necessitating meticulous diagnostic evaluation. Successful laparoscopic excision and shunt revision underscore the efficacy of tailored interventions. This contribution enhances the understanding of atypical complications in VP shunt recipients, guiding clinicians and radiologists in both diagnosis and management.

Management of cerebrospinal fluid pseudocysts in the laparoscopic age.

Abdominal CSF pseudocysts are an uncommon but challenging complication of ventriculoperitoneal shunts. Pseudocysts consist of a loculated intraperitoneal compartment that inadequately absorbs CSF and may be infected or sterile at diagnosis. The treatment goal is to clear infection if present, reduce inflammation, and reestablish long-term function in an absorptive (intraperitoneal) space. This aim of this paper was to study the efficacy of primary laparoscopic repositioning of the distal shunt catheter for treatment of sterile abdominal CSF pseudocysts. All patients treated for abdominal CSF pseudocysts at Dallas Children's Health from 1991 to 2021 were retrospectively reviewed. Patient history and pseudocyst characteristics were analyzed, with a primary outcome of pseudocyst recurrence at 1 year. Of 92 primary pseudocysts, 5 initial treatment strategies (groups) were used depending on culture status, clinical history, and surgeon preference: 1) shunt explant/external ventricular drain (EVD) placement (23/92), 2) distal tubing externalization (13/92), 3) laparoscopic repositioning (35/92), 4) open repositioning (4/92), and 5) other methods such as pseudocyst drainage or direct revision to another terminus (17/92). Seventy pseudocysts underwent shunt reimplantation in the peritoneal space. The 1-year peritoneal shunt survival for groups 1 and 2 combined was 90%, and 62% for group 3. In group 3, 1-year survival was better for those with normal systemic inflammatory markers (100%) than for those with high markers (47%) (p = 0.042). In a univariate Cox proportional hazards model, the risk of pseudocyst recurrence was increased if the most recent abdominal procedure was a nonshunt abdominal surgery (p = 0.012), and it approached statistical significance with male sex (p = 0.054) and elevated inflammatory markers (p = 0.056. Multivariate Cox analysis suggested increased recurrence risk with male sex (p = 0.05) and elevated inflammatory markers (p = 0.06), although the statistical significance threshold was not reached. The length of hospital stay was shorter for laparoscopic repositioning (6 days) than for explantation/EVD placement (21 days) (p < 0.0001). Ultimately, 62% of patients had a peritoneal terminus at the last follow-up, 33% (n = 30) had an extraperitoneal terminus (19 pleura, 8 right heart, and 3 gallbladder), and 5 patients were shunt free. Some sterile pseudocysts with normal systemic inflammatory markers can be effectively treated with laparoscopic repositioning, resulting in a significantly shorter hospitalization and modestly higher recurrence rate than shunt explantation.

Management of ventriculoperitoneal shunt complications in children: A review of 34 cases.

The primary objective of this study was to analyse the demographics of the children who presented with ventriculoperitoneal shunt (VPS) complications. The secondary objectives were to review the clinical characteristics, surgical procedures performed for the management of VPS complications and the final outcome. This is a single-institution observational study that included children below 12 years of age who required VPS revisions during the study period. During the study period of 10 years, n = 336 VPS catheters were implanted for the treatment of hydrocephalus in children. Forty (11.90%) children developed various VPS complications and required VPS revisions in the follow-up period. A total of n = 30 (8.92%) children (n = 21 boys and n = 9 girls) were selected/recruited for the present study, and they required n = 34 revision procedures. The mean interval from VPS insertion to the diagnosis of the complication was 7.29 months. VPS complications that required revisions occurred in the following order of frequency: (1) VPS catheter, cerebrospinal fluid (CSF) or shunt tract infection n = 8 (2.38%); (2) malfunction of distal VPS catheter n = 7 (2.08%); (3) coiling of distal VPS catheter at abdominal area n = 6 (1.78%); (4) extrusion of VPS catheter n = 5 (1.48%); (5) CSF leak from abdominal wound site/umbilicus n = 4 (1.19%); (6) malfunction of ventricular catheter n = 3 (0.89%) and (7) CSF pseudocyst peritoneal cavity n = 1 (0.29%). Surgical procedures were performed for the treatment of abovementioned complications in the following order of frequency: (1) revision of distal VPS catheter n = 14 (4.16%), (2) removal of entire VPS catheter ± external ventricular drainage (EVD) n = 7 (2.08%), (3) distal VPS catheter converted as EVD n = 6 (1.78%), (4) revision of proximal VPS catheter n = 3 (0.89%), (5) revision of entire VPS catheter n = 3 (0.89%) and (6) CSF pseudocyst excision n = 1 (0.29%). This study also documented n = 2 (6.6%) deaths during the post-operative period. VPS insertion done for the treatment of hydrocephalus in infants and children was associated with various complications. Seventy per cent of the complications occurred within the first 6 months after the VPS insertion. Two-thirds of the complications were related to the distal VPS catheter.

