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Role of protein content in CSF ascites following ventriculoperitoneal shunting. Case report
Insights
A ventriculoperitoneal shunt complication, ascites, in a child with craniopharyngioma resolved when cerebrospinal fluid protein normalized. This suggests high CSF protein levels may cause ascites after VP shunting.
Area of Science:
- Pediatric Neurosurgery
- Neurology
- Oncology
Background:
- Craniopharyngioma is a brain tumor that can cause hydrocephalus requiring cerebrospinal fluid (CSF) shunting.
- Ventriculoperitoneal (VP) shunting is a common procedure to treat hydrocephalus.
- Ascites, or abdominal fluid accumulation, is a rare complication of VP shunting.
Observation:
- An 11-year-old girl with recurrent craniopharyngioma developed massive ascites post-VP shunt placement for hydrocephalus.
- The ascites resolved after shunt removal and recurred when the shunt was reinserted.
- Cerebrospinal fluid (CSF) protein levels were elevated during ascites development and normalized after tumor excision.
Findings:
- Elevated CSF protein levels are hypothesized to be the cause of ascites in this case.
- The resolution of ascites after shunt removal and its non-recurrence after reinsertion (with normalized CSF protein) support this hypothesis.
- Review of 12 prior cases suggests a potential link between high CSF protein and VP shunt-induced ascites.
Implications:
- This case highlights a potential mechanism for ascites following VP shunting, particularly in patients with high CSF protein.
- Accurate diagnosis and management of CSF protein levels may be crucial in preventing or treating this complication.
- Further research into the relationship between CSF protein and peritoneal complications of shunting is warranted.
Abstract:
The case is reported of an 11-year-old girl with a recurrent craniopharyngioma who developed massive ascites following a ventriculoperitoneal (VP) shunt procedure for hydrocephalus, associated with an elevated cerebrospinal fluid (CSF) protein level. The ascites resolved after removal of the shunt. The CSF protein returned to normal levels following excision of the recurrent craniopharyngioma, and ascites did not recur after a second VP shunt was inserted for recurrent hydrocephalus. In this case, elevated CSF protein is believed to have been responsible for ascites developing after VP shunting. There was no recurrence of ascites after the peritoneal cavity was again used for shunting, at which time the protein had returned to normal values. Twelve previous cases of ascites complicating VP shunting are reviewed and the etiology of the condition is discussed.