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Ventriculoperitoneal shunt in cryptococcal meningitis with hydrocephalus
1Department of Neurology, Chang Gung Memorial Hospital, Taiwan, Republic of China.
Surgical Neurology
|May 1, 1990
Summary
Ventriculoperitoneal shunting can be a critical intervention for cryptococcal meningitis patients with hydrocephalus, especially when performed early. Prompt shunting improves outcomes, even during active infection, without increasing risks.
Area of Science:
- Neurology
- Neurosurgery
- Infectious Diseases
Background:
- Cryptococcal meningitis frequently causes hydrocephalus, necessitating management of increased intracranial pressure.
- Ventriculoperitoneal shunting is a neurosurgical intervention used to treat hydrocephalus.
Observation:
- Fourteen patients with cryptococcal meningitis and hydrocephalus treated with ventriculoperitoneal shunts were reviewed.
- Early shunting improved consciousness and relieved herniation signs in eight patients.
- Shunting relieved papilledema in five patients but did not prevent optic atrophy in two.
Findings:
- The duration of altered consciousness before shunting critically impacts treatment outcomes.
- Low cerebrospinal fluid protein concentration was a favorable prognostic indicator for shunting.
- Shunting was effective in improving paraparesis in one patient.
- Active cryptococcal meningitis does not contraindicate shunting, and premedication with antifungals is not necessary.
Implications:
- Timely ventriculoperitoneal shunting is crucial for managing hydrocephalus in cryptococcal meningitis.
- Visual failure may result from factors beyond increased intracranial pressure, including direct fungal invasion.
- Shunting can be safely performed during active central nervous system infection without increased morbidity or mortality.