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Updated: Jun 9, 2025
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Ascites production and prognosis after ventriculoperitoneal shunt for diffuse midline gliomas in children: A case
Chunxia Huang1, Xubin Chai2,3, Yunpeng Han1
1Department of Clinical Laboratory, Guangdong Sanjiu Brain Hospital, Guangzhou, China.
Insights
Diffuse midline glioma (DMG) patients with hydrocephalus treated with shunts can develop malignant ascites. Continuous monitoring of cerebrospinal fluid (CSF) and ascitic fluid is crucial for early detection and intervention.
Area of Science:
- Neuro-oncology
- Pediatric neurosurgery
- Cancer metastasis
Background:
- Diffuse midline glioma (DMG) is an aggressive pediatric brain tumor.
- Hydrocephalus is a common complication of DMG, often managed with ventriculoperitoneal shunts (VPS).
- VPS can lead to ascites, a serious concern in patients with brain tumors.
Purpose of the Study:
- To report on pediatric cases of diffuse midline glioma (DMG) with H3 K27M mutation.
- To describe the development of carcinomatous ascites following VPS insertion in these patients.
- To highlight the importance of monitoring for metastatic spread via ascitic fluid.
Main Methods:
- Case series of 3 pediatric patients with brainstem DMG (H3 K27M mutation).
- All patients developed hydrocephalus requiring VPS insertion.
- Post-operative development of malignant ascites with confirmed tumor cells in ascitic fluid.
Main Results:
- All 3 patients developed intra-abdominal metastasis manifesting as carcinomatous ascites.
- Initial response of primary tumors and hydrocephalus to treatment was observed.
- Despite palliative chemotherapy, all patients succumbed within one month of ascites development.
Conclusions:
- These cases highlight the critical need for vigilant monitoring of both CSF and ascitic fluid in DMG patients.
- Regular biochemical and cytologic analysis of fluids aids in early detection of disease progression.
- Proactive monitoring and timely intervention are essential for potentially improving outcomes in pediatric glioma patients.
Rationale:
DMG is a highly invasive and lethal type of brain tumor. As these tumors progress, they often compromise the CSF circulation, leading to hydrocephalus. Ventriculoperitoneal shunt (VPS) is commonly employed to manage hydrocephalus; however, the complication of VPS-induced ascites, particularly in the presence of tumor cells, is a significant concern that merits attention.
Patient Concerns:
This case series details 3 pediatric patients diagnosed with brainstem DMG harboring the H3 K27M mutation. Each developed hydrocephalus underwent VPS insertion. Post-operatively, all patients developed carcinomatous ascites with tumor cells detected within the ascitic fluid.
Diagnoses:
All 3 patients were diagnosed with intra-abdominal metastasis of DMG H3K27M mutant cancer cells, each presenting with distinct complications.
Interventions:
Initially, the patients' primary head tumors responded to treatment, and their hydrocephalus resolved. However, some time after discharge, each patient developed malignant ascites and received palliative chemotherapy to control symptoms and improve quality of life.
Outcomes:
Despite the interventions, all 3 patients died within 1 month of developing malignant ascites, with central respiratory failure being the direct cause of death.
Lessons:
These cases underscore the importance of continuous monitoring of both the CSF and ascitic fluid in patients with gliomas. Regular assessments of biochemical composition, cytology, and other diagnostic tests are crucial for early detection of disease progression. This proactive approach facilitates timely clinical judgment and intervention, potentially improving patient outcomes.
