Background:Ventriculoperitoneal (VP) shunts are among the most frequently performed operations in the management of hydrocephalus. Hepatic cerebrospinal fluid (CSF) pseudocyst is a rare but important complication in patients with a VP shunt insertion. In addition to presenting our own case, we performed a PubMed search to comprehensively illustrate the predisposing factors, clinical picture, diagnostic methods, and surgical treatment. This article represents an update for this condition.Case Description:A 40-year-old male was admitted to a hospital complaining of fever, abdominal distention, and pain. He had undergone a VP shunt for communicating hydrocephalus caused by a head trauma one year earlier. Laboratory studies showed liver enzymes alterations, and imaging studies demonstrated a well-defined intraaxially hepatic cyst with the shunt catheter placed inside. Staphylococcus epidermis was cultured via CSF. After removing the VP shunt and an adequate antibiotic treatment, the complication of hepatic CSF pseudocyst was resolved.Conclusion:Hepatic CSF pseudocyst is a rare complication of a VP shunt. Once the diagnosis is verified and if the CSF is sterile, just simply remove the peritoneal catheter and reposition a new one in the abdomen. We believe that it is not necessary to remove or aspirate the hepatic intraaxial pseudocyst, because of the risk of bleeding. In case of CSF infection, the VP shunt can be removed and/or an external derivation can be made, and after treatment with antibiotics, a new VP shunt is placed in the opposite side of the peritoneum.

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Object The main objective was to study the epidemiological data obtained in patients with cervical spinal trauma (CST) in the north area of São Paulo City between 1997 and 2006. Methods All patients with severe CST in the north area of São Paulo City were studied. The data analyzed were age, sex, incidence, causes of trauma, level of trauma, morbidity, deaths, and complications. Analytical tests were performed to study risks of trauma and complications. The chi-square and analysis of variance tests were used for analytical data (significance level p < 0.05). Results The study population consisted of 217 patients who were hospitalized for CST. The average incidence rate was 21.6 cases annually or 1.8 cases monthly. The mean patient age was 36.75 years. The 20–40-year-old age bracket was found to be most highly represented, corresponding to 52.6% of total patients. Patients were predominantly male; 191 patients (88.01%) were male compared with only 26 female patients (11.99%). The ratio of men to women was 7.35:1. Injuries in the craniocervical region corresponded to 43 (19.8%) of the cases; injuries in the cervical subaxial region corresponded to 174 (80.2%) of the cases and were associated with worse neurological lesions. Additionally, 40.6% of patients presented with complications in other organs and systems; several patients presented with multiple complications, and 33 patients (15.02%) died. During the hospitalization period, 4 patients presenting as Grade A on the American Spinal Injury Association (ASIA) Scale evolved to Grade C, 1 patient presenting as ASIA Grade A evolved to Grade B, and 2 patients evolved to Grade E. Two patients who had been admitted without neurological lesions evolved to ASIA Grade C (1 patient postsurgery and 1 patient post-traction). Two patients presenting initially as ASIA Grade E evolved to Grade D, and another to central cord syndrome. On average, patients with incomplete lesions improved 1 grade in ASIA classification during hospitalization. Conclusions Data from severe CST observed in the current study suggest many differences in the characteristics described in the majority of published epidemiological studies and those found in patients in the north area of São Paulo City. It is likely that these differences reflect the urban and cultural habits and behaviors of the population specific to this area.

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