Abdominal CSF pseudocysts in patients with ventriculo-peritoneal shunts. Report of fourteen cases and review of the literature

Abstract

The abdominal intraperitoneal cerebrospinal fluid pseudocyst is an infrequent but important complication in patients with ventriculoperitoneal shunts. Since 1954, 115 cases of paediatric pseudocysts have been reported in the literature. One additional report deals with an adult patient. We report on 14 cases of sonographically diagnosed abdominal pseudocysts. Their aetiology, diagnosis, clinical signs and symptoms and surgical management are investigated. In our hydrocephalus series we have an incidence of pseudocyst formation of 4.5%. The most common presentation of the paediatric patients is with symptoms of elevated intracranial pressure and abdominal pain, whereas the adults have predominantly local abdominal signs. Diagnosis is readily made with ultrasonography. Predisposing factors for pseudocyst formation are multiple shunt revisions and infection. Microscopically, the pseudocysts consist of fibrous tissue without epithelial lining. The treatment involves surgical removal of the catheter with or without excision of the pseudocyst wall and placement of a new catheter intraperitoneally in a different quadrant or an intra-atrial shunt. Recurrences are rare, especially under appropriate medical treatment of infection. In our series, microbiologically proven infection was present in 30% of the cases.

Abdominal cerebrospinal fluid pseudocysts in patients with ventriculoperitoneal shunts: 30 years of experienceFNx01

“…Rainov described an incidence of 4.5%. [6] In our series, we observed an incidence of pseudocyst formation of 2.04%.…”

“…The reaction of the peritoneum and the intestinal serosa is apparently noninfectious but a poorly understood inflammatory process. [6,8,10] In our patients, this inflammatory process was particularly located around the tip of the peritoneal catheter. The pseudocysts were histologically examined.…”

“…Abdominal pseudocyst formation with signs of shunt malfunction and/or abdominal symptoms is very infrequent, but they are important complications. [2][3][4][5][6] In the literature, the incidence of the formation of CSF pseudocyst ranged between 2 and 5%. Rainov described an incidence of 4.5%.…”

“…[6,7] In our patient population, we observed only a 4-yearold girl who primarily presented with abdominal symptoms such as abdominal pain and diarrhoea. The other children presented with symptoms of elevated intracranial pressure, as described in literature.…”

“…After appropriate antibiotic therapy, the catheter can be replaced into the peritoneal cavity; moreover, the transfer to a ventriculoatrial system is possible. [4][5][6][7]9] Many authors accept this schedule and agree with the concept that distal catheter can be replaced in almost all cases in the peritoneal cavity after adequate treatment with the externalisation of the catheter and antibiotic therapies. [4,[7][8][9] The excision of the pseudocysts had been carried out in all our cases.…”