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Reversible porencephaly. Alteration of the cerebrospinal fluid flow after shunt malfunction
K Sugimoto1, T Enomoto, T Nose
1Department of Neurosurgery, University of Tsukuba, Ibaraki, Japan.
Insights
Porencephalic cysts in infants, a rare complication after shunt surgery, resolved with ventriculoperitoneal (VP) shunt revision and cyst peritoneal (CP) shunt, or VP shunt alone.
Area of Science:
- Pediatric Neurosurgery
- Neurology
- Medical Device Complications
Background:
- Shunt malfunction or Ommaya reservoir insertion can lead to hypertensive hydrocephalus.
- Porencephalic cysts are a rare postoperative complication following neurosurgical procedures.
- Understanding the pathogenesis of these cysts is crucial for effective treatment.
Observation:
- Four infants with five porencephalic cysts were observed.
- Cysts were located along the ventricular catheter after shunt malfunction and Ommaya reservoir insertion.
- These cysts developed due to cerebrospinal fluid (CSF) extravasation into the white matter.
Findings:
- Porencephalic cysts resolved after ventriculoperitoneal (VP) shunt revision combined with a cyst peritoneal (CP) shunt.
- In some cases, VP shunt revision alone led to cyst resolution.
- The study highlights the effectiveness of specific surgical interventions for porencephalic cysts.
Implications:
- CP shunt following VP shunt revision is effective for closed porencephaly.
- VP shunt revision alone is effective for communicating porencephaly.
- These findings offer valuable insights into managing this rare neurosurgical complication.
Abstract:
The cases of four infants (five lesions) are reported, where "porencephalic cysts," located along the ventricular catheter after shunt malfunction and Ommaya reservoir insertion, disappeared after ventriculoperitoneal (VP) shunt revision and combined cyst peritoneal (CP) shunt, or after VP shunt alone. This pathological state is thought to be a rare postoperative complication. Its pathogenesis and therapy are discussed. Shunt malfunction or Ommaya reservoir insertion may result in a hypertensive hydrocephalic state. Cerebrospinal fluid (CSF) flows out through a catheter penetrating the site of the ventricular wall and expands in the surrounding white matter to form a porencephalic cavity. Once this porencephalic state occurs, it will not disappear spontaneously because the CSF flows in one direction. As treatment for closed porencephaly, CP shunt following a VP shunt revision was markedly effective; for communicating porencephaly, a VP shunt revision alone was effective.