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Abdominal cerebrospinal fluid pseudocyst: A complication of ventriculoperitoneal shunt in children
B Z Roitberg1, T Tomita, D G McLone
1Division of Neurosurgery, Children's Memorial Hospital, Chicago, Ill., USA.
Insights
Abdominal cerebrospinal fluid (CSF) pseudocysts in children are effectively treated by temporarily removing the ventriculoperitoneal (VP) shunt. Most patients can have their VP shunt safely reinserted, indicating successful management of these complex CSF collections.
Area of Science:
- Pediatric Neurosurgery
- Infectious Disease Management
- Cerebrospinal Fluid Dynamics
Background:
- Abdominal cerebrospinal fluid (CSF) pseudocysts are a known complication of CSF shunting in pediatric patients.
- Understanding the management and outcomes of these pseudocysts is crucial for optimizing treatment strategies.
Purpose of the Study:
- To analyze the treatment outcomes of abdominal CSF pseudocysts in pediatric patients.
- To compare current treatment experiences with previous institutional data.
- To evaluate the efficacy of shunt externalization and reinsertion in managing these pseudocysts.
Main Methods:
- Retrospective analysis of 27 pediatric patients treated for abdominal CSF pseudocysts between 1991 and 1996.
- Treatment involved removal of the ventriculoperitoneal (VP) shunt and placement of an external ventricular drain, with intravenous antibiotics.
- Cyst aspiration (intraoperative or ultrasound-guided) was performed in some cases; spontaneous resolution was also observed.
Main Results:
- In 78% of cases (21/27), the VP shunt was successfully reinserted into the abdomen at a new site.
- Positive culture rates were significantly higher in younger children (≤4 years) at 77% compared to older children (≥5 years) at 28% (p = 0.03).
- Spontaneous resolution occurred in 15 patients, while 12 required aspiration.
Conclusions:
- Externalizing the shunt is an effective method for resolving abdominal CSF pseudocysts.
- Reinsertion of a VP shunt is feasible and safe in the majority of pediatric patients.
- While infection is a contributing factor, it may not be the sole cause of all abdominal CSF pseudocysts.
Abstract:
The present paper is a retrospective analysis of 27 consecutive patients, treated for abdominal cerebrospinal fluid (CSF) pseudocyst at the Children's Memorial Hospital in the years 1991-1996. This series is compared to the previous experience from our institution. Treatment consisted of the removal of the ventriculoperitoneal (VP) shunt and placement of an external ventricular drain. Antibiotics were administered intravenously for 10 days. The cysts were aspirated intraoperatively in 9 patients and postoperatively with ultrasound guidance in 3 patients, while they resolved spontaneously in 15 others. In 21 of 27 cases (78%), the shunt could be reinserted into the abdomen in a new location. Four patients had a ventriculopleural shunt, and in 2 patients, a ventriculoatrial shunt was inserted. Forty-four percent of the patients had a positive culture on presentation. The positive culture rate was 77% for those 4 years old and younger and only 28% for those aged 5 and above (p = 0.03). We conclude that abdominal CSF pseudocysts are resolved by externalizing the shunt. A VP shunt can be safely reinserted in the majority of the patients. Infection, while an important factor, is not likely to account for all cases of pseudocyst.