Cerebrospinal Fluid Pseudocyst Research Articles

Abdominal cerebrospinal fluid pseudocysts in patients with ventriculoperitoneal shunts: 30 years of experienceFNx01

<b>Aim:</b> We evaluated the treatment outcome of the patients having cerebrospinal fluid pseudocyst following ventriculo-peritoneal shunt. <b> Materials and Methods:</b> During the period of 1975 to 2005, 392 hydrocephalic patients underwent ventriculo-peritoneal shunt, of these eight developed abdominal cerebrospinal fluid pseudocyst. The medical records regarding the etiology of hydrocephalus, age of shunting, infectious screening, therapy and follow up were evaluated. <b> Results:</b> Cerebrospinal fluid analysis was normal in all except in 4 patients who showed high level of C-reactive protein. One patient had significant abdominal symptoms as pain, vomiting and diarrhea. All were treated by cyst excision, exteriorization of shunt and antibiotic treatment. A new shunt was placed once cerebrospinal fluid cultures were negative. <b> Conclusions:</b> cyst excision, appropriate antibiotic therapy followed by new shunt placement once cerebrospinal fluid cultures are negative constitutes the required treatment for these patients with abdominal pseudocyst.

Mammography and Breast Surgery May Damage Ventriculoperitoneal Shunts: Case Report

This is a case of a cerebrospinal fluid pseudocyst in the breast caused by a ruptured VP shunt. There were few similar cases mentioned in the medical literature. A 70 year old female presented with a one-month-old growing mass in the left breast. She had a cyst removed from the same breast 3 months before that. CT thorax showed a 4.3 cm fluid mass at the tip of a disconnected ventriculoperitoneal (VP) shunt in the subcutaneous fat of the left breast. CT brain showed mild dilatation of the ventricles. The shunt was surgically replaced. We postulated this was an iatrogenic complication of mammography or breast surgery. We recommend such patients when undergoing mammography or any invasive procedure on the breast tell the technician or the doctor performing the procedure about their shunt so as to avoid damaging it.

An alternative approach for management of abdominal cerebrospinal fluid pseudocysts in children

Cerebrospinal fluid (CSF) abdominal pseudocyst is an uncommon but important complication of ventriculoperitoneal shunts. From the collected series, several features about the etiology and management become apparent. Retrospective data were obtained from 12 children treated with cerebrospinal fluid abdominal pseudocyst defined an alternative approach for management of these patients. There were eight girls and four boys who ranged in age from 12 days to 18 years old (mean 7.7 months). The most frequent etiology of the hydrocephalus was Chiari type II malformation in six cases. Initial presentation with shunt malfunction was detected in nine cases. Abdominal distention and/or pain were the most frequent finding in our series (10/12). In only one case, infection was detected for all cerebrospinal fluid abdominal pseudocysts (8.3%). Ventriculoperitoneal shunt (VPS) externalization, antibiotics, and cyst aspiration was performed in 8/12 cases as initial management of abdominal pseudocyst. Ventriculoperitoneal shunt reinsertion in abdominal cavity and/or endoscopic third ventriculostomy (ETV) was performed as final management in 9/12. Ventriculoatrial shunt was used only in three cases. Recurrence of the abdominal cyst was observed in two cases. Based on the success rate (75%) in our series submitted to this management, a ventriculoperitoneal shunt can be safely reinserted in the majority of the patients. Endoscopic third ventriculostomy could be performed in selected cases as an alternative approach. Although infection has been reported as responsible for pseudocyst formation, it was only exceptionally found in our series.

Acute hydrocephalus caused by an abdominal cerebro-spinal fluid pseudocyst around the tip of a ventriculo-peritoneal shunt

A case of cerebro-spinal fluid pseudocyst in the abdominal soft tissues around the tip of a ventriculo-peritoneal shunt, perforating the abdominal wall, is described. The rarity of this sort of complication is stressed, along with the important role of imaging in its detection.

Giant abdominal cerebrospinal fluid pseudocyst: An uncommon cause of acute abdomen

We report a case of a 35-year-old patient with a giant intra-peritoneal cerebrospinal fluid pseudocyst that arose as a complication of a ventriculoperitoneal shunt. It was diagnosed by computed tomography. The features of interest are its size, its clinical presentation as acute abdomen, and the fact that the patient was an adult.

