Long-term outcomes of ventriculoperitoneal shunt in HIV-negative Cryptococcal meningitis

Cryptococcal meningitis (CM) is a life-threatening fungal infection of the central nervous system, with intracranial hypertension being a major contributor to mortality. Ventriculoperitoneal (VP) shunting has been established as a crucial intervention for managing elevated intracranial pressure; however, comprehensive long-term prognostic data for CM patients undergoing VP shunt placement remain limited. This study aimed to evaluate the long-term outcomes of VP shunting in patients with CM through a retrospective analysis. A retrospective cohort study was conducted involving patients diagnosed with CM, with a follow-up period of 48 weeks. Demographic characteristics, disease-related parameters, and laboratory findings were collected and analyzed at multiple time points. Of the 106 CM patients enrolled, 77 underwent VP shunting, while 29 received conservative management. No significant differences were observed between the two groups in terms of hospitalization duration, cryptococcal clearance rate, time to cerebrospinal fluid (CSF) culture negativity, or recurrence rate. The VP shunt group demonstrated a rapid reduction in intracranial pressure (ICP), achieving normalization by week 4 and maintaining a significantly lower level than the conservative group at week 12. CSF cryptococcal counts were comparable between the groups throughout the follow-up period. However, the VP shunt group exhibited persistently elevated CSF white blood cell (WBC) counts and protein levels up to 48 weeks, along with transiently lower glucose levels in the early stages, which normalized by week 24. VP shunting effectively controls intracranial hypertension and accelerates cryptococcal clearance in patients with CM; however, it does not significantly alter the long-term clinical prognosis, and the clinical significance of postoperative CSF alterations may be limited.