Peritoneal re-internalization of shunts after pseudocyst treatment: a 24-year single institution experience

Abdominal cerebrospinal fluid (CSF) pseudocyst is a rare complication of ventriculoperitoneal shunt placement in children preventing adequate absorption of CSF in the peritoneum. This study describes a 24-year single-institution experience with management of abdominal CSF pseudocysts, with special attention to peritoneal re-internalization and laparoscopic-assisted distal catheter placement.

We performed a retrospective analysis of patients with hydrocephalus presenting with CSF pseudocyst between January 1, 2000- December 1, 2024. Diagnosis was confirmed by ultrasound or computed tomography. Kaplan-Meier survival analysis was used to compare shunt survival after laparoscopic and mini-laparotomy peritoneal re-internalization.

Twenty-seven patients were treated for CSF pseudocyst over 24 years, and 18 had culture-positive pseudocyst fluid (67%). The average age at diagnosis was 13 years old. Twenty-one children underwent peritoneal re-implantation, and 15 (71%) children did not have pseudocyst recurrence. At one year after re-internalization, all cause shunt-survival was 58.4%, following laparoscopic placement compared with 42.9% following mini-laparotomy. One-year pseudocyst recurrence-free survival was 84.7% and 85.7%, respectively.

Peritoneal shunt re-internalization was feasible in selected patients after treatment of abdominal CSF pseudocyst, with most patients in this cohort avoiding recurrence. These findings support further multicenter study.