Chest wall abscess with intestinal perforation and distal catheter migration of Ventriculoperitoneal (VP) shunt without anal extrusion: A case report

Hydrocephalus is the symptomatic accumulation of cerebrospinal fluid (CSF) within the brain ventricles. Common treatments include direct etiological procedure e.g. a Ventriculoperitoneal (VP) shunt, which can potentially lead to complications such as infection, obstruction, cerebrospinal fluid pseudocyst, bowel perforation, shunt catheter migration, peritoneal inclusion cyst, and spontaneous VP shunt catheter extrusion. A rare case of extrusion on a 2 years old boy was reported; the individual in question came with a lump on his chest and was diagnosed with hydrocephalus on the patent right VP shunt. From a theoretical perspective, treatment of extrusion can be done via emergency removal, antibiotic treatment, nil per oral, and reinsertion if needed. From the particular case, it was concluded that treatment is possible with removal of the catheter and reinsertion of the VP shunt and through postoperative monitoring.

Recurrent giant abdominal cerebrospinal fluid pseudo cyst: A case report and review of literature

Cerebrospinal fluid pseudo cyst is a rare complication of ventriculoperitoneal shunt procedure for hydrocephalus. It is a collection of fluid that accumulate around the tip of the distal catheter and surrounded by a wall of fibrous tissue lacking a true epithelium. There is no exact etiology for this entity. It is associated with high recurrence rate. We are reporting one such case of recurrent cerebrospinal fluid pseudo cyst which was managed by initial exteriorization of abdominal end of shunt followed by excision of the cyst and revision of abdominal end of ventriculoperitoneal shunt.

S3022 Hepatic Cerebrospinal Fluid Pseudocyst: A Rare Complication of Ventriculoperitoneal Shunt

Introduction: Ventriculoperitoneal shunts (VPS) are commonly used in the management of hydrocephalus to drain cerebrospinal fluid (CSF) into the peritoneal cavity. The placement of VPS has prolonged the survival of patients with hydrocephalus. Abdominal pseudocysts are long-term complication of VPS that are identified later in life. Hepatic CSF pseudocyst is a rare long-term complication of VPS that should be differentiated from other cystic lesions of liver. Case Description/Methods: A 49-year-old man with intellectual disability from congenital hydrocephalus s/p placement of right and left-sided VPS at age of 3 months and 7 years respectively presented with exertional dyspnea and abdominal distension. On presentation his vitals were unremarkable except tachycardic (115/min)., He had abdominal distention, hepatomegaly but no tenderness. Initial labs showed D-dimer 2.20 mcg/mL, AST 27 u/L, ALT 38 u/L, alkaline phosphate 126 u/L and total bilirubin 0.5 mg/dL. Chest CT with IV contrast was negative for pulmonary embolism, however revealed a large 18x13x13.5 cm cyst in right hepatic lobe. CT abdomen and pelvis demonstrated a 17.5x12.6x12.7 cm cystic lesion in the right hepatic lobe with the tip of VP shunt catheter within cyst cavity. Hepatobiliary nuclear scan was unremarkable for any biliary leak or sphincter of oddi dysfunction. CT head was negative for any acute abnormalities. Shunt series x-rays were negative for disruption of VPS catheter. Robotic laparoscopic cyst fenestration with partial hepatectomy was performed and catheter was repositioned to the right lower quadrant of abdomen. Patient was discharged home two days later with significant reduction of cyst size on follow up imaging. (Figure) Discussion: This case illustrates a rare complication of VPS that result in hepatic CSF pseudocyst. If hydrocephalus is absent, patients with hepatic CSF pseudocyst are asymptomatic at earlier stages., or they may present with abdominal pain, distention, or palpable right upper quadrant abdominal mass. A subset of patients with hepatic CSF pseudocyst are complicated with bacterial or parasitic infection and present with abdominal pain, distention, or right upper quadrant mass. Abdominal ultrasound and CT scan assist in diagnosis by identifying the tip of VPS catheter in the pseudocyst cavity. Asymptomatic patients are managed conservatively while surgical repositioning of VPS catheter with or without cyst fenestration or surgical excision of cyst may be required for complete resolution of symptoms.Figure 1.: CT of abdomen showing a large right hepatic lobe cyst with evidence of tip of right VPS catheter within the cavity of the cyst (arrows) on transverse (A), axial (B) and lateral (C) views. CT scan of the head (D) showing VPS catheters both in right and left lateral ventricles without evidence of ventricular dilation. Shunt series x-ray (E) shows now distortion of VPS catheter. Robotic laparoscopic cyst fenestration (F) shows VPS catheter within cyst cavity containing CSF.