C S F pseudocysts peritoneal cavity following V P shunt surgery: Report of three cases in children and review of literature

Abdominal cerebrospinal fluid (CSF) pseudocyst is an uncommon complication following ventriculo-peritoneal (VP) shunt. The following report's our experience with three cases of CSF pseudocyst in children. VP shunt was done earlier for communicating hydrocephalus following tubercular meningitis (TBM) in all cases. Clinical presentation was with progressive abdominal distension and features of intestinal obstruction. Clinically we were able to diagnose all cases as CSF pseudocyst peritoneal cavity. Ultrasound examination confirmed the clinical findings in all. CT scan of abdomen and pelvis showed a large unilocular CSF pseudocyst with shunt catheter within it on one patient (case 3). Ultrasound guided aspiration of cyst was done in case 1 alone, but failed to resolve the symptoms. All patients needed formal exploration. Near total cyst excision, adhesiolysis and relocation of peritoneal end of VP shunt catheter in right supra hepatic space was done in all. Two patients who developed shunt tract infection needed shunt removal. The follow up period is 6-8 months.

Hepatic cerebrospinal fluid pseudocyst: A case report and review of the literature

An abdominal pseudocyst is a rare, but important complication in patients with a ventriculo-peritoneal (VP) shunt insertion. Several predisposing factors for this complication have been suggested, including infection, obstruction or dislodgement, but the pathophysiology is still unknown. However, the abdominal inflammatory process is accepted widely as a hypothesis for the formation of an abdominal pseudocyst. In this study, we report the case of a 21-year-old male that presented with a high-grade fever, poor appetite, shortness of breath and unconsciousness 1 week after receiving a VP shunt insertion for obstructive hydrocephalus. Ultrasonography and computed tomographic scans of the abdomen revealed a well-defined large hepatic cyst surrounding the peritoneal tube of the VP shunt. A hepatic cerebrospinal fluid (CSF) cyst was diagnosed and Staphylococcus epidermis was cultured via CSF. After externalization of the VP shunt and adequate antibiotic treatment, the hepatic cyst was resolved. There was no recurrence observed in the regular follow up.

Laparoscopic management of CSF pseudocyst abdomen

Cerebrospinal fluid (CSF) pseudocyst formation is an uncommon cause of ventriculoperitoneal shunt malfunction in children. Standard management consisted of laparotomy with repositioning of the shunt and drainage of the pseudocyst. Recurrence of pseudocyst in these patients is well known and resulted in multiple laparotomies and eventually a ventriculo-atrial shunt. We managed a patient laparoscopically with drainage of the pseudocyst and repositioning of the shunt. The patient experienced no complications from the procedure, and there has been no recurrence of the pseudocyst in 2 years of follow-up. This technique has proven to be safe, with results comparable to the conventional open technique. <br>

An Unusual Case of Cerebrospinal Fluid Pseudocyst in a Previously Augmented Breast

Cerebrospinal fluid (CSF) drainage catheters can cause a myriad of complications, in large part because they may migrate from their normal location to almost anywhere in the body. We present the unique case of a female patient who had previously undergone bilateral breast augmentation who experienced sudden painless swelling of her right breast 6 weeks after placement of a ventriculoperitoneal shunt. Radiologic examination demonstrated ensnarement of the distal aspect of the shunt around her implant, with subsequent formation of a CSF pseudocyst. Management of this patient included replacement of the shunt, drainage of the CSF pseudocyst, and preservation of the implant.

Distal ventriculoperitoneal shunt failure secondary to Clostridium difficile colitis

Distal ventriculoperitoneal shunt obstruction is typically associated with cerebrospinal fluid (CSF) infection, fluid pseudocysts, bowel obstruction, bowel perforation, or improper shunt placement in the abdomen. We describe a unique etiology for distal shunt obstruction secondary to Clostridium difficile pancolitis that occurred because of inflammation and ascites, which led to incomplete drainage and absorption of CSF. This case illustrates the importance of considering distal shunt obstruction in a patient with signs of abdominal pathology in the setting of mental status changes, and the effective treatment of this patient initially with distal catheter externalization followed by internalization of a new distal catheter after resolution of the pancolitis.

