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

Marcelo Corti1, Maria Priarone1, Ricardo Negroni2

  • 1School of Medicine, University of Buenos Aires, Buenos Aires, Argentina.

Revista Da Sociedade Brasileira De Medicina Tropical
|September 18, 2014
PubMed
Abstract

Insights

Ventriculoperitoneal shunting (VPS) can prevent mortality in patients with acquired immunodeficiency syndrome (AIDS)-related cryptococcal meningitis and intracranial hypertension (ICH). This procedure is effective even when Cryptococcus neoformans infection persists after antifungal therapy.

Area of Science:

  • Infectious Diseases
  • Neurosurgery
  • Critical Care Medicine

Background:

  • Cryptococcosis is a significant opportunistic mycosis, particularly in human immunodeficiency virus (HIV)-positive individuals.
  • Central nervous system involvement, specifically cryptococcal meningitis, is a common and serious complication.

Purpose of the Study:

  • To evaluate the efficacy of ventriculoperitoneal shunting (VPS) in managing uncontrollable intracranial hypertension (ICH) in patients with acquired immunodeficiency syndrome (AIDS)-related cryptococcal meningitis.
  • To assess the impact of VPS on preventing mortality in this patient population.

Main Methods:

  • A cohort of 15 patients with AIDS-related cryptococcal meningitis and persistent ICH was studied.
  • Ventriculoperitoneal shunting (VPS) was performed after 2 weeks of antifungal therapy (amphotericin B deoxycholate with or without fluconazole) if ICH remained uncontrollable.
  • Patients had persistent Cryptococcus neoformans infection at the time of VPS.

Main Results:

  • Ventriculoperitoneal shunting (VPS) successfully resolved uncontrollable intracranial hypertension (ICH) in 12 out of 15 patients.
  • The procedure demonstrated a potential benefit in managing a critical complication of cryptococcal meningitis in AIDS patients.

Conclusions:

  • Ventriculoperitoneal shunting (VPS) should be considered for patients with cryptococcal meningoencephalitis experiencing intracranial hypertension (ICH), even in the presence of positive cerebrospinal fluid cultures.
  • VPS offers a viable option for managing refractory ICH in this immunocompromised population.

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