Subcapsular hepatic pseudocyst as a rare complication of ventriculoperitoneal shunt: A case report

Abdominal pseudocysts are an uncommon complication of ventriculoperitoneal shunt (VPS) placement. Patients may be asymptomatic, or present with symptoms such as abdominal pain, abdominal distension, fever, or vomiting. A 13-year-old girl presented to the emergency department complaining of abdominal pain for one week, with a history of VPS insertion for treatment of hydrocephalus in infancy. Diagnosis of an abdominal pseudocyst was made based on abdominal imaging, demonstrating a hepatic cerebrospinal fluid (CSF) pseudocyst free from infection. The patient was managed with aspiration of the CSF pseudocyst, and no intervention was performed on the VPS as the collection was near the distal catheter of the VPS, there were no signs of high intracranial pressure, and the VPS was in a good position. Hepatic pseudocyst is a rare complication of VPS, and can be challenging to diagnose as the primary symptom, acute abdominal pain, is non-specific. Hepatic pseudocyst should be considered when evaluating patients with VPS presenting with abdominal pain.

Cerebrospinal Fluid Pseudocyst Presenting as an Inguinal Hernia

Cerebrospinal Fluid Pseudocyst Presenting as an Inguinal Hernia

A case of recurrent abdominal cerebrospinal fluid pseudocyst associated with a ventriculoperitoneal shunt in a child

A case of recurrent abdominal cerebrospinal fluid pseudocyst associated with a ventriculoperitoneal shunt in a child

Hepatic Liquoric Cyst as a Complication of Ventriculoperitoneal Shunt Insertion: A Case Report

Abstract Background The ventriculoperitoneal shunt (VPS) procedure is still the most used technique for management of hydrocephalus. This article reports a case of hepatic cerebrospinal fluid (CSF) pseudocyst as a rare, but important, complication of the VPS insertion. Case Description An 18-year-old male presented to the hospital complaining of temporal headache and visual turbidity for approximately 3 months with a history of VPS insertion for treatment of hydrocephalus and revision of the valve in adolescence. The diagnosis was based on abdominal imaging, demonstrating an extra-axial hepatic CSF pseudocyst free from infection. Following the diagnosis, the management of the case consisted in the removal and repositioning of the catheter on the opposite site of the peritoneum. Conclusion The hepatic CSF pseudocyst is an infrequent complication of VPS procedure, but it needs to be considered when performing the first evaluation of the patient. Several techniques are considered efficient for the management of this condition, the choice must be made based on the variables of each individual case.

Hemorrhagic abdominal pseudocyst following ventriculoperitoneal shunt: a case report

BackgroundAbdominal cerebrospinal fluid (CSF) pseudocyst is an uncommon but important complication of ventriculoperitoneal (VP) shunts. While individual articles have reported many cases of abdominal CSF pseudocyst following VP shunts, no case of a hemorrhagic abdominal pseudocyst after VP shunts has been reported so far.Case presentationThis article reports a 68-year-old woman with a 4-month history of progressive abdominal pain and distention. She denied any additional symptoms. A VP shunt was performed 15 years earlier to treat idiopathic normal pressure hydrocephalus and no other abdominal surgery was performed. Physical examination revealed an elastic palpable mass in her right lower abdomen, which was dull to percussion. Abdominal computed tomography (CT) scan indicated a large cystic collection of homogenous iso-density fluid in the right lower abdominal region with clear margins. The distal segment of the peritoneal shunt catheter was located within the cystic mass. Abdominal CSF pseudocyst was highly suspected as a diagnosis. Laparoscopic cyst drainage with removal of the whole cystic mass was performed, 15-cm cyst which found with thick walls and organized chronic hematic content. No responsible vessel for the cyst hemorrhage was identified. No further shunt revision was placed. Histological examination showed that the cyst wall consisted of outer fibrous tissue and inner granulation tissue without epithelial lining, and the cystic content was chronic hematoma. The patient had an uneventful postoperative course and remained asymptomatic for 8-mo follow-up.ConclusionTo the best of our knowledge, this is the first report of hemorrhagic onset in the abdominal pseudocyst following VP shunt. Such special condition can accelerate the appearance of clinical signs of the abdominal pseudocyst after VP shunts, and its mechanisms may be similar to the evolution of subdural effusion into chronic subdural hematoma (CSDH).