Sonographically Guided Aspiration of Cerebrospinal Fluid Pseudocysts in Children and Adolescents

Cerebrospinal fluid (CSF) pseudocyst formation is an uncommon cause of ventriculoperitoneal shunt malfunction in children. Traditional staged treatment consists of shunt externalization, antibiotics, and later shunt revision and internalization. We sought to evaluate whether sonographically guided pseudocyst aspiration to alleviate acute symptoms and to exclude CSF infection could obviate shunt externalization and expedite the care of these patients. Sonographically guided CSF pseudocyst aspiration is an effective technique, allowing exclusion or confirmation of infection and providing relief of abdominal symptoms. In patients with sterile collections, staged surgical revision with shunt externalization can be avoided, speeding and simplifying treatment.

Ultrasound-guided aspiration in the management of children with cerebrospinal fluid pseudocysts

Ultrasound-guided aspiration in the management of children with cerebrospinal fluid pseudocysts

Cerebrospinal fluid pseudocyst of the breast

A 39 year old lady presented with a lump in her right breast. She was known to have had a ventriculo-peritoneal shunt inserted for childhood hydrocephalus. Mammography revealed a calcified, fractured shunt with an associated soft tissue swelling which resolved following shunt removal. Shunt fracture secondary to calcification is extremely rare, and presentation as a breast lump has not been previously described. This case identifies a rare cause of breast lumps and highlights the importance of complete triple assessment in all patients presenting with a breast lump.

One-trocar laparoscopy: a valid procedure to treat abdominal complications in children with peritoneal shunt for hydrocephalus.

The aim of this paper is to show the efficacy of laparoscopy using only one umbilical trocar to treat abdominal complications of hydrocephalic children with ventriculoperitoneal shunts (VPS). In a 15-year period, 14 laparoscopies were performed on as many children with VPS complications: in the last 4 patients only one trocar was used to solve the complications, and this subgroup will be the object of the present study. Concerning the indication for surgery, the patients presented one catheter lost in the abdominal cavity; one cerebrospinal fluid pseudocysts; one bowel obstruction; and one malfunctioning peritoneal limbs of the catheter. We used the one-trocar laparoscopic approach in all the 4 patients, and the 10-mm trocar was always introduced through the umbilical orifice in open laparoscopy. The laparoscopic technique was curative in all four cases and permitted the solution of the complication. One-trocar laparoscopic surgery can be considered as the ideal procedure in case of abdominal complications of VPS in children with hydrocephalus.

小児の髄液短絡術に伴う腹腔内髄液仮性嚢胞 : 12症例における検討

小児の髄液短絡術に伴う腹腔内髄液仮性嚢胞 : 12症例における検討

SHUNT INFECTION AND MALFUNCTION AFTER AUGMENTATION CYSTOPLASTY

Maintenance of a sterile intraperitoneal environment is critical in patients with ventriculoperitoneal shunts. Recent series have reported a broad discrepancy in the rate of shunt infection (0% to 20%) following augmentation cystoplasty. The need for distal shunt revision has not been well defined. We report the incidence of shunt infection and revision at our institution after bladder augmentation. We retrospectively reviewed the records of all patients with myelodysplasia and a ventriculoperitoneal shunt who underwent augmentation cystoplasty since August 1990. All patients included in the study had a minimum of 12 months of followup. A total of 55 patients with a ventriculoperitoneal shunt secondary to myelodysplasia required augmentation cystoplasty for management of a neuropathic bladder. Standard perioperative intravenous and oral antibiotic preparation, mechanical bowel preparation and intraoperative shunt isolation were used. Mean postoperative followup was 60.4 months (range 12 to 111). One patient presented with an extruded peritoneal shunt tip and positive cultures from cerebrospinal fluid and urine. Bladder perforation occurred in 2 patients and the shunt was empirically externalized. Revision was required for 5 (9%) distal shunt obstructions, including 1 cerebrospinal fluid pseudocyst. The incidence of shunt infection after augmentation cystoplasty is low (less than 2% in this large series), and presence of a ventriculoperitoneal shunt should not preclude bladder augmentation. Meticulous perioperative and intraoperative preparation contributes to the low rate of adverse events. Although the rate of distal revision after augmentation is significant, it does not exceed the reported distal failure rate for ventriculoperitoneal shunts in children without a history of urological surgery.

