Challenges in the management of cerebrospinal fluid ascites: a case report

Area of Science:

• Neurosurgery
• Pediatric Neurology
• Gastroenterology

Background:

• Ventriculo-peritoneal (V-P) shunts are common for hydrocephalus.
• Cerebrospinal fluid (CSF) ascites is a rare complication of V-P shunts.
• Craniopharyngioma is a rare brain tumor often treated with shunts.

Observation:

• A 7-year-old girl with craniopharyngioma developed CSF ascites post-V-P shunt.
• Management attempts included abdominal paracentesis, diuretics, and a ventriculo-pleural shunt, all ineffective.
• The patient's ascites resolved completely after conversion to a ventriculo-atrial (V-A) shunt.

Findings:

• V-A shunt conversion is an effective treatment for refractory CSF ascites in pediatric patients.
• Non-surgical and alternative shunt strategies may fail in managing this complication.
• Successful management requires careful consideration of shunt type and patient anatomy.

Implications:

• Highlights the potential efficacy of V-A shunts for CSF ascites when V-P shunts fail.
• Suggests a need for individualized treatment approaches in managing shunt complications.
• Informs clinical decision-making for pediatric neurosurgeons managing hydrocephalus and its sequelae.