Gigantic Abdominal Pseudocyst: An Unusual Evolution of the Ventriculoperitoneal Shunt

Background: The ventriculoperitoneal (VPS) shunt is the most common procedure in the treatment of hydrocephalus in children. Abdominal cerebrospinal fluid pseudocysts are a rare complication of the ventriculoperitoneal shunt with an incidence ranging from less than 1% to 10% and are more prevalent in children. The malfunction of the ventriculoperitoneal shunt can cause headaches, nausea, vomiting, altered level of consciousness and abdominal pain due to the accumulation of cerebrospinal fluid. There is no consensus on which type of treatment is better in this case, but there are several available methods. Aim: To report an unusual case of a giant abdominal cerebrospinal fluid pseudocyst as a complication of the VPS. Case Presentation: Female 1 y/3 months old patient, less than 7 kg, that has been diagnosed with hydrocephalus prenatally, confirmed postnatally associated with an esophageal atresia and distal tracheoesophageal fistula (AE/FTE, Gross III), was admitted to our service with progressive abdominal distention without obstructive intestinal signs or peritoneal inflammatory signs. The CT scan of the abdomen showed a large liquid collection (estimated volume of 600 ml), centered on the umbilical region, diagnosed as a giant abdominal cerebrospinal fluid (CSF) pseudocyst from the VPS. All of data and information were obtained from her medical records at the infirmary of the Conjunto Hospitalar de Sorocaba (CHS), São Paulo. Conclusion: Abdominal CSF as a cause of these giant pseudocysts should be considered as a diagnostic hypothesis for cases of large abdominal distensions without intestinal involvement in patients with a VPS. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Ultrasound-guided percutaneous aspiration of abdominal pseudocyst following ventriculoperitoneal shunt implantation in a child: A case report

Pseudocyst is a rare complication of ventriculoperitoneal shunt (VPS) seen in 1–4% of pediatric age group and it’s usually managed by surgical excision. We report a new case of cerebrospinal fluid pseudocyst complicating VPS that was managed by percutaneous aspiration resulting in a successful outcome. A 2-year-old male presented with fever, abdominal pain, diarrhea, and vomiting. Abdomen examination showed palpable tender epigastric mass. Ultrasound examination and CT scan of the abdomen demonstrated localized epigastric fluid collection. He was managed with IV antibiotics, shunt externalization, and percutaneous aspiration of the pseudocyst. On follow-up examination, no similar symptoms were recorded. Percutaneous aspiration is a more conservative and effective approach in managing VPS pseudocyst in the new era of interventional radiology. Although the occurrence of abdominal pseudocyst is rare, a high index of suspicion should be maintained to avoid the risk of ascending infection.

Mis-diagnosed giant ovarian cyst and ventriculoperitoneal shunt malfunction

Abdominal pseudocysts are common complications of ventriculoperitoneal shunt (VPS). We report the case of a 37-year-old woman treated by VPS for congenital obstructive hydrocephalus, who presented shunt dysfunction related to a voluminous abdominal cyst initially diagnosed as cerebrospinal fluid pseudocyst. The cyst was drained and the VPS was removed after endoscopic third ventriculocisternostomy (ETV). A few months later, a large new abdominal cyst appeared and was operated on. Diagnosis was rectified as massive ovarian mucinous cystadenoma. In any intra-abdominal cyst, differential diagnoses need considering to avoid mis-diagnosis in shunted patients, especially if the cyst is very large. The etiology of the hydrocephalus should also be investigated in case of shunt dysfunction. Even in case of longstanding shunt, ETV can be an alternative to shunt revision surgery in obstructive hydrocephalus, enabling VPS withdrawal and treatment of the hydrocephalus.