Laparoscopy-Assisted Abdominal Shunt Revisions in Children with Hydrocephalus

Abdominal shunt revisions are frequently necessary for ventriculoperitoneal shunt systems in children with hydrocephalus internus. There are many well-known problems related to abdominal shunt revisions such as difficulties in reaching the abdominal cavity, intra-abdominal adhesions, cerebrospinal fluid pseudocyst, or problems in retrieving dislocated catheters. From 6/1996 to 12/1997 we operated on twenty (20) children aged from 2-15 years (body weight 4.8-68 kg) with abdominal shunt insufficiency using the laparoscopy assisted technique. In only one case was it impossible to reach the abdominal cavity laparoscopically and conventional open surgery was necessary. We had no complications such as injured vessels or bowel and saw a complete recovery in all patients. In comparison to conventional surgery, we found handling simple, minor trauma to the patients, good intra-abdominal view, short operation times and good cosmetic results to be the advantages of laparoscopy-assisted abdominal shunt revision. In addition hospitalisation time can be reduced.

Abdominal Cerebrospinal Fluid Pseudocyst: A Complication of Ventriculoperitoneal Shunt in Children

The present paper is a retrospective analysis of 27 consecutive patients, treated for abdominal cerebrospinal fluid (CSF) pseudocyst at the Children’s Memorial Hospital in the years 1991–1996. This series is compared to the previous experience from our institution. Treatment consisted of the removal of the ventriculoperitoneal (VP) shunt and placement of an external ventricular drain. Antibiotics were administered intravenously for 10 days. The cysts were aspirated intraoperatively in 9 patients and postoperatively with ultrasound guidance in 3 patients, while they resolved spontaneously in 15 others. In 21 of 27 cases (78%), the shunt could be reinserted into the abdomen in a new location. Four patients had a ventriculopleural shunt, and in 2 patients, a ventriculoatrial shunt was inserted. Forty-four percent of the patients had a positive culture on presentation. The positive culture rate was 77% for those 4 years old and younger and only 28% for those aged 5 and above (p = 0.03). We conclude that abdominal CSF pseudocysts are resolved by externalizing the shunt. A VP shunt can be safely reinserted in the majority of the patients. Infection, while an important factor, is not likely to account for all cases of pseudocyst.

The use of laparoscopy in the diagnosis and treatment of abdominal complications of ventriculo-peritoneal shunts in children.

Ventriculo-peritoneal shunts (VPS) are the most frequent operative procedures used to treat hydrocephalic children. Abdominal complications of VPS are now a rare event; however, their frequency varies from 5% to 47% according to reports. Anything that causes an obstruction or impediment of the VP derivation system will lead to intracranial hypertension, which requires immediate surgery. From 1985 to 1995 at the Division of Pediatric Surgery of the Federico II University of Naples, ten laparoscopies were performed in ten children with VPS complications. Cerebrospinal fluid pseudocysts were found in four infants. There was one case of abdominal wall perforation by the tip of the catheter at the umbilical level, two bowel obstructions, and one catheter was lost in the abdominal cavity. Finally, two children had malfunctioning of the peritoneal limb of the catheter. The laparoscopic technique was curative in all ten cases, thus avoiding a conventional laparotomy and the consequent risk of adhesions, which could cause further complications.

Appendicitis in Children with a Ventriculoperitoneal Shunt

The presentation of an acute abdomen in children with a ventriculoperitoneal shunt requires skilful diagnostic workup. Apart from complications caused by the shunt, primary abdominal pathological conditions must be taken into consideration, particularly in the older child. A series of 6 children with a ventriculoperitoneal shunt had to be treated surgically for appendicitis. Their medical records were analyzed retrospectively. Despite difficulties with the initial diagnosis, the time from admission to final diagnosis and operation was relatively short. An accurate history, careful evaluation of the clinical signs and, above all, ultrasound of the abdomen were helpful in decision making. During the operation the shunts were left in place. Only 1 patient developed a cerebrospinal fluid pseudocyst in the early postoperative period, which made a conversion into a ventriculoatrial shunt necessary. No ascending infection occurred, even when the abdominal tip of the shunt came in close contact with the focus of inflammation. An acute abdomen due to shunt infection should be managed conservatively and by removal of the shunt from the abdomen, thus avoiding an unnecessary laparotomy. On the other hand, a primary intra-abdominal disease requires surgical treatment, during which the shunt system can be left in place.