Pelvic pseudocyst presenting with vaginal drainage of cerebrospinal fluid in an adolescent: A rare complication of ventriculoperitoneal shunt

Abstract The case report describes a 16-year-old female with a ventriculoperitoneal (VP) shunt due to congenital hydrocephalus. She presented with abdominal pain and vaginal leakage of cerebrospinal fluid (CSF). CT imaging demonstrated multiple intra-abdominal and pelvic CSF pseudocysts as well as possible erosion of the VP shunt into the vagina. She was taken to the OR for externalization of the shunt and resection of pseudocysts. Surprisingly, the VP shunt tubing was not related to the vagina at all. Instead, there was a large, inflamed pseudocyst within the pelvis and CSF was draining through the fallopian tubes which were located within it. This cyst was only partially resected to protect the fallopian tubes and surrounding structures. Post-operatively, cultures of the CSF demonstrated an infection by Propionibacterium, pathogens that form part of the normal skin flora, but rarely of the vaginal flora in adolescent girls (Huang et al., 2014) [1] . Vaginal drainage stopped and the patient made a full recovery. This case highlights the very rare finding of a CSF pseudocyst decompressing through the fallopian tubes and provides an overview of the complications associated with VP shunts.

Large abdominal cerebro-spinal fluid pseudocyst mimicking mesenteric cyst in an adult: A rare presentation

Abdominal cerebrospinal fluid pseudocyst occurring after ventriculoperitoneal shunt procedure for hydrocephalous is a rare complication. It is sometimes seen in children and is very rare in adults. We are here in reporting a case of 23 years unmarried female who underwent ventricul operitoneal shunt procedure for hydrocephalus at the age of 6 months and remained asymptomatic thereafter. After 22 years of this procedure, she presented with abdominal pain, distention, vomiting and a progressively increasing large cystic lump in upper and mid-abdomen that was initially diagnosed as mesenteric cyst. However, on CECT abdomen, it came out to be a large abdominal cerebro spinal fluid (CSF) pseudo cyst. It was an unusual delayed complication of ventriculoperitoneal shunt procedure that was successfully managed with surgical intervention. This case emphasizes that this unusual presentation should be known to the surgeons who mostly deal with abdominal masses.

Unusual cause of abdominal distension: Infected abdominal cerebrospinal fluid pseudocyst

Unusual cause of abdominal distension: Infected abdominal cerebrospinal fluid pseudocyst

Subcutaneous Cerebrospinal Fluid Pseudocyst: An Unusual Complication of Ventriculoperitoneal Shunt

Ventriculoperitoneal shunt (VPS) is a therapeutic procedure used for the treatment of hydrocephalus of diverse etiologies. With increasing longevity following successful treatment, delayed complications are being observed more frequently. A pseudocyst is a known complication that affects patients treated with VPS. Most pseudocysts are seen in the abdomen. Rarely, a patient can have cerebrospinal fluid (CSF) collection only around shunt tube located in the subcutaneous plane and may be termed as subcutaneous CSF pseudocyst. We describe a case of subcutaneous CSF pseudocyst over chest and abdominal wall in a 12-year- male child.

Cerebrospinal Fluid Pseudocyst Complicating Ventriculoperitoneal Shunt: Report of Four Cases

Abstract Background Cerebrospinal fluid (CSF) abdominal pseudocyst (APC) is an uncommon complication following ventriculoperitoneal (VP) shunt. Aim To study the clinical features and management of this entity. The authors present their experience with cases of CSF pseudocyst in children. Materials and Methods Retrospective analysis of four cases diagnosed to have APC following VP shunt between 2005 and 2015. Results Clinical presentation was with progressive abdominal distension, highlights of intestinal obstruction, and signs of raised intracranial pressure (ICP). Diagnosis is readily made with ultrasonography and computed tomographic (CT) scan of the abdomen. The duration between insertion of the shunt and the presentation ranged from 4.11 to 12 years. In three patients, the cyst was unilocular and of varying size. The fourth one had a multilocular cyst. In three patients, the treatment involved was surgical removal of the catheter with excision of the pseudocyst wall and placement of a new catheter intraperitoneally in a different quadrant. Ultrasound-guided aspiration of the cyst and relocation of the distal end was done in one patient. Conclusion Initial suspicion with appropriate investigation and early treatment can avert morbidity and